Presentation on theme: "Medication Administration"— Presentation transcript:
1 Medication Administration November 2009 CEAdvocate Condell Medical CenterObjectives prepared by: Mike Higgins, FF/PMGrayslake Fire DepartmentPower point prepared by Sharon Hopkins, RN, BSN, EMT-P
2 ObjectivesUpon successful completion of this module, the EMS provider will be able to:1. Identify the six rights of drug administration correctly2. Identify medical control’s role in drug administration3. Identify knowledge of proper use of standard precautions4. Identify knowledge of proper disposal of contaminated equipment5. Identify the importance of maintaining a sterile and clean environment
3 Objectives6. Accurately calculate the drug dosage for a pt with weight stated in pounds, converting weight to kilograms7. Identify the various routes used to administer medication8. Identify the proper technique for drawing up meds from an ampule9. Identify the proper technique for drawing up meds from a vial10. Identify the proper administration of a medication from a prefilled syringe
4 Objectives11. Identify the proper administration of sub-lingual medications12. Verbalize the proper administration of rectal medications13. Identify the proper administration of IV piggy-back medications14. Identify the proper administration of in-line nebulizer medications15. Identify the proper administration of endotracheal medications
5 Objectives16. Identify proper documentation of medication administration17. Demonstrate the proper administration of subcutaneous medications18. Demonstrate the proper administration of intramuscular medications19. Demonstrate proper administration of intravenous medications / IO meds20. Demonstrate the insertion of the EZ-IO correctly
6 6 Right of Medication Administration The RIGHT patientIn the field this is the patient lying in front of youWhen doing clinical in the hospital, it is extremely important to check wrist bands for identifying the right patientThe RIGHT drugCheck all medications 3 times prior to administrationDid you grab the correct medication?Just to reinforce, there are more items to evaluate before administering medication than what is listed in the 6 rights (ie: expiration date, clarity of solution).
7 6 Rights The RIGHT dose The RIGHT time Most field medications can be easily calculated in your headDouble check if you are ever unsure of the doseThe RIGHT timeIn the field the time is now
8 6 RightsThe RIGHT routeIV/IOInjectedIMSQInhaledIVPB
9 6 Rights The RIGHT documentation Drug name Dose – verify order in mg Dose often stated in ‘amps”, “tab”Route of deliveryTime administeredPerson administering the medicationUse skill check boxPatient response to the medication
10 AllergiesImportant to screen all patients for their allergy status prior to medication administrationIf you are in doubt regarding an allergic reaction versus side effect (ie: abdominal distress), contact medical control for clarification
11 Facts and Allergies Lidocaine and Novocain Morphine sulfate These are different “caine” families so allergy to one does not cross over to the otherMorphine sulfateThis is NOT a sulfa drugLasix – furosemideThere is a low risk of patients allergic to sulfa drugs having a reaction to LasixMonitor the patient receiving Lasix if they have a sulfa allergy
12 Medical Control You operate under the license of the Medical Director You are still individually responsible for having knowledge of the medications you are deliveringInappropriate delivery of medications, even when the patient does not suffer harm, may result in legal ramifications
13 Medical Control Medical control is available as an on-line resource Clarification regarding indicationsClarification regarding dosageClarification regarding orders received from a physician on the sceneIn an acute care center, clinic, doctor’s office, you cannot accept orders unless that physician is willing to go with to the hospital
14 Standard Precautions HANDWASHING Establishing routes for drug administration creates the potential exposure to blood and body fluidsDecrease risk of exposure by following standard precautionsGlovesGogglesMaskThe best standard precaution often forgotten:HANDWASHING
