Transcript November 2009 Medication Administration

Medication Administration
November 2009 CE
Advocate Condell Medical Center
Objectives prepared by: Mike Higgins, FF/PM
Grayslake Fire Department
Power point prepared by Sharon Hopkins, RN, BSN, EMT-P
Objectives
Upon successful completion of this module, the
EMS provider will be able to:





1. Identify the six rights of drug administration
correctly
2. Identify medical control’s role in drug
administration
3. Identify knowledge of proper use of standard
precautions
4. Identify knowledge of proper disposal of
contaminated equipment
5. Identify the importance of maintaining a
sterile and clean environment
Objectives





6. Accurately calculate the drug dosage for a pt
with weight stated in pounds, converting weight
to kilograms
7. Identify the various routes used to administer
medication
8. Identify the proper technique for drawing up
meds from an ampule
9. Identify the proper technique for drawing up
meds from a vial
10. Identify the proper administration of a
medication from a prefilled syringe
Objectives





11. Identify the proper administration of sublingual medications
12. Verbalize the proper administration of rectal
medications
13. Identify the proper administration of IV
piggy-back medications
14. Identify the proper administration of in-line
nebulizer medications
15. Identify the proper administration of
endotracheal medications
Objectives





16. Identify proper documentation of medication
administration
17. Demonstrate the proper administration of
subcutaneous medications
18. Demonstrate the proper administration of
intramuscular medications
19. Demonstrate proper administration of
intravenous medications / IO meds
20. Demonstrate the insertion of the EZ-IO
correctly
6 Right of Medication
Administration

The RIGHT patient



In the field this is the patient lying in front of
you
When doing clinical in the hospital, it is
extremely important to check wrist bands for
identifying the right patient
The RIGHT drug

Check all medications 3 times prior to
administration

Did you grab the correct medication?
6 Rights

The RIGHT dose



Most field medications can be easily
calculated in your head
Double check if you are ever unsure of the
dose
The RIGHT time

In the field the time is now
6 Rights

The RIGHT route


IV/IO
Injected
IM
 SQ



Inhaled
IVPB
6 Rights

The RIGHT documentation






Drug name
Dose – verify order in mg
 Dose often stated in ‘amps”, “tab”
Route of delivery
Time administered
Person administering the medication
 Use skill check box
Patient response to the medication
Allergies


Important to screen all patients for their
allergy status prior to medication
administration
If you are in doubt regarding an allergic
reaction versus side effect (ie: abdominal
distress), contact medical control for
clarification
Facts and Allergies

Lidocaine and Novocain


Morphine sulfate


These are different “caine” families so allergy
to one does not cross over to the other
This is NOT a sulfa drug
Lasix – furosemide


There is a low risk of patients allergic to sulfa
drugs having a reaction to Lasix
Monitor the patient receiving Lasix if they
have a sulfa allergy
Medical Control



You operate under the license of the
Medical Director
You are still individually responsible for
having knowledge of the medications you
are delivering
Inappropriate delivery of medications,
even when the patient does not suffer
harm, may result in legal ramifications
Medical Control

Medical control is available as an on-line
resource



Clarification regarding indications
Clarification regarding dosage
Clarification regarding orders received from a
physician on the scene
 In an acute care center, clinic, doctor’s
office, you cannot accept orders unless that
physician is willing to go with to the hospital
Standard Precautions



Establishing routes for drug administration
creates the potential exposure to blood and
body fluids
Decrease risk of exposure by following standard
precautions
 Gloves
 Goggles
 Mask
The best standard precaution often forgotten:
 HANDWASHING
Sterile vs Clean Environment

Sterile – free from all forms of life




Generally uses extensive heat or chemicals
Difficult in the field to maintain sterile
environments
Most packages are sterile until opened
Clean environment


Minimize risk of infection
Careful handling of equipment to prevent
contamination
Disposal of Equipment

Minimize tasks done in a
moving ambulance


Immediately dispose of sharps in a sharps
container


Need to decrease risk of EMS exposure
Rigid, puncture-resistant container
Recap needles only as a last resort

Use one handed technique
Metric System




Pharmacology’s principle system of
measurement
Widely used in science and medicine
3 fundamental units
 Grams – weight or mass
 Liters – volume
 Meters – distance
To avoid use of multiple zero’s , usually change
the prefixes (ie: kilo, centi, milli, micro)
Drug Administration and
Mathematical Skills

To properly prepare and administer
medications, need understanding of:






