1. VECURONIUM BROMIDE Familiarization Training

2. General Information Vecuronium is a non-depolarizing neuromuscular blocking agent, preventing acetylcholine from binding to muscle receptors on the end plate, thus resulting in compete paralysis.

3. General Information Onset of action is within about one minute after administration. Effects persist between 25 and 35 minutes. Question: Why are the onset and duration of this medication important to us specifically?

4. INDICATIONS Maintenance of chemical paralysis for patients on a ventilator during inter-facility transport. Question: What are the other indications for this drug per TransCare protocols.

5. PRECAUTIONS ET tube placement should be assessed and documented q 10min. Continuous end tidal CO2 monitoring and SaO2 are to be used to ensure ET patency.* Assess and treat for under-sedation: – Tachycardia – Hypertension – Lacrimation

6. PRECAUTIONS CONTINUED – Diaphoresis – Twitching or muscle spasm Remember paralytics do not obtund consciousness or alter patients pain threshold. Administration of sedatives and analgesics may be required. Typically Versed is used for sedation and Fentanyl for analgesia. Make sure you have orders for both!!

7. ADMINISTRATION/DOSING DOSING IS WEIGHT BASED! Make sure you get an accurate weight prior to departure! Medication must be reconstituted prior to administration. Use 10ml sterile water. NOTE: Make sure to use sterile water that is labeled “for injection”. Adult Dose: 0.08 – 0.1 mg/kg IVP Pediatric Dose: Same but greater recovery time.

8. ADMINISTRATION/DOSING Drug is supplied as 10mg/10ml powder form vial and again must be reconstitiuted.

9. CONTRAINDICATIONS/CAUTIONS As with all medications, a hypersensitivity to this drug. List of Cautions

10. ADVERSE REACTIONS Although protocol lists no side effects, here are some adverse reactions Prolonged Paralysis Respiratory Depression Apnea Anaphylaxis Bronchospasm

11. CONCLUSION Being familiar with this protocol/waiver is a big part of being comfortable with his medication. Monitor your patient carefully and check and re- check vent settings and tube placement regularly. Get a weight from the hospital. If you are uncomfortable or unfamiliar with any aspect of this medication or vent equipment call operations manager on duty