15 Sterile vs Clean Environment Sterile – free from all forms of lifeGenerally uses extensive heat or chemicalsDifficult in the field to maintain sterile environmentsMost packages are sterile until openedClean environmentMinimize risk of infectionCareful handling of equipment to prevent contamination
16 Disposal of Equipment Minimize tasks done in a moving ambulance Need to decrease risk of EMS exposureImmediately dispose of sharps in a sharps containerRigid, puncture-resistant containerRecap needles only as a last resortUse one handed technique
17 Metric System Pharmacology’s principle system of measurement Widely used in science and medicine3 fundamental unitsGrams – weight or massLiters – volumeMeters – distanceTo avoid use of multiple zero’s , usually change the prefixes (ie: kilo, centi, milli, micro)
18 Drug Administration and Mathematical Skills To properly prepare and administer medications, need understanding of:MultiplicationDivisionFractionsDecimal fractionsProportionsPercentages
19 Converting Pounds to Kilograms Many medications are dosed based on patient weightAdults – acceptable to be “close enough”Can round off the adult weightPediatrics – must practice a more precise formulaLess room for error in calculation
20 Pounds to Kilograms 1 kilogram = 2.2 pounds In the field, usually acceptable to take the adult patient’s weight in pounds and divide in half to be close enough to the kilogramsIn peds, need to take the weight in pounds and divide by 2.2
21 Exercise Convert 150 pounds to kilograms 150/2.2 can be written as 150 2.2As a fraction, top number (numerator) is divided by the bottom number (denominator)150 = dividend2.2 = divisorThe divisor must always be a whole numberAnswer = quotient
22 Exercise 2.2 150 Need to make 2.2 a whole number Need to make 2.2 a whole numberIn the metric system, you are multiplying by “10”When multiplying with any derivative of 10, count the zeros and move the decimal that many numbers to the rightWhat you do with the divisor, you must do with the dividend (actions inside and outside the box must match)
23 Example – 150# = ? kilograms 2.2 150 = 22 1500 68.1 22 1500.0 132 180 =68.1132180176402218Decimal moved to the right once in the divisor (ie: 2.2) and therefore had to be moved by the same number of spaces in the dividend (ie: 150). Bring up the new decimal place so it does not get forgotten in the answer. Do regular division making sure to be neat enough to line up your numbers.
24 Medication By Patient Weight Most typical order is Lidocaine (mg/kg) and pediatric drugs (mg/kg)Calculate the patient’s kilogramDivide pounds by 2.2Acceptable to divide the adult weight by 2Multiply the kilogram by the number of mg per kilogramThen you need to calculate the volume (ml) to draw up in the syringeThe pediatric patient does not have a lot of room for error so their weight needs to be precise – divide pounds by 2.2.
25 Example Give your 132 pound patient 1.5mg/kg Lidocaine Lidocaine is packaged as 100 mg/5mlSteps to calculateConvert pounds to kilogramsBased on the kilograms, calculate the number of mg requiredMultiply kilograms by mg/kg requiredCalculate the ml volume to draw up
26 Answer 132 2.2 = 1320 22 = 60 kg 1.5 mg/kg = 1.5 mg x 60 kg = 90mg Now, draw up 90 mg (Lidocaine comes 100 mg/5ml)Formula #1: x ml = desired dose x vol on handdose on handFormula #2: mg in bottle = mg orderedml in bottle x ml
27 Formula #1 Formula #1: x ml = desired dose x vol on hand dose on hand x ml = 90 mg x 5 ml100 mgx ml = (this fraction means 450 100)(top number divided by bottom number)x ml = 4.5 ml
28 Formula #2 Formula #2: mg in bottle = mg ordered ml in bottle x ml 100 mg = 90 mg5 ml x ml(cross multiply) x = 450(divide by 100 to get x = 450x by itself)(divide top by bottom #) / 100 = 4501004.5 ml is answer
29 Do Brain Check Give 90 mg Lidocaine Lidocaine packaged 100 mg / 5 ml Your answer was to give 4.5 mlBrain check90 mg is slightly smaller than the total amount of 100 mg4.5 ml is slightly smaller than 5 mlSo our math must be correct
30 Routes of Medication Administration 4 basic categoriesPercutaneousApplied or absorbed thru the skinPulmonaryAbsorbed via inhalation or injectionEnteralAbsorbed thru the gastrointestinal (GI) tractParenteralAdministration outside the GI tractGenerally includes the use of needlesTo remember the “enteral” route – think Entemann’s the dessert people (things you eat).
