Medication Stuff

Acetaminophen Route

orally

Acetaminophen indications

-mild/moderate discomfort (pain)

-fever (>100.4 °F, 38°C)

Acetaminophen contraindications

Head injury

Allergy/age (have to be over 3 mo)

Liver disease

Swallow (can’t swallow/can’t receive med)

Hypotension (Systolic BP under 90)

Acetaminophen containing products in last 4hrs

Respiratory distress

Persisten vomiting

Acetaminophen Dose

under 3 mo = none

3 mo = 1.25 mL

4-11 mo = 2.5 mL

12-23 mo = 3.75 mL

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2-4 yo = 160 mg/5mL (one unit dose)

5-12 yo = 320 mg/10mL (two unit doses)

13 yo+ = 640 mg/20mL (four unt doses)

RPMDDD

acronym to check before administering medication

Route, Patient, Medication, Date, Dosage, Documentation

Activated Charcoal Route

Orally

Activated Charcoal Indications

Poisoning by mouth

Activated Charcoal Contraindications

-altered mental status

-received an emetic (already had activated charcoal)

Activated Charcoal Dose

1 gram/kg Po (bodyweight/2.2)

Albuterol Route

inhaled

Albuterol Indications

-signs & symptoms of respiratory distress

-bronchospasm/wheezing associated with asthma, COPD/emphysema, or allergic reactions (anaphylaxis)

Albuterol Contraindications

known hypersensitivity (allergic)

Albuterol Dose (Inhaler)

Max of 2 doses (4 puffs) over 30 min period

Albuterol Dose (Nebulizer)

2 or older: 2.5mg connected to 6-8 lpm O2

less than 2: 1.25mg connected to 6-8 lpm O2

both max repeat one time

Adverse effects of albuterol

-tachycardia/palpitations

-hypertension

-angina

-nervousness/anxiety

-tremors

-dizziness

-headache

-sweating

-nausea/vomiting

-sore throat

Adverse effects of activated charcoal

may indirectly induce vomiting & cause nausea

Aspirin Route

tablets orally (chewed by patient)

Aspirin Indications

-suspected acute coronary syndrome (heart attack)

-ST Elevation MI (STEMI)

basically chest pain/cardiac problems

Aspirin Contraindications

-known hypersensitivity (allergy)

-received full dose of aspirin before EMS arrival

Aspirin Dose

324 mg or 325 mg (four 81 mg tablets usually)

Adverse effects of aspirin

-heartburn

-nausea & vomiting

-wheezing

Epinephrine Route

intramuscularly in lateral thigh (auto injector or syringe)

Epinephrine Indications

-mod-sev allergic reaction w resp distress

-mild allergic reaction w history of life threatening allergic reaction

-patients w severe asthma

Epinephrine Contraindications

None in presence of anaphylaxis

Must medically consult b4 giving to asthma patients w pregnancy or cardiac history tho

Epinephrine Dose (syringe)

adult: 0.5 mg in 0.5 mL given IM in lateral thigh

pediatric: 0.15 mg in 0.15 mL given IM in lateral thigh

Epinephrine Dose (auto-injector)

adult (5 yo and +): 0.3 mg IM in lateral thigh via epi auto injector

pediatric (less than 5 yo): 0.15 mg IM in lateral thigh via epi auto injector

Adverse effects of epinephrine

-tachycardia/palpitations

-angina

-headache

-nausea/vomiting

-dizziness

-hypertension

-nervousness/anxiety

-tremors

Naloxone (Narcan) Route

intra-nasally

Naloxone Indications

to reverse respiratory depression induced by opioid/narcotic agent

basically help with overdose stuff

Naloxone Contraindications

Patient under 28 days of age

Naloxone adverse effects

opioid withdrawal

Naloxone Dose

Adult: 2mg IN w 1mL per nare

Pediatric (28 days to adult): 2 mg IN w 1mL per nare

repeat as necessary to maintain respiratory activity

Nitroglycerin Indications

Chest pain

Nitroglycerin contraindications

-blood pressure below 90mmHg systolic

-heart rate less than 60 or greater than 150bpm

-medication not prescribed for patient

-ped patient under 13

-took CARLV med in past 48 hours (need medical consult to overrule this contraindication)

