1. MEDICATION ADMINISTRATION

2. 6 Rights of Drug Administration
Right Patient
Right Drug
Right Dose
Right Time
Right Route
Right Documentation

3. GENERAL RULES Documentation should include: Drug name Route
Location (where IM, SQ, IV, IO)
Time
Authority (protocol, Medical Direction)
Patient response

4. Drug Calculations Metric Conversions
•Kg, g, mg, mcg •Lbs. to Kg •L to mL
(Keep in mind cc and mL are the same)

5. K H D B D C M * * M
Kg, g, mg, mcg
•To convert if going from large value to smaller value, move the decimal point 3 places to the right for each conversion.
•If going from smaller value to larger value, move the decimal point 3 places to the left for each conversion.
3.0 Kg = 3→0→0→0. g = 3000 g
3.0 Kg = 3→0→0→0→0→0→0. = 3,000,000 mg 3.0 Kg = 3→0→0→0→0→0→0→0→0→0. =3,000,000,000 mcg

6. Same Rule for L to mL K H D B D C M * * M
1 L = 1→0→0→0. = 1,000 mL
•500 mL = 5←0←0. = .5 L

7. Conversion to mg K H D B D C M * * M
•300 mcg= . 3 mg
•6 Kg= 6,000,000 mg
•450 g = 450,000 mg•
.42 Kg= 420,000 mg
•14 g= 14,000 mg
•1,000 mcg= 1 mg

8. Drug Calculations Need to know: Desired dose Volume on hand
grams, milligrams
Also known as weight of the drug
Volume on hand
milliliters
Concentration on hand
Weight to volume
Example: 1 mg/ml

9. General Rules
Less than 1 milliliter or milligram should be written with a zero prior to the decimal point
Example: 0.4 mg, 0.5 ml
Concentration is always listed with weight/volume
Example: 25 grams /50 ml

10. Concentration
•The concentration is found by dividing the weight by the volume. (Ex: 50 mg/2 mL)
•The answer will result in the concentration/mL of medication
•25 mg/mL

11. GENERAL RULES
Always verify medication allergies prior to giving medication

12. Subcutaneous Injections (SubQ)

13. Sites for subcutaneous injection.

14. A subcutaneous injection is a shot given into the fat layer between the skin and muscle. Subcutaneous injections are used to give small amounts medicine

15. How to give a subcutaneous injection: Wipe the area with an alcohol wipe where you plan to give the injection. Hold the syringe with your writing hand. Place the syringe between your thumb and first finger. With your other hand, grasp the skin.

16. Needle placement for subcutaneous injection.

17. A needle that is ½ inch to 5/8 of an inch long with a gauge of 25 to 30 is usually sufficient to administer the medication
Subcutaneous injection require a smaller, shorter needle

18. Intramuscular Injections (IM)

19. Sites for Intramuscular Injection.

20. Epinephrine in Anaphylaxis and Severe Asthma: IM (preferred method) Epi dosage- 0.3mg-0.5mg Adult Dose Repeating every minutes X’s 3- if the patient is not improving Contact Med Control for additional dosages Peds 0.01mg/kg IM-Repeat X’3 if patient is not improving Max dose in children 0.3mg

21. Why You Ask?
Anaphylaxis is a form of distributive shock…
Distributive shock results from excessive vasodilation and the impaired distribution of blood flow.
When Epi is administered SubQ… The vasoconstriction properties take control, limiting blood flow to the area and therefore absorption into systemic circulation.
When administered IM, on the other hand, The vasodilation properties predominate in skeletal muscle, allowing for rapid absorption.
This is because the injection into the muscle tissue results in smoother and more reliable drug absorption, with higher peak therapeutic levels of the drug achieved sooner than with subcutaneous injection

22. How To Give An Intramuscular Injection: (Thigh): Look at the thigh and divide it into 3 equal parts. The middle third is where the injection will go. The thigh is a good place to give an injection because it is easy to see. It is also a good spot for children younger than 3 years old.