31 Percutaneous Medication Routes Meds absorbed through skin or mucous membranesSublingual routeMedication absorbed through the mucous membrane under the tongueSub = below; lingual = tongueArea extremely vascularModerate to rapid rate of absorptionAvoids the digestive tract
32 Mucous Membranes cont’d Nasal routeUses a medication atomization device (MAD)Coming soon to Region XRelatively rapid absorption rate in the absence of IV accessMAD provides a fine mist that allows even and widespread distribution of medication across the nasal mucosaThe Region is preparing to incorporate use of the MAD device in the near futureMAD – stands for medication atomization device – a device that produces a fine aerosol mist that permits disbursement of medication across the nasal mucosa for absorption. Some of the medications that can be delivered via this method include fentanyl, versed, and narcan.
33 Pulmonary Medication Route To administer medications into the pulmonary system via inhalation or injectionGenerally include gases, fine mists, or liquidsMost medications used for bronchodilation for respiratory emergenciesInhalation also used for humidification
34 NebulizerUses pressurized oxygen to disperse a liquid into a fine aerosol spray or mistInhalation carries the aerosol to the lungs
35 Enteral Route - Rectally Medication absorbed through the GI tractExtreme vascularity promotes rapid drug absorptionAbsorption more predictableMedications administered rectally do not pass through the liver so are not subject to alteration in the liverAdvantageous for the unconscious patient
36 Parenteral Route Any drug administration outside of the GI tract Typically, this route involves the use of needlesMedication is injected into the circulation or into tissuesSome parenteral forms (ie: IVP) are the most rapid for drug delivery
37 Syringes Plastic or glass tube for drawing up medications Range of sizesMedications are given in dosages by weight (ie: mg)Syringes represent volume (ie: ml)Weights (ie: mg) must be mathematically converted to volume (ie: ml)
38 Syringe Markings Plunger Barrel Hash marks Use most appropriate sized syringe for higher accuracyTB Syringe
39 Medications in Ampules Breakable vessel with liquid medicationCone-shaped top with thin neckThin neck is the vulnerable point for intentionally breaking open the ampuleContains a single dose of med
40 Withdrawing From an Ampule Confirm the medication and dosageHold the ampule uprightTap the top to dislodge trapped liquidPlace gauze (or alcohol wipe package) around thin nickSnap top off away from youPlace tip of needle into ampule and withdraw liquidDispose of ampule into sharps container
41 Medications in VialsPlastic or glass containers with self-sealing rubber topRubber top prevents leakage from puncturesMay contain single or multiple dosesLiquid is vacuum packaged
42 Withdrawing From a Vial Confirm the medication and dosagePrepare the syringe and needle based on volume of liquid to draw upUse 1 ml TB syringe for any dose < 1 mlBecause of the vacuum, draw up the same amount of air as volume to be removedCleanse rubber top with an alcohol wipeInsert needle straight into rubber top
43 Vial cont’d Inject the air from the syringe into the vial Withdraw the desired volume of liquidWatch to keep tip of needle in liquidHelpful to draw a small amount of extra fluid to accommodate removing air bubblesHold syringe with needle pointing upwardTap side of syringe with finger to displace bubbles to distal end of syringeExpel air bubbles and confirm exact volume required in syringe
44 Medications in Prefilled Syringes Tamperproof containers packaged with medication already in the syringeGenerally contain standard dosagesMay require assembly
45 Prefilled Syringe Confirm the medication and dosage Assemble syringe Pop off protective capsTwist glass tube containing liquid into syringeGlass tube becomes the plungerExpel excess airConfirm dosage volume requiredLidocaine cap is twisted to unlock and then remove the cap
46 Nonconstituted Medications Extends viability and storage of time for drugs with short shelf life or instability in liquid formConsists of 2 vialsPowdered medicationLiquid mixing solution
47 Reconstituting Medications Confirm medication and dosagePrepare syringe with liquidCleanse off top of powder vialInject liquid into powder vialGently roll vial between palms to dilute powderCheck that ALL particles have dissolvedRedraw up liquid into syringe, expel excess air
49 Medication Administration Just because you administer medications now, does not mean your technique is accurateThe first rule in medicine:Primum non NocereHippocratesFirst, do no harm!