Multiplication
Division
Fractions
Decimal fractions
Proportions
Percentages
Converting Pounds to Kilograms

Many medications are dosed based on
patient weight
 Adults – acceptable to be “close
enough”
 Can round off the adult weight
 Pediatrics – must practice a more
precise formula
 Less room for error in calculation
Pounds to Kilograms



1 kilogram = 2.2 pounds
In the field, usually acceptable to take the
adult patient’s weight in pounds and
divide in half to be close enough to the
kilograms
In peds, need to take the weight in
pounds and divide by 2.2
Exercise

Convert 150 pounds to kilograms
 150/2.2 can be written as 150  2.2




As a fraction, top number (numerator) is
divided by the bottom number (denominator)
150 = dividend
2.2 = divisor
 The divisor must always be a whole
number
Answer = quotient
Exercise




2.2 150
Need to make 2.2 a whole number
In the metric system, you are multiplying by
“10”
When multiplying with any derivative of 10,
count the zeros and move the decimal that
many numbers to the right
What you do with the divisor, you must do with
the dividend (actions inside and outside the box
must match)
Example – 150# = ? kilograms
2.2 150
= 22 1500
68.1
22 1500.0
132
180
176
40
22
18
Medication By Patient Weight


Most typical order is Lidocaine (mg/kg)
and pediatric drugs (mg/kg)
 Calculate the patient’s kilogram
 Divide pounds by 2.2
 Acceptable to divide the adult weight
by 2
 Multiply the kilogram by the number of
mg per kilogram
Then you need to calculate the volume
(ml) to draw up in the syringe
Example



Give your 132 pound patient 1.5mg/kg Lidocaine
Lidocaine is packaged as 100 mg/5ml
Steps to calculate
 Convert pounds to kilograms
 Based on the kilograms, calculate the number
of mg required
 Multiply kilograms by mg/kg required
 Calculate the ml volume to draw up
Answer




132  2.2 = 1320  22 = 60 kg
1.5 mg/kg = 1.5 mg x 60 kg = 90mg
Now, draw up 90 mg (Lidocaine comes 100
mg/5ml)
Formula #1: x ml = desired dose x vol on hand
dose on hand

Formula #2: mg in bottle = mg ordered
ml in bottle
x ml
Formula #1

Formula #1: x ml = desired dose x vol on hand
dose on hand
x ml = 90 mg x 5 ml
100 mg
x ml = 450
(this fraction means 450  100)
100
(top number divided by bottom number)
x ml = 4.5 ml
Formula #2

Formula #2: mg in bottle = mg ordered
ml in bottle
x ml
100 mg = 90 mg
5 ml
x ml
(cross multiply)
100 x = 450
(divide by 100 to get
100 x = 450
x by itself)
100
100
(divide top by bottom #) 450 / 100 = 450100
4.5 ml is answer
Do Brain Check




Give 90 mg Lidocaine
Lidocaine packaged 100 mg / 5 ml
Your answer was to give 4.5 ml
Brain check



90 mg is slightly smaller than the total
amount of 100 mg
4.5 ml is slightly smaller than 5 ml
So our math must be correct
Routes of Medication
Administration

4 basic categories

Percutaneous


Pulmonary


Absorbed via inhalation or injection
Enteral


Applied or absorbed thru the skin
Absorbed thru the gastrointestinal (GI) tract
Parenteral
Administration outside the GI tract
 Generally includes the use of needles

Percutaneous Medication Routes

Meds absorbed through skin or mucous membranes
 Sublingual route
 Medication absorbed through the mucous
membrane under the tongue
 Sub = below; lingual = tongue
 Area extremely vascular
 Moderate to rapid rate of absorption
 Avoids the digestive tract
Mucous Membranes cont’d

Nasal route





Uses a medication atomization device (MAD)
Coming soon to Region X
Relatively rapid absorption rate in the absence of
IV access
MAD provides a fine mist that allows
even and widespread distribution of
medication across the nasal mucosa
The Region is preparing to
incorporate use of the MAD device in
the near future
Pulmonary Medication Route




To administer medications into the
pulmonary system via inhalation or
injection
Generally include gases, fine mists, or
liquids
Most medications used for bronchodilation
for respiratory emergencies
Inhalation also used for humidification
Nebulizer


Uses pressurized oxygen to disperse a
liquid into a fine aerosol spray or mist
Inhalation carries the aerosol to the lungs
Enteral Route - Rectally



Medication absorbed through the GI tract
Extreme vascularity promotes rapid drug
absorption
Absorption more predictable