23. Deltoid Muscle (Upper arm muscle): You will give the injection in the center of an upside down triangle. Feel for the bone that goes across the top of the upper arm. The bottom of it will form the base of the triangle. The point of the triangle is directly below the middle of the base at about the level of the armpit. The correct area to give an injection is in the center of the triangle, 1 to 2 inches below the bone that goes across the top of the upper arm. This site should not be used if the person is very thin or the muscle is very small.

24. Intramuscular Injections: Go into the muscle below the subcutaneous layer, so the needle must be thicker and longer to ensure that the medicine is being injected into the proper tissue. Twenty (20) or 22 G needles that are an inch or an inch and a half long are usually appropriate for this type of injection. A person who is thin, with very little fatty tissue can use the inch long needle; a heavier person may need to use the inch and a half long needle.

25. Select the site: It should be free of scars or bumps
Select the site: It should be free of scars or bumps. Clean the site with an alcohol pad. Spread the skin with your fingers and inject the needle straight down in a dart-like motion all the way. Pull back on the plunger a little. If you see blood enter the syringe, pull the needle out a little and inject the medication. If you do not see blood, simply inject.

26. Needle placement for intramuscular injection.

27. Seizures: Midazolam (Versed) 1mg-5mg IM (Peds 0
Seizures: Midazolam (Versed) 1mg-5mg IM (Peds 0.1mg/kg) Repeat X’s 1 Max Dose 10mg (Note: IN is the preferred Method) Pain Management: Fentanyl 50mcg-200mcg Slow Push-May Repeat every 10 minutes 25mcg-100mcg as needed max dose 200mcg (reassess patient’s pain after each injection, recheck blood pressure. Withhold if SBP < 90mmHg Hypoglycemia: Glucagon 1mg IM Unconscious with blood suger <60

28. Intranasal Administration

29. Intranasal Medication Administration: Basic Concepts
This delivery route has several advantages:
Its easy and convenient
Almost everyone has a nose
The nose is a very easy access point for medication delivery (even easier than the arm, especially in winter)
No special training is required to deliver the medication
No shots are needed
It is painless
It eliminates any risk of a needle stick to you, the medical provider

30. IN Medications
Naloxone (we won’t talk about this one) Midazolam (Versed)-Seizures 1mg-5mg Repeat X’s 1 Max dose 10mg >50kg:10mg IN <50kg:0.2 mg/kg IN
Intranasal administration is as effective as IV therapy, more effective than rectal administration, faster onset than either. Found to be very effective in controlling prolonged seizes in children. Fentanyl: Pain Control 50mcg-200mcg Slow Push-May Repeat every 10 minutes 25mcg-100mcg as needed max dose 200mcg (reassess patient’s pain after each administration, recheck blood pressure. Withhold if SBP < 90mmHg

31. Sublingual Administration

32. Sublingual Medication Administration
Nitroglycerin in the Treatment of Angina and CHF
Angina occurs when the heart muscle is not getting enough blood. Nitro works by relaxing and widening blood vessels so blood can flow more easily to the heart.
Dosage: 0.4mg SBP >100mmHg
Direct the spray between the underside of the tongue and the floor of the oral cavity.
SIDE EFFECTS: Headaches, dizziness, lightheadedness, nausea, flushing, and burning/tingling under the tongue may occur
NO NTG IF THE PATIENT HAS USED VIAGRA OR LEVITRA IN LAST 24 HOURS, OR CIALIS IN LAST 48 HOURS
Repeat dosage every 5 minutes until pain relieved provided SBP >100mmHg. Reassess, Reassess, Reassess (you can always give a bolus)

33. Pulmonary Drug Administration Medications THAT are administered into the pulmonary system via inhalation
Albuterol -2.5ml in 3ml Repeat X’s 2
Atrovent 0.02% in 2.5ml
Do Not repeat Atrovent alone or in combination
without Med Control

34. Oral Drug Administration
Any medication taken by mouth and swallowed into the GI tract.
Be sure the patient has an adequate level of consciousness to prevent aspiration.
Baby Aspirin: 324mg
Oral Glucose: 25G (one tube)
Activated Charcoal: 50G-Adult 1/G children <110 LBS
(conscious with intact gag