50 Sublingual Medication Route Use Standard PrecautionsConfirm medication and dosage 3 timesHave patient lift their tonguePlace the tablet between the tongue and the floor of the oral cavityInstruct the patient to allow the pill to dissolve
51 In-line Nebulizer Administration Route For administration of Albuterol when the patient is no longer able to ventilate effectively to inhale the medication into their lungsCan begin to bag the patient and force the medication into the lungs even prior to intubationSet the equipment up and ventilate via a mask while waiting for intubation
52 Endotracheal Administration Route Discouraged route but not forbiddenStudies have failed to demonstrate adequate absorption of medication via this routeIf used, double the calculated IVP dosageHyperventilate to distribute the medicationAcceptable for: Lidocaine, Epinephrine, Atropine, and Narcan (ie: LEAN)
53 Rectal Medication Confirm medication and dosage 3 times Via syringe Use a small diameter syringe based on size of patientLubricate tip of syringeTurn the patient onto their sideInsert tip of syringe into rectumInject medicationRemove syringe and hold cheeks togetherPermits retention and absorption
54 Rectal Administration Via IV catheterIn place of a syringe tip being placed into the rectum, can place an IV catheter on the needleless syringe and then inject the medicationReduces the diameter of the equipment usedHelpful alternative especially in the pediatric population
56 Preparing The Syringe Pull medication into the syringe Tap the side of the barrel to displace air bubbles to the distal tipExpress out the excess air bubblesConfirm accuracy of medication dosageRubber edge of the plunger lines up with the dosage marking on the barrelThen draw up an additional 0.1 ml of air for SQ or IM injectionsThe air plug pushes the med farther into the site preventing leakage of medAdditionally, the air plug assures that all medication has been expelled from the syringe and none remains in the needle.
57 Preparing the Site Wipe the intended site with alcohol Start wiping from the center moving outwardLet the site air dryIntroducing alcohol into the site causes irritationDo not blow on the site to hasten drying – causes contamination
58 SQ Route Layer of connective tissue between skin and muscle Less blood supply than IM so slower absorption rateSlow onset of action but long duration of drug action due to less blood supplyMaximum volume of medication is 1 mlPreferred needle size is 25 – 27 G; 3/8 - 5/8 inchPreferred is 450 angle (900 angle acceptable if using ½ inch needle)SQ medications are deposited into loose connective tissue just below the dermis. This area is not rich in blood vessels so the absorption rate is slow. There are pain receptors in this area though. Keep dose volume small.Larger volumes in the subcutaneous layer can cause irritation and possibly an abscess.
60 SQ Technique Prepare the syringe and needle Identify the site Cleanse the sitePinch a fold of skin upQuickly dart the needle into the fold at a 450 angle900 angle is an alternative especially with ½” needleRelease the foldAspirate checking for blood returnInject steadilyQuickly withdraw the needle and discardMassage the site to enhance absorptionIf injecting Heparin, do not aspirate and do not massage the area.
61 Aspiration Before Injection PurposeTo check for inadvertent entry into a vesselIf you did not check you could be giving an IVP drug instead of a SQ or IMMore common for vessel entry during an IMIf blood is returned, remove needle and prepare a new syringe and needleIf you use the same needle and syringe that blood has been drawn into, you may not be able to detect if you have aspirated blood again at the new injection site and injecting blood into the area can be irritating to surrounding tissue.