Medications administered rectally do not pass
through the liver so are not subject to
alteration in the liver
Advantageous for the unconscious patient
Parenteral Route


Any drug administration outside of the GI
tract
Typically, this route involves the use of
needles


Medication is injected into the circulation or
into tissues
Some parenteral forms (ie: IVP) are the
most rapid for drug delivery
Syringes





Plastic or glass tube for drawing up
medications
Range of sizes
Medications are given in dosages by
weight (ie: mg)
Syringes represent volume (ie: ml)
Weights (ie: mg) must be mathematically
converted to volume (ie: ml)
Syringe Markings




Plunger
Barrel
Hash marks
Use most
appropriate
sized syringe for
higher accuracy
TB Syringe
Medications in Ampules




Breakable vessel with liquid medication
Cone-shaped top with thin neck
Thin neck is the vulnerable
point for intentionally breaking
open the ampule
Contains a single dose of med
Withdrawing From an Ampule







Confirm the medication and dosage
Hold the ampule upright
Tap the top to dislodge trapped liquid
Place gauze (or alcohol wipe package) around
thin nick
Snap top off away from you
Place tip of needle into ampule and withdraw
liquid
Dispose of ampule into sharps container
Medications in Vials

Plastic or glass containers with self-sealing
rubber top



Rubber top prevents leakage from punctures
May contain single or multiple doses
Liquid is vacuum packaged
Withdrawing From a Vial


Confirm the medication and dosage
Prepare the syringe and needle based on
volume of liquid to draw up




Use 1 ml TB syringe for any dose < 1 ml
Because of the vacuum, draw up the same
amount of air as volume to be removed
Cleanse rubber top with an alcohol wipe
Insert needle straight into rubber top
Vial cont’d


Inject the air from the syringe into the vial
Withdraw the desired volume of liquid





Watch to keep tip of needle in liquid
Helpful to draw a small amount of extra fluid to
accommodate removing air bubbles
Hold syringe with needle pointing upward
Tap side of syringe with finger to
displace bubbles to distal end of
syringe
Expel air bubbles and confirm exact
volume required in syringe
Medications in Prefilled Syringes



Tamperproof containers packaged with
medication already in the syringe
Generally contain
standard dosages
May require assembly
Prefilled Syringe


Confirm the medication and dosage
Assemble syringe






Pop off protective caps
Twist glass tube containing
into syringe
Glass tube becomes the plunger
Expel excess air
Confirm dosage volume required
Lidocaine cap is twisted to unlock and then
remove the cap
liquid
Nonconstituted Medications


Extends viability and storage of time for
drugs with short shelf life or instability in
liquid form
Consists of 2 vials


Powdered medication
Liquid mixing
solution
Reconstituting Medications






Confirm medication and dosage
Prepare syringe with liquid
Cleanse off top of powder vial
Inject liquid into powder vial
Gently roll vial between palms to dilute powder
 Check that ALL particles have dissolved
Redraw up liquid into syringe, expel excess air
Medication
Administration
Medication Administration


Just because you administer medications
now, does not mean your technique is
accurate
The first rule in medicine:
Primum non Nocere
Hippocrates
First, do no harm!
Sublingual Medication Route





Use Standard Precautions
Confirm medication and
dosage 3 times
Have patient lift their tongue
Place the tablet between the tongue and
the floor of the oral cavity
Instruct the patient to allow the pill to
dissolve
In-line Nebulizer Administration
Route


For administration of Albuterol
when the patient is no longer
able to ventilate effectively to
inhale the medication into their lungs
Can begin to bag the patient and force the
medication into the lungs even prior to
intubation

Set the equipment up and ventilate via a
mask while waiting for intubation
Endotracheal
Administration
Route
Discouraged route but not
forbidden
Studies have failed to demonstrate adequate
absorption of medication via this route
If used, double the calculated IVP dosage
Hyperventilate to distribute the medication
Acceptable for: Lidocaine, Epinephrine,
Atropine, and Narcan (ie: LEAN)
Rectal Medication


Confirm medication and dosage 3 times
Via syringe






Use a small diameter syringe based on size of
patient
Lubricate tip of syringe
Turn the patient onto their side
Insert tip of syringe into rectum
Inject medication
Remove syringe and hold cheeks together
 Permits retention and absorption
Rectal
Administration

