Medications and Administration Protocols

EMR Scope Medications, Patient Rights, Medication Assistance

What are the 6 Patient Rights?

Right Person

Right Medication

Right Time

Right Route

Right Amount

Right Documentation

What are the components of the structured medication administration procedure checklist?

1. Vital Signs

2. Indications

3. Contraindications & Cautions

4. Description of Amount, Route, and Special Instructions.

5. Inspection of medication packaging checking for expiry, and verification by partner with documentation.

What are the five requirements that must be satisfied before you are permitted to assist a patient with their medication?

1. The medication is only available as a prescription and has been prescribed to that patient.

2. The patient has requested assistance with their medication.

3. The medication is related to the emergency services being provided to the patient.

4. The medication is administered as prescribed.

5. The patient is not being transported between health facilities.

What is the Classification of Acetaminophen (Tylenol)?

Analgesic, Antipyretic

What are the five contraindications for Tylenol?

1. Hypersensitivity to acetaminophen or any component of the formulation.

2. Severe hepatic impairment or severe active liver disease.

3. Acetaminophen taken within the last 4 hours from all sources.

4. Total acetaminophen intake within the last 24 hours exceeds the daily maximums.

5. Suspected acetaminophen overdose.

What are the cautions for acetaminophen?

1. Hepatic Impairment

2. Heavy Alcohol Use

3. Chronic Malnutrition

4. Hypovolemia

What is the route and dosage range for acetaminophen?

500-1000mg P.O

What is the 24-hour daily maximum dose for acetaminophen?

4000mg (2,000mg for suspected or known liver disfunction)

What is the typical onset time for acetaminophen?

30 minutes

What are the components of Entonox?

50% Oxygen, 50% Nitrous Oxide

What is the classification of Entonox?

Non-Narcotic Inhaled Analgesia

What are the contraindications for Entonox? Hint: PAINDIE

1. Pneumothorax

2. Air Embolism

3. Inhalation Injury

4. Nitroglycerin in the last 5 minutes

5. Decompression Sickness

6. Inability to comply with medication administration

7. Enclosed Spaces

What are the cautions for Entonox? Hint: SADFC

1. Signs of Shock

2. Abdominal Distention

3. Depressant Drug Use

4. Facial Injuries (can they use the bite stick?)

5. COPD

What must you do after discontinuing Entonox for any reason?

Patient must be placed on high flow oxygen.

What are the adverse effects of Entonox?

Lightheadedness, dizziness, sedation, drowsiness, disorientation, nausea/vomiting

What must be done prior to administering Entonox?

Flip the canister 10 times to mix the oxygen and nitrous oxide effectively.

What is the classification of Ibuprofen?

Analgesic, Antipyretic, NSAID.

What are the contraindications for Ibuprofen?

1. Hypersensitivity to Ibuprofen and any other NSAID medications

2. Active GI hemorrhage or ulcers

3. Pregnancy

What is the adult route and dosages for ibuprofen?

300 - 400 mg P.O

What is the maximum adult daily dose for ibuprofen?

1200mg

What is the correct ibuprofen dosage for a pediatric patient?

10mg/kg

What is the maximum daily dose of ibuprofen for a pediatric patient?

40mg/kg

How often can a dose of acetaminophen be re-administered?

Every 4 hours until daily maximum

How often can a dose of ibuprofen be administered in an adult patient?

Every 4-6 hours until maximum reached

How often can ibuprofen be administered in a pediatric patient?

May repeat once after 6 hours

Can ibuprofen and acetaminophen be administered together?

Yes

What are the cautions for ibuprofen?

Alternative treatments should be considered for patients with a history of gastrointestinal, renal, or significant cardiovascular disease.

All NSAIDS have the potential to cause significant adverse reactions.

What are the adverse effects for ibuprofen?

GI upset of varying severities including ulceration, bleeding, and perforation.

What is the classification of salbutamol?

Bronchodilator, Sympathomimetic

What must you do before administering salbutamol?

Confirm bronchospasm (wheezing) on auscultation

What are the two devices used to administer salbutamol?

Nebulizer and MDI (Metered-Dose Inhaler) with Spacer (Aerochamber)

What is the correct dosage for nebulized salbutamol in patients older than one year?

5mg

Can you nebulize salbutamol in patients requiring assisted ventilations with a BVM due to ineffective respirations?

Yes, via the port nearest to the mask.

What is the correct dosage of nebulized salbutamol for patients younger than 1 year?

2.5mg

What is the correct adult dosage for salbutamol administered with an MDI ?

4 × 100mcg

What are the dosages for salbutamol administered to pediatric patients via MDI, according to their weight?

< 10 kg, not indicated, use nebulizer

10 - 20kg 5 × 100mcg

> 20kg 10 × 100mcg

How many times can you re-administer nebulized salbutamol?

As required

How many times can you re-administer salbutamol via MDI to a pediatric patient ?

Up to 3 times

What are the indications for salbutamol?

Bronchospasm and wheezing associated with asthma, bronchitis, emphysema, or secondary to other causes such as anaphylaxis.

What are the contraindications for salbutamol?

Known allergy or hypersensitivity to salbutamol

HR greater than 120bpm.