62 Pediatric SQ Injections Most common site is posterior upper armNext site used is the anterior aspect of the thighLimited volume up to 1 ml of volume SQUse 450 angle injected into pinched skinSite has limited use in poor perfusion state
63 IM RouteMuscle is extremely vascular and allows for systemic delivery throughout the whole body and a moderate absorption rateAbsorption is relatively predictableWhen using the buttock, important to avoid the sciatic nerveIf you strike the sciatic nerve, the patient could develop chronic painTypical needle size is 21 – 23 G; 1 – 11/2”Use 900 angleVolume limitation dependent on the site usedIn a child, use 1 inch long needle G.
65 IM Sites Deltoid Easily reached Smaller sized muscle limits volume used2 ml maximumSite is finger breadths below the acromial process (AC) and above the armpit creaseArea often identified as a triangleAcromial process is the bony bump on the shoulder.
66 IM routes cont’d Buttocks – dorsal gluteal Can inject up to 5 ml Minimal discomfort feltMust stay away from the sciatic nerveAvoid this site in kids < 2 and in emaciated patientsFind the site in the upper, outer quadrant of the buttockMust avoid the sciatic nerveIn children, avoid the gluteal muscle until approximately 2 years of age and after they have been walking for a time to sufficiently develop this muscle.
67 IM site cont’d - Ventrogluteal Volume 1 – 3 mlGood site for children <7monthsPlace the palm over the trochanter of the femurMake a V with the 2nd and 3rd fingersThe 3rd finger runs straight up to the iliac crestThe 2nd finger angles forward to the anterior superior iliac crestThe injection is made inside the V formed between the 2nd and 3rd fingers
68 IM routes cont’d Thigh Vastus lateralis – side of the thigh Rectus femoris – muscle over the front of the thighCan inject up to 5 ml volumePractice often is to divide larger volumes into 2 injections of smaller volume
69 Thigh Injection Site To find the site Place one hand at the top of the thigh at the groinPlace one hand on the distal (lower) thigh above the kneeThe area between the 2 hands can be usedAnterior surface of the thigh at the midline is the rectus femorisLateral to the midline is the vastus lateralis
70 Pediatric IM Injection Thigh is preferred site in pedsEspecially used in infants and young toddlersLarge muscle massNo proximal nerves or blood vesselsLimited subcutaneous fat layerMore developed muscle than other sitesCan accommodate larger volumes than other pediatric injection sites
71 IM Technique Prepare syringe and needle Identify site Prepare site – let alcohol air dryPull the skin tautDart the needle in at 900The quicker the dart like insertion, the less painfulSlowly and steadily inject the medicationQuickly withdraw needle and properly discardMassage site – enhances absorption
72 Intravenous Administration Route Quickest route to deliver medication directly into the bloodstreamFastest absorption rateDependent on adequate perfusionMany medications are in prefilled syringesPop off protective capsAssemble syringeExpel airConfirm dosageAdminister medicationWatch for response
73 IVP Medication Confirm medication 3 times for accuracy Prepare syringe Consider need for a flushSecure medication syringe into an IV port as close to the IV site as possiblePinch off the IV tubingInject the medication at the prescribed speed for the medicationA flush of normal saline pushes the drug through the tubing and into circulation. The amount of flush is dependent on the medication (ie: Adenosine is 20 ml flush) and the patient ((ie: pediatrics is 5 ml).
74 Needleless IV TubingStandard IV tubing to minimize the event of needle stickPort wiped with alcoholNeedle twisted onto portMust pinch tubing above injection siteFluid will move in direction of least resistance
75 IVPB Administration Route To administer a medication over a longer period of timeAll IV bags hanging need to be labeledThe bags can be hung at the same heightThe IV bags will both drip independently of the other IV bagSecure the IVPB into a port as close to the IV site as possibleLabel IV bag with date, time, medication amount added, initials of person adding medication.