CARLV

acronym for meds helping with pulmonary artery hypertension or erectile dysfunc (useful as contraind for nitro)

Cialis- erectile dysfunction

Adcirca - pulmonary artery hypertension

Revatio -pulmonary artery hypertension

Levitra - erectile dysfunction

Viagra - erectile dysfunctio

Nitroglycerin Route

sublingually (one spray or one tablet)

Nitroglycerin Dose

Adult: 0.4mg sublingually (one tablet or one spray)

repeat in 3-5 min if chest pain persists

max 3 doses (add more w/ medical consultation)

ped: contraindicated for under 13

Nitroglycerin Adverse effects

-hypotension

-headache

-dizziness

-tachycardia

Oral Glucose Route

orally

Oral Glucose Indications

-altered mental status w/ known diabetic history

-unconscious for an unknown reason

-measured blood glucose level less than 70mg/dL

Oral Glucose Contraindications

not clinically significant

Oral Glucose Dose

both adult and ped: 10-15g oral glucose btwn gum & cheek (consider single additional dose of oral glucose if not improved after 10min)

ped give with several small administrations

Oxygen Route

inhalation

Oxygen Indications

-evidence of hypoxia (less than 94% SpO2)

-respiratory distress

-cardiopulmonary arrest

-trauma

-suspected CO exposure

-dyspnea (shortness of breath)

Oxygen contraindications

not clinically significant

Oxygen Adverse Effects

high conc of oxygen will reduce respiratory drive in some COPD patients; make sure to carefully monitor

Oxygen Dose

adult & ped: 12-15lpm via NRB (below 90%, Carbon monoxide (CO) exposure) mask or 2-6 lpm via nasal cannula (90-94%)

bvm (below 90% and can’t breathe on own) 15lpm every 5-6 sec adult, 2-3 sec pediatric

Scene Size Up

Scene Safe?

BSI/PPE

number of patients

MOI or NOI

call for additional resources? (ALS

need to take c-spine?

Primary Assessment

ask for general impression

x-exsanguination (massive bleeding)? apply direct pressure, then tourniquet

mental status, introduce yourself & determine via AVPU

airway, open and patent? if not head tilt chin lift/jaw thrust and adjunct/suction as needed

breathing, get rate, rhythm, quality (is BVM needed), and SpO2 reading (provide oxygen if needed)

circulation, get rate, rhythm, quality, and skin assessment (color, temp, condition)

evaluate patient priority (high/low)

Secondary Asses. significant MOI

-request ALS

-determine chief complaint

-get base vitals

-rapid head to toe exam (DCAP-BTLS)

-SAMPLE/OPQRST

-interventions

-move to ambulance

-transport

-detailed physical exam

-reassessment (VIPS, vital signs, interventions, primary & secondary asses.)

Rapid head to toe exam

Secondary Assessment Non-Sig MOI

-determine chief complaint

-get base vitals

-perform focused physical exam based on chief complaint (check sys above and below too) (DCAP-BTLS)

-SAMPLE

-OPQRST

-interventions

-move to ambulance

-transport

-detailed physical exam

-reassessment (VIPS, vital signs, interventions, primary & secondary asses.)

Secondary Assessment Unresponsive Medical (NOI)

-request ALS

-interview fam/bystanders for info

-get base vitals

-rapid head to toe exam

-SAMPLE/OPQRST

-interventions

-move to ambulance

-transport

-reassesment (VIPS)

Secondary Assessment Responsive Medical (NOI)

-determine chief complaint

-get base vitals

-perform focused exam (above, main, and below body sys)

-SAMPLE

-OPQRST

-interventions

-move to ambulance + transport

-reassesment (VIPS)

how often do you check vitals for high priority

every 5 min

how often do you check vitals for low priority

every 15 min

base vitals

glucose level (blood sugar), HR (heart/pulse rate), SpO2 (oxygen saturation/level), RR (respiratory rate), BP (blood pressure)