Trauma Pharm

3 Indications for TXA administration

-Traumatic injury within 3 hours
-Signs of hemorrhagic shock with SBP<90 mmHg OR HR>120
-Uncontrolled bleeding despite tourniquet application

8 Contraindications for TXA

-Shock unrelated to trauma
-SBP>90 or HR<120
-Injuries > 3 hours prior
-Bleeding that is controlled by tourniquet
-Patients under 15 years old
-Active thrombotic event within past 24 hrs
-Drowning/Hanging pt
-CVA, MI, PE, DVT

Dosage form of TXA

1 gram/10 mL vial, infused in 50-100 mL Normal Saline IV Bag over 10 minutes.

6 Common side effects of TXA

-Fatigue
-Headaches
-Backaches
-Abdominal pain
-Pulmonary Embolism
-Deep Vein Thrombosis

3 Precautions when administering TXA

-Patients with hx of Renal problems, DVT and coagulopathies
-Pt must have a circulation
-Include total IV fluid of TXA given in documentation

Duration of TXA's effects

2-4 hours.

Routes of administration for TXA

IV Drip

Pharmacokinetics of TXA

Onset: 5-10 minutes
Peak: N/A
Duration: 2-4 hours

3 Precautions regarding Pt respiratory status administering Morphine

Monitor for respiratory depression, use EtCO2. and be prepared to provide supplemental oxygen/ventilations.

If respiratory arrest develops after Morphine administration

Administer naloxone.

Pediatric Use of Ketamine

Not approved for pediatric administration.

Fentanyl Pediatric Dosage, Max Dosage, Routes

2mcg/Kg IM/IN/IV
Max single dose 50 mcg
Max combined dose 100 mcg
May repeat once after 3 minutes.

What are the 4 Pediatric protocol indications for administration of Fentanyl?

SO-P-15 General Injury and Trauma
SO-P-25 Amputation Injuries
SO-P-30 Crush Injuries
SO-P-95 Burns - Electrical/Chemical/Thermal

When MUST you contact Base when administering Fentanyl?

When pt is < 2 years old

5 Side Effects of Fentanyl

Dizziness, nausea, vomiting, respiratory depression, convulsions.

Blood Pressure Precaution when administering Fentanyl

Hold if BP < 90 systolic.

Important to Monitor pt for __________ AFTER administering Fentanyl.

Respiratory depression.

What should be documented before and after administering Fentanyl?

Pain scale and vital signs.

What is Fentanyl classified as?

Synthetic opiate analgesic.

What effect does Fentanyl have on pain pathways?

Inhibits pain pathways.

What should be done if respiratory arrest develops after administering Fentanyl?

Administer naloxone.

Muscle rigidity may develop if Fentanyl is given __________.

Rapid IV push.

Chemical burns treatment involves __________ before administering Fentanyl.

Brushing away remaining dry chemical and irrigating with water/saline.

Fentanyl is less likely to cause __________ than Morphine.

Hypotension.

TXA (Tranexamic Acid)

Antifibrinolytic that prevents the breakdown of fibrin and blood clots.

Onset of TXA

5-10 minutes

3 Indications for TXA administration

1. Traumatic injury within 3 hours

2. Signs of hemorrhagic shock w/ SBP < 90 or HR > 120

3. Uncontrolled bleeding despite tourniquet application

8 Contraindications for TXA

1. Shock unrelated to trauma

2. SBP > 90 or HR < 120

3. Injuries > 3 hours prior

4. Controlled bleeding by tourniquet

5. Patients under 15 years old

6. Active thrombotic events

7. Drowning/Hanging pt

8. Pt hx: CVA, MI, PE, DVT

Dosage form of TXA

1 gram/10 mL vial, infused in 50-100 mL Normal Saline IV Bag (over 10 minutes)

6 Common side effects of TXA

Fatigue, headaches, backaches, abdominal pain, pulmonary embolism and deep vein thrombosis.

3 TXA Precautions

1. Use caution in patients with hx renal problems, DVT, and coagulopathies.

2. Patients must have a circulation for TXA to be administered

3. Include total IV fluid of TXA given in documentation of total IV fluid

Duration of TXA's effects

2-4 hours.

Routes of administration for TXA

IV Drip.

Onset of TXA

5-10 minutes

Peak of TXA

N/A

Classification of Morphine Sulfate

Opiate analgesic

6 Effects/Characteristics of Morphine

Opiate agonist, potent analgesic, inhibits pain pathways, increases pain threshold, produces sedation, and causes vasodilation.