76 Disposal of Contaminated Equipment As soon as possible dispose of equipment into sharps containerAfter giving an injection, snap the protective cover over the needleAfter starting the IV, the needle should be covered as it is retracted after the injection
77 Side Effects and Complications Remember for all injectionsOnce delivered, cannot get the medication backBe very sure of 5 “rights’PatientDrugDoseRouteTimeOnce administered, monitor for known side effects and any other changes to the patient
78 Documentation of Medication Administration TimeDrug nameDrug dosage in mgRoutePatient response
79 EZ-IO Indications Shock, arrest, impending arrest Unconscious/unresponsive to verbal stimuli2 unsuccessful IV attempts or 90 seconds duration of a peripheral attempt
80 EZ IO Contraindications Fracture of the tibia or femur Infection at insertion sitePrevious orthopedic procedureKnee replacementPrevious IO within 48 hoursPre-existing medical conditionTumor near site, peripheral vascular diseaseInability to locate landmarksExcessive tissue at insertion siteFor excessive tissue, hold leg up by heel. Often, the excess fat and skin drop to the backside and you may now be able to feel landmarks.
81 EZ IO Needles Adult patients Pediatric patients 88 pounds or over (40 kg)15 G; 25 mm blue needlePediatric patientspounds (3 kg – 39 kg)15 G; 15 mm pink needleThink “pink” for “peds”
82 EZ IO Equipment 10 ml syringe filled with 0.9 NS 5 ml of NS in syringe for peds patientEZ connect tubingMaterial to cleanse siteEZ IO driverEZ IO needle in it’s casePrimed IV tubing1000 ml bag for adults250 ml IV bag for geriatric and pediatric patientsPressure bag (B/P cuff is no pressure bag)
83 EZ IO drill with storage case Should carry 2 of each size needle in case of a failed attempt on the first leg.
84 EZ IO Site Most common site: proximal tibia Palpate the tibial tuberosityBump below the patellaIdentify 2-3 finger widths below the patellaMove 1 finger width medially (toward the big toe)In smaller children often will not be able to palpate the tibial tuberosity
85 EZ IO - Technique Prime EZ connect tubing Takes 1 ml to prime tubing Leave syringe attachedAttach needle to driverInsert needle at 900 angle into siteRelease trigger once decreased resistance is feltRemove driver from needleRemove stylet by rotating counterclockwise
86 EZ IO Technique cont’d Connect EZ primed tubing to needle May notice backflow of bone marrowBlood will NOT pump out of needleUsing syringe, aspirate then flush with remaining NS to confirm placementNeedle stands up on ownFlushes easilyNo infiltration felt
87 EZ IO Technique cont’d Remove syringe Attach primed IV tubing Secure pressure bag to permit flow of fluidBegin infusionSecure tubing to legApply wristbandMonitor site for infiltrationCan administer any IVP medication that would normally be given IV pushApply wristband to same side as IO placement. Wristband is used for all failed and successful attempts.In absence of a pressure bag, may manually squeeze IV fluid bag to begin the flow of IV fluids.
88 EZ IO Documentation Same information for starting an IV Time Solution Size IV bagSitePerson actually performing the puncture
89 Case Study #1 Your patient weighs 150 pounds They need to receive 1.5 mg / kg LidocaineLidocaine packaged as 100 mg/5 mlHow much Lidocaine needs to be drawn up and given?