Via IV catheter
 In place of a syringe tip being placed into the
rectum, can place an IV catheter on the
needleless syringe and then inject the
medication
 Reduces the diameter of the equipment used
 Helpful alternative especially in the
pediatric population
Parenteral Medication Routes





Intradermal injection
Subcutaneous injection
Intramuscular injection
Intravenous injection
Intraosseous injection
Preparing The Syringe





Pull medication into the syringe
Tap the side of the barrel to displace
air
bubbles to the distal tip
Express out the excess air bubbles
Confirm accuracy of medication dosage
 Rubber edge of the plunger lines up with the
dosage marking on the barrel
Then draw up an additional 0.1 ml of air for SQ
or IM injections
 The air plug pushes the med farther into the
site preventing leakage of med
Preparing the Site



Wipe the intended site with alcohol
Start wiping from the center moving
outward
Let the site air dry


Introducing alcohol into the site causes
irritation
Do not blow on the site to hasten drying –
causes contamination
SQ Route






Layer of connective tissue between skin and
muscle
Less blood supply than IM so slower absorption
rate
Slow onset of action but long duration of drug
action due to less blood supply
Maximum volume of medication is 1 ml
Preferred needle size is 25 – 27 G; 3/8 - 5/8 inch
Preferred is 450 angle (900 angle acceptable if
using ½ inch needle)
Subcutaneous Medication
Routes

Sites

Deltoid

Abdominal

Thighs

Buttocks
SQ Technique





Prepare the syringe and needle
Identify the site
Cleanse the site
Pinch a fold of skin up
Quickly dart the needle into the fold at a 450 angle






900 angle is an alternative especially with ½” needle
Release the fold
Aspirate checking for blood return
Inject steadily
Quickly withdraw the needle and discard
Massage the site to enhance absorption
Aspiration Before Injection

Purpose




To check for inadvertent entry into a vessel
If you did not check you could be giving an IVP
drug instead of a SQ or IM
More common for vessel entry during an
IM
If blood is returned, remove needle and
prepare a new syringe and needle
Pediatric SQ Injections





Most common site is posterior upper arm
Next site used is the anterior aspect of the
thigh
Limited volume up to 1 ml of volume SQ
Use 450 angle injected into pinched skin
Site has limited use in poor perfusion state
IM Route






Muscle is extremely vascular and allows for
systemic delivery throughout the whole body
and a moderate absorption rate
Absorption is relatively predictable
When using the buttock, important to avoid the
sciatic nerve
 If you strike the sciatic nerve, the patient
could develop chronic pain
Typical needle size is 21 – 23 G; 1 – 11/2”
Use 900 angle
Volume limitation dependent on the site used
Intramuscular Medication Route

Sites
 Deltoid


Buttock
 Dorsal gluteal
 Ventrogluteal
Thigh
 Vastus lateralis
 Rectus femoris
IM Sites

Deltoid




Easily reached
Smaller sized muscle limits volume used
 2 ml maximum
Site is 2 - 3 finger breadths below the acromial
process (AC) and above the armpit crease
Area often identified as a triangle
IM routes cont’d


Buttocks – dorsal gluteal
 Can inject up to 5 ml
 Minimal discomfort felt
 Must stay away from the
sciatic nerve
 Avoid this site in kids < 2 and in
emaciated patients
Find the site in the upper,
outer quadrant of the buttock

Must avoid the sciatic nerve





IM site cont’d - Ventrogluteal
Volume 1 – 3 ml
Good site for children <7months
Place the palm over the
trochanter of the femur
Make a V with the 2nd and 3rd
fingers
 The 3rd finger runs straight up
to the iliac crest
 The 2nd finger angles forward
to the anterior superior iliac crest
The injection is made inside the V formed between
the 2nd and 3rd fingers
IM routes cont’d

Thigh
 Vastus lateralis – side of
the thigh
 Rectus femoris – muscle
over the front of the thigh
 Can inject up to 5 ml
volume
 Practice
often is to divide
larger volumes into 2
injections of smaller
volume
Thigh Injection Site

To find the site





Place one hand at the top of the thigh at the
groin
Place one hand on the distal (lower) thigh
above the knee
The area between the 2 hands can be used
Anterior surface of the thigh at the midline is
the rectus femoris
Lateral to the midline is the vastus lateralis
Pediatric IM Injection

Thigh is preferred site in peds
 Especially used in infants and young
toddlers
 Large muscle mass
 No proximal nerves or blood
vessels
 Limited subcutaneous fat layer
 More developed muscle than other
sites
 Can accommodate larger volumes than other
pediatric injection sites
IM Technique