Onset of Morphine Sulfate IV

1-2 minutes

Onset of Morphine Sulfate IM

15-30 minutes

Peak effect of Morphine Sulfate IV

20 minutes

Peak effect of Morphine Sulfate IM

30-60 minutes

Duration of Morphine Sulfate

2-7 hours

4 Dosage forms of Morphine Sulfate

10 mg/1 ml Ampule, Vial, and Carpuject,
10 mg/10 ml Vial.

Routes of administration for Morphine Sulfate

IM (intramuscular), IV (intravenous), and IO (intraosseous).

SO-C-15 Chest Pain of Suspected Cardiac Origin, what is the specification/requirement that must be met in order to administer Morphine as a Standing Order?

Chest pain is unrelieved after 3 doses of NTG / unable to give NTG

SO-C-15 Chest Pain of Suspected Cardiac Origin
Morphine Routes and Dosage, how many times can you repeat?

5 mg IV or 4 mg Carpuject
May repeat ONCE after approx. 3 mins for continued pain (hold if BP ≤ 90)

SO-E-30 Snake Envenomation
Morphine Routes and Dosage, how many times can you repeat?

For pain management:
5 mg IV/IM or 4 mg Carpuject
May repeat once in 3 minutes to control pain.
*BHC REQUIRED*

SO-M-05 Abdominal / Flank Pain Non-Traumatic
Morphine Routes and Dosage, how many times can you repeat?

As needed for severe pain:
5 mg IV/IM or 4 mg Carpuject
May repeat once after 3 minutes if SBP > 90.

SO-E-05 Burns - Electrical/Chemical/Thermal
Morphine Routes and Dosage, how many times can you repeat?

For pain, w/ SBP>90:
5mg IV or 4mg via Carpuject
(May administer IO if site already established).
May repeat ONCE after approx. 3 mins to control pain

SO-T-05 General Injury and Trauma
Morphine Routes and Dosage, how many times can you repeat?

For pain, w/ SBP>90:
5mg IV / IM or 4mg Carpuject
May repeat ONCE in 3 mins to control pain

SO-T-015 Amputation Injuries
Morphine Routes and Dosage, how many times can you repeat?

As needed for severe pain, w/ SBP>90:
5mg IV / IM
May repeat ONCE in 3 mins to control pain

SO-T-020 Crush Injuries
Morphine Routes and Dosage, how many times can you repeat?

As needed for severe pain, if SBP>90:
5mg IV / IM or 4mg Carpuject
May repeat ONCE in 3 mins to control pain

5 Side Effects of Morphine

Dizziness, Nausea, Vomiting, Respiratory depression, Hypotension.

3 Precautions regarding pt Respiratory Rate while administering Morphine and Fentanyl

Monitor for respiratory depression and be prepared to provide supplemental oxygen/ventilations.

If respiratory arrest develops after Morphine administration, what do you do?

Administer naloxone.

Morphine Controlled Substance Classification

Morphine is classified as a controlled substance.

What is a MUST on documentation when administering morphine and fentanyl?

Document pain scale and vital signs before and after administration.

Classification of Lidocaine

Antiarrhythmic

3 Cardiac effects of Lidocaine

Depresses automaticity & excitability
Decreases ventricular irritability

Onset of Lidocaine

1-2 minutes

Peak effect of Lidocaine

3-5 minutes

Duration of action for Lidocaine

10-20 minutes

3 Dosage forms of Lidocaine

2% 100mg/5mL PFS, 2% 100mg/5mL Vial,
2% 400mg/20mL Vial

Routes of administration for Lidocaine

Intravenous (IV) and intraosseous (IO).

3 Indications for IO access

1. Cardiopulmonary arrest, Respiratory arrest, Trauma related arrest (adult or child)
2. Life-threatening unstable vital signs
3. Unconscious diabetic with BGL<60 & unresponsive to IM Glucagon

4 Contraindications for IO infusion

1. Fractures in the target extremity at insertion site

2. Excessive soft tissue at the insertion site

3. Previous orthopedic procedures within the past 6 weeks on extremity selected for IO insertion

4. Skin infection / other infection at the IO insertion site

Lidocaine administration rate for conscious patients

Administer slowly at 50 mg/min.

SO-P-40 Pediatric Cardiac Arrest
Dosage and max dosage of Lidocaine IV/IO, how many times can you repeat?

