Procedure 32 - Treatment: Medication Administration

What does the Medication Administration policy allow EMS to do?

Administer medications via multiple routes.

Where should specific guidance for IM injections, SQ injections, and nebulizer therapy be found?

In the specific treatment policy.

What is the first "right" checked in medication preparation?

Right medication for the patient's needs.

What is the second "right" checked in medication preparation?

Right dose/amount.

What is the third "right" checked in medication preparation?

Right time.

What is the fourth "right" checked in medication preparation?

Right route for administration.

What date must be checked when preparing medication?

The expiration date.

What patient history must be checked when preparing medication?

Patient allergies to the medication.

What must be confirmed before giving oral (PO or SL) medications?

An appropriate swallow reflex and mentation to prevent aspiration.

What should be clearly directed when giving oral medication?

How the medication should be administered (chewed, swallowed, held under the tongue).

When can medications be given down an endotracheal tube?

When vascular access is delayed and an ET tube is in place.

What happens to the medication dose when given via the endotracheal route?

The dose is doubled.

How is medication administered down the endotracheal tube?

Rapidly injected in a bolus that is diluted or followed by normal saline to flush the tube.

What is the maximum fluid bolus volume for flushing an endotracheal medication dose?

10 mL.

What medications may be given down the endotracheal tube?

Epinephrine, Atropine, Naloxone (Narcan), and Lidocaine.

What should be assured before using a Mucosal Atomization Device (MAD)?

No trauma to the nares, perforations from illicit drug use, or excessive nasal secretions that would contraindicate intranasal medication use.

How much medication is drawn up per nostril for MAD administration?

Half of the total volume required, divided between the two nostrils.

What extra volume may be drawn up to account for dead space in the atomizer?

An extra 0.1 mL of medication.

What is the maximum volume that may be infused per nostril with MAD?

A maximum of 1 mL (plus dead space allowance).

Why is the MAD medication divided in half between nostrils?

To effectively double the absorption area.

What is removed from the syringe before attaching the atomizer tip?

The blunt fill or filter needle.

How should the atomizer be aimed when placed in the nostril?

Slightly up and inward, towards the top of the opposite ear.

How is MAD medication delivered into the nostril?

By briskly compressing the syringe plunger.

Should an additional 0.1 mL be drawn up for the second nostril dose in MAD administration?

No, because that area of the device is now filled with fluid.

In what type of syringe is IV bolus medication prepared?

A Luer lock syringe.

What must be cleared from the syringe before IV bolus administration?

All air, and excess medication expelled.

What technique is used to clean the IV port before bolus medication administration?

"Scrub the hub" with an alcohol pad, using aseptic technique.

How is IV patency checked before bolus medication administration?

By aspirating blood or monitoring fluid flow with no signs of infiltration.

Where should the IV line be clamped during bolus medication administration?

Proximal to the infusion port, to occlude flow.

Why is the IV line clamped proximal to the infusion port during bolus administration?

To allow the medication to flow into the vein and not back up into the IV bag.

What determines the time needed to administer an IV bolus medication?

The medication itself; refer to the protocol or drug formulary for guidance.

What should be done to the IV line after bolus medication administration?

Flush the IV line thoroughly to assure complete medication administration.

What should be monitored at the IV catheter site after bolus medication administration?

Signs of infiltration.

How should the syringe be disposed of after IV bolus medication administration?

Into the sharps container.

How are continuous IV drip medications prepared?

Pre-mixed IV medications are selected, or an appropriate dose is added to an IV fluid bag.

What should be affixed to the fluid bag if EMS adds medication for a continuous drip?

A label listing the added medication(s), amount or concentration, and date/time.

What must be completed before administering a continuous IV drip medication?

Drip rate calculations.

How should a drip rate be confirmed for continuous IV medication?

With another paramedic or by using a drug reference (protocols, for example).

What should be done to the bag before inserting the administration line for a continuous drip?

Gently roll the bag to distribute the medication.

What happens to main-line fluid during piggyback drip administration?

It will be turned off.

What should be monitored for consistency during a continuous IV drip?

The flow rate for desired drops per minute or mL per hour.

What should be assessed after any medication administration?

The patient for condition changes.

When should medications be discontinued after administration?

If serious adverse effects occur or as directed by Medical Control.

What medication details must be documented on the PCR?

The name of medication and who administered it.

What dose information must be documented on the PCR?

Dose and concentration of medication.

What time information must be documented on the PCR?

Time of administration.

What route information must be documented on the PCR?

Route/site of administration.

What must be documented for narcotic medications?

Documentation of narcotic waste with an appropriate witness signature.

What patient response must be documented after medication administration?

Patient response to the medication.

What should be used for pediatric dosing when actual weight is unknown?

A length based/color coded resuscitation tape (Broselow-Luten Pediatric Tape).

Should a parent's estimate of a pediatric patient's weight be relied upon for dosing?

No, do not rely on a parent's estimate of the patient's weight.

What provider levels can administer medications per CFD protocol?

EMT-A, EMT-B, and EMT-P.