Procedure 32 — Treatment: Medication Administration

What is the policy purpose for medication administration?

To allow EMS to administer medications via multiple routes.

What should be referenced instead of this general policy for IM injections, SQ injections, and nebulizer therapy?

The specific treatment policy for each.

What are the six checks (rights) performed during preparation for medication administration?

Right medication, right dose, right time, right route, expiration date, and patient allergies.

What must be confirmed before giving an oral or sublingual medication, to prevent aspiration?

Appropriate swallow reflex and mentation.

What should be given to the patient along with an oral/sublingual medication?

Clear direction on administration (chewed, swallowed, or held under the tongue).

When can medications be given down an endotracheal tube?

When vascular access is delayed and an endotracheal 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 when flushing an endotracheal medication?

10 mL.

Name four medications that may be given down the endotracheal tube.

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

What three conditions should be checked before intranasal medication administration via MAD?

No trauma to the nares, no perforations from illicit drug use, and no excessive nasal secretions.

What syringe size is used to draw up medication for MAD administration?

A 1 or 3 mL syringe.

How is the medication volume divided for intranasal MAD administration?

Divided in half, to be given in each nostril.

What extra volume may be drawn up for MAD administration to account for dead space?

An extra 0.1 mL.

What is the maximum volume of medication infused per nostril for MAD administration?

1 mL, plus dead space allowance.

Why is the medication volume split between both nostrils for MAD administration?

It effectively doubles the absorption area.

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

The blunt fill or filter needle.

How is one nostril managed while administering the first dose via MAD?

Occlude it with your free hand.

How is the atomizer tip positioned in the nostril during MAD administration?

Snugly, aiming slightly up and inward, toward the top of the opposite ear.

How is the medication delivered into the nostril during MAD administration?

Briskly compress the syringe plunger.

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

No, because the dead space area of the device is already filled with fluid.

What is done with the remaining MAD medication volume?

Move the device to the opposite nostril and administer it.

What type of syringe is used to prepare an IV bolus medication?

A Luer lock syringe.

What must be cleared from a syringe before administering an IV bolus medication?

All air, with any 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 the syringe attached to the IV line for bolus administration?

Twist it onto the IV line port, or use the medication port of the fluid bag.

How is IV patency checked before bolus medication administration?

Aspirating blood or monitoring fluid flow for no signs of infiltration.

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

Proximal to the infusion port.

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

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 administering a bolus medication?

Flush it thoroughly to assure complete medication administration.

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

Any signs of infiltration.

What should be monitored in the patient after IV bolus medication administration?

The patient's response.

Where is the syringe disposed of after IV bolus medication administration?

The sharps container.

What should be done to a fluid bag label if EMS prepares a medicated IV drip by adding medication?

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

What should be confirmed before administering a continuous IV drip?

The drip rate calculation, with another paramedic or a drug reference.

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

Gently roll the bag to distribute the medication.

Where is the medication bag connected for a continuous IV drip?

To the closest port available.

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

It is turned off.

What is controlled to maintain a continuous IV drip?

The flow rate, for the desired drops per minute or mL per hour, monitored for consistency.

What should be assessed following medication administration, as part of post-medication assessment?

The patient for condition changes.

When should medications be discontinued after administration?

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

What must be documented about who administered a medication?

Name of medication and who administered it.

What dosing details must be documented after medication administration?

Dose and concentration of medication.

What time detail must be documented after medication administration?

Time of administration.

What route detail must be documented after medication administration?

Route/site of administration.

What additional documentation is required for narcotic administration?

Documentation of narcotic waste with an appropriate witness signature.

What patient outcome must be documented after medication administration?

Patient response to the medication.

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

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

What should not be relied on for pediatric dosing?

A parent's estimate of the patient's weight.

What provider levels can perform medication administration?

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