1 mg/Kg, maximum dose of 100 mg, one time only (no repeat)

PR-115 IO Pain - Lidocaine
Dosage and max dosage for IO pain control in adults

20 mg of 2% lidocaine, may repeat 20mg ONCE for a total of 40 mg. Administer slowly (over 1 minute)

PR-115 IO Pain - Lidocaine
What is the age that separate Adults from Peds, and what are their dosages?

Adult/Adolescent (≥15 Y.O.): 20mg 2% Lidocaine May repeat 20mg ONCE (total 40mg) for pain control

Child (≤14 Y.O): 2% Lidocaine 0.5mg/Kg IO (Max & Total Dose 20mg – DO NOT REPEAT)

3 Cardiac effects of Lidocaine

Depresses automaticity & excitability
Decreases ventricular irritability

3 Anesthetic effects (at a lower dose than cardiac) of Lidocaine

1. Binds to sodium channels

2. Prevents sodium ion from passing through voltage gated channels

3. Terminates pain signals before they can be formed and transmitted to the central nervous system

Effect of Lidocaine on conduction velocity at high doses

Slows conduction velocity.

Effect of Lidocaine on conduction velocity at ordinary doses

Increases conduction velocity

3 Classifications of Ketamine

Anesthetic, Analgesic, CNS Depressant.

3 Effects of Ketamine (Low and Slow)

1. Profound anesthesia/analgesia without respiratory depression

2. Skeletal muscle relaxation

3. Blocks nerve transmission impulses associated with pain perception

4 Effects of Ketamine (High and Rapid)

1. Blocks sensory perception

2. Induces a distorted reality

3. Induces euphoria & dysphoria

4. Induces visual and auditory hallucinations.

Onset of Ketamine IV

30 seconds.

Onset of Ketamine IN

2 minutes

Peak Effect of Ketamine

5-15 minutes.

Duration of Ketamine Effects

15-30 minutes.

5 Dosage forms for Ketamine

50mg/1mL, 100mg/1mL, 20mg/2mL, 100mg/2mL Ampule & Vial
500mg/5mL, 500mg/10mLVial Only

Routes of Administration for Ketamine

IV, IM (intramuscular), IN (intranasal).

5 Side Effects of Ketamine

Tachycardia, tachypnea, arrhythmia, hypertension, nausea.

3 Precautions for Ketamine Administration

Use caution in hypotensive patients, chronic alcoholics, and acutely intoxicated patients.

Controlled Substance Status of Ketamine

Ketamine is classified as a controlled substance.

Pediatric dosage of Ketamine?

Not approved for pediatric administration.

Fentanyl Classification

Synthetic opiate analgesic

Onset of Fentanyl

Less than 1 minute.

Peak effect of Fentanyl

3-5 minutes.

Duration of Fentanyl

30-60 minutes.

Routes of Administration for Fentanyl

IM, IV, IN, IO.

2 Dosage Forms of Fentanyl?

100mcg/2mL Carpuject

100mcg/2mL Vial

SO-C-15 Chest Pain of Suspected Cardiac Origin
What specific requirement of the protocol must be met to administer Fentanyl?

If pain is unrelieved after 3 doses of NTG / unable to give NTG

SO-C-15 Chest Pain of Suspected Cardiac Origin
Fentanyl Routes, Dosage for Chest Pain? How many times can you repeat?

50mcg IV
May repeat ONCE after approx. 3 mins for continued pain (hold if BP ≤ 90)

SO-M-05 Non-Traumatic Abdominal or Flank Pain
Fentanyl Routes & Dosage for Severe Pain? How many times can you repeat?

50 mcg IV/IM or 100 mcg IN
May repeat once in 3 minutes to control pain.

SO-E-030 Snake Envenomation
Fentanyl Routes & Dosage for Severe Pain? How many times can you repeat?

For pain management (BHC REQUIRED)
50mcg IV / IM or 100mcg IN
May repeat ONCE in 3 mins to control pain

SO-E-05 Burns - Electrical/Chemical/Thermal
Fentanyl Routes & Dosage for Severe Pain? How many times can you repeat?

For pain, w/ SBP>90:
50mcg IV / IM or 100mcg IN
May repeat ONCE in 3 mins to control pain

SO-T-05 General Injury and Trauma
Fentanyl Routes & Dosage for Severe Pain? How many times can you repeat?

For pain, w/ SBP>90:
50mcg IV / IM or 100mcg IN
May repeat ONCE in 3 mins to control pain

SO-T-015 Amputation Injuries
Fentanyl Routes & Dosage for Severe Pain? How many times can you repeat?

As needed for severe pain, w/ SBP>90:
50mcg IV / IM or 100mcg IN
May repeat ONCE in 3 mins to control pain