90 Case Study #1 Calculate pounds to kilograms 150 2.2 = 68.1 rounded to 68 kgCalculate total mg of medicationTo receive 1.5 mg per kgMultiply 1.5 x 68 = 102mgCalculate how much medication to deliverUse formula of your choice
91 Case Study #1 Formula #1 X ml = desired dose x vol on hand dose on handX ml = 102 mg x 5 ml100mgX ml = 510100X ml = 510 100X ml = 5.1 ml (in the adult rounded to 5 ml)
92 Case Study #1 Formula #2 100 mg = 102 mg 5 ml x ml 100 x = 510 x = 100X = ml (rounded to 5 ml)
93 Case Study #2Your 45 year-old patient is having an allergic reaction with airway involvementThe vital signs are stableWhat medications are indicated?How do you administer each of the medications?
94 Case Study #2 Epinephrine 1:1000 – 0.3 mg SQ Bronchodilator, vasoconstrictorShort needle (3/8 - 5/8”)450 anglePinch up the skinBenadryl 50 mg IVP slowly or IMAntihistamineLong needle (1” up to 1 1/2”)900 anglePull the skin taut before injecting
95 Case Study #2Always aspirate to check for inadvertent entry into a veinIf blood is noted, withdraw needlePrepare a new needle and syringeInjecting the blood can cause irritationWith blood in the syringe, may not be able to detect aspiration of new blood at new site
96 Case Study #3 You are on the scene of a full arrest You cannot find peripheral veinsWhat is you next alternative?How do you confirm needle placement?
97 Case Study #3 EZ IO needle is indicated Confirmation of needle placementNeedle stands up by itselfAble to flush the needle easily through the EZ connect tubingFluid flows with a pressure bag attachedNo infiltration is noted
98 EZ IO Needle Needle always flushed via the EZ connect tubing NEVER flush the needle directly – too much pressure
99 Case Study #4 You have an 8 month-old infant with a blood sugar of 45 The patient responds weakly to verbal stimuliWhat medication is necessary?How do you prepare the medication?How do you administer the medication?
100 Case Study #4 - Hypoglycemia Ages > 16 – Dextrose 50%Ages 1 – 15 – Dextrose 25%Age < 1 years-old - Dextrose 12.5%Diluted strength due to vein irritationCalculate the dosageDraw up equal amounts normal saline and D25% to make a 1:1 dilutionAdminister slowly due to vein irritation
101 Case Study #4 Dextrose is given IVP Wipe off the injection port with alcoholPush on the needleless syringe and twist to connectPinch off the tubing above the injection portSlowly and steadily administer the medicationEvaluate the site for infiltrationEvaluate the patient’s response
102 Case Study #5 You are on the scene for a 5 year old having a seizure Patient weighs 50 poundsHistory of seizure disorderGlucose level of 80You are unable to establish a peripheral IVWhat do you do for the airway?What medication is indicated?How do you administer the medication?
103 Case Study #5 Airway control – bag the patient Medication and route In active seizure, the respiratory status of the patient is difficult to evaluate and assume the patient is not ventilating wellMedication and routeValium 0.5 mg/kg (max 10 mg) rectally
104 Case Study #5 Calculate dose 50 pounds 2.2 = 22.7 = 23 kg Multiple 0.5 mg x 23 kg = 11.5 mg = 12 mgMax dose is 10 mgValium comes 10 mg per 2 mlMake sure syringe is needlelessInsert syringe into buttocksInject medication and remove syringeHold cheeks together
105 Pediatric ResourcesWhat resources are available to calculate a pediatric dosage?Back of the SOP’sMedical ControlBroselow tapeValium listed as diazepamNarcan listed as NaloxoneNormal saline listed as crystalloid
106 BibliographyBledsoe, B., Clayden, D., Papa, F. Prehospital Emergency Pharmacology 5th Edition. BradyBledsoe, B., Porter, R., Cherry, R., Paramedic Care: Principles and Practices. Brady. 2009Edmunds, M. Introduction to clinical Pharmacology. ElsevierMarenson, D. Pediatric Prehospital Care. BradyRegion X SOP’s March 2007, Amended January 1, 2008Sanders, M. Paramedic Textbook. Rev 3rd edition. Mosby. 2007wps.prenhall.com