Prepare syringe and needle
Identify site
Prepare site – let alcohol air dry
Pull the skin taut
Dart the needle in at 900
 The quicker the dart like insertion, the less
painful
Slowly and steadily inject the medication
Quickly withdraw needle and properly discard
Massage site – enhances absorption
Intravenous Administration Route


Quickest route to deliver medication directly into
the bloodstream
Fastest absorption rate


Dependent on adequate perfusion
Many medications are in prefilled syringes






Pop off protective caps
Assemble syringe
Expel air
Confirm dosage
Administer medication
Watch for response
IVP Medication






Confirm medication 3
times for accuracy
Prepare syringe
Consider need for a flush
Secure medication syringe
into an IV port as close to
the IV site as possible
Pinch off the IV tubing
Inject the medication at the prescribed
speed for the medication
Needleless IV Tubing




Standard IV tubing to minimize the event
of needle stick
Port wiped with alcohol
Needle twisted onto port
Must pinch tubing above
injection site

Fluid will move in direction
of least resistance
IVPB Administration Route



To administer a medication over
a longer period of time
All IV bags hanging need to be
labeled
The bags can be hung at the
same height


The IV bags will both drip
independently of the other IV bag
Secure the IVPB into a port as
close to the IV site as possible
Disposal of Contaminated
Equipment



As soon as possible
dispose of equipment into
sharps container
After giving an injection,
snap the protective cover
over the needle
After starting the IV, the
needle should be covered
as it is retracted after the
injection
Side Effects and Complications


Remember for all injections
 Once delivered, cannot get the medication back
 Be very sure of 5 “rights’
Patient
Drug
Dose
Route
Time
Once administered, monitor for known side effects
and any other changes to the patient
Documentation of Medication
Administration





Time
Drug name
Drug dosage in mg
Route
Patient response
EZ-IO

Indications



Shock, arrest, impending arrest
Unconscious/unresponsive to verbal stimuli
2 unsuccessful IV attempts or 90 seconds
duration of a peripheral attempt
EZ IO

Contraindications



Fracture of the tibia or femur
Infection at insertion site
Previous orthopedic procedure
Knee replacement
 Previous IO within 48 hours


Pre-existing medical condition



Tumor near site, peripheral vascular disease
Inability to locate landmarks
Excessive tissue at insertion site
EZ IO Needles

Adult patients



88 pounds or over (40 kg)
15 G; 25 mm blue needle
Pediatric patients



7 - 88 pounds (3 kg – 39 kg)
15 G; 15 mm pink needle
Think “pink” for “peds”
EZ IO Equipment







10 ml syringe filled with 0.9 NS
 5 ml of NS in syringe for peds patient
EZ connect tubing
Material to cleanse site
EZ IO driver
EZ IO needle in it’s case
Primed IV tubing
 1000 ml bag for adults
 250 ml IV bag for geriatric and pediatric
patients
Pressure bag (B/P cuff is no pressure bag)
EZ IO drill
with storage
case
EZ IO Site


Most common site:
proximal tibia
Palpate the tibial tuberosity




Bump below the patella
Identify 2-3 finger widths below the patella
Move 1 finger width medially (toward the
big toe)
In smaller children often will not be able
to palpate the tibial tuberosity
EZ IO - Technique





Prime EZ connect tubing
 Takes 1 ml to prime tubing
 Leave syringe attached
Attach needle to driver
Insert needle at 900 angle into site
 Release trigger once decreased resistance is
felt
Remove driver from needle
Remove stylet by rotating counterclockwise
EZ IO Technique cont’d

Connect EZ primed tubing to needle



May notice backflow of bone marrow
Blood will NOT pump out of needle
Using syringe, aspirate then flush with
remaining NS to confirm placement



Needle stands up on own
Flushes easily
No infiltration felt
EZ IO Technique cont’d








Remove syringe
Attach primed IV tubing
Secure pressure bag to permit flow of fluid
Begin infusion
Secure tubing to leg
Apply wristband
Monitor site for infiltration
Can administer any IVP medication that
would normally be given IV push
EZ IO Documentation

Same information for starting an IV
 Time
 Solution
 Size IV bag
 Site
 Person actually performing the puncture
Case Study #1




Your patient weighs 150 pounds
They need to receive 1.5 mg / kg
Lidocaine
Lidocaine packaged as 100 mg/5 ml
How much Lidocaine needs to be drawn
up and given?
Case Study #1

Calculate pounds to kilograms


Calculate total mg of medication



150  2.2 = 68.1 rounded to 68 kg
To receive 1.5 mg per kg
Multiply 1.5 x 68 = 102mg
Calculate how much medication to deliver

Use formula of your choice
Case Study #1

Formula #1

X ml = desired dose x vol on hand
dose on hand
X ml = 102 mg x 5 ml
100mg
X ml = 510
100
X ml = 510  100
X ml = 5.1 ml (in the adult rounded to 5 ml)
Case Study #1

Formula #2

100 mg
5 ml
100 x
100x
100
x
X
= 102 mg
x ml
= 510
= 510
100
= 510  100
= 5.1 ml (rounded to 5 ml)
Case Study #2




Your 45 year-old patient is having an
allergic reaction with airway involvement
The vital signs are stable
What medications are indicated?
How do you administer each of the
medications?
Case Study #2

Epinephrine 1:1000 – 0.3 mg SQ





Bronchodilator, vasoconstrictor
Short needle (3/8 - 5/8”)
450 angle
Pinch up the skin
Benadryl 50 mg IVP slowly or IM




Antihistamine
Long needle (1” up to 1 1/2”)
900 angle
Pull the skin taut before injecting
Case Study #2

Always aspirate to check for inadvertent
entry into a vein


If blood is noted, withdraw needle
Prepare a new needle and syringe
 Injecting the blood can cause irritation
 With blood in the syringe, may not be able
to detect aspiration of new blood at new
site
Case Study #3




You are on the scene of a full arrest
You cannot find peripheral veins
What is you next alternative?
How do you confirm needle placement?
Case Study #3


EZ IO needle is indicated
Confirmation of needle placement




Needle stands up by itself
Able to flush the needle easily through the EZ
connect tubing
Fluid flows with a pressure bag attached
No infiltration is noted
EZ IO Needle

Needle always flushed via the EZ connect
tubing

NEVER flush the needle directly – too much
pressure
Case Study #4





You have an 8 month-old infant with a
blood sugar of 45
The patient responds weakly to verbal
stimuli
What medication is necessary?
How do you prepare the medication?
How do you administer the medication?
Case Study #4 - Hypoglycemia



Ages > 16 – Dextrose 50%
Ages 1 – 15 – Dextrose 25%
Age < 1 years-old - Dextrose 12.5%




Diluted strength due to vein irritation
Calculate the dosage
Draw up equal amounts normal saline and
D25% to make a 1:1 dilution
Administer slowly due to vein irritation
Case Study #4

Dextrose is given IVP






Wipe off the injection port with alcohol
Push on the needleless syringe and twist to
connect
Pinch off the tubing above the injection port
Slowly and steadily administer the medication
Evaluate the site for infiltration
Evaluate the patient’s response
Case Study #5





You are on the scene for a 5 year old having a
seizure
 Patient weighs 50 pounds
 History of seizure disorder
 Glucose level of 80
You are unable to establish a peripheral IV
What do you do for the airway?
What medication is indicated?
How do you administer the medication?
Case Study #5

Airway control – bag the patient


In active seizure, the respiratory status of the
patient is difficult to evaluate and assume the
patient is not ventilating well
Medication and route

Valium 0.5 mg/kg (max 10 mg) rectally
Case Study #5

Calculate dose








50 pounds  2.2 = 22.7 = 23 kg
Multiple 0.5 mg x 23 kg = 11.5 mg = 12 mg
Max dose is 10 mg
Valium comes 10 mg per 2 ml
Make sure syringe is needleless
Insert syringe into buttocks
Inject medication and remove syringe
Hold cheeks together
Pediatric Resources

What resources are available to calculate a
pediatric dosage?



Back of the SOP’s
Medical Control
Broselow tape
Valium listed as diazepam
 Narcan listed as Naloxone
 Normal saline listed as crystalloid

Bibliography








Bledsoe, B., Clayden, D., Papa, F. Prehospital
Emergency Pharmacology 5th Edition. Brady. 2001.
Bledsoe, B., Porter, R., Cherry, R., Paramedic Care:
Principles and Practices. Brady. 2009
Edmunds, M. Introduction to clinical Pharmacology.
Elsevier. 2006.
Marenson, D. Pediatric Prehospital Care. Brady. 2002.
Region X SOP’s March 2007, Amended January 1,
2008
Sanders, M. Paramedic Textbook. Rev 3rd edition.
Mosby. 2007
wps.prenhall.com
www.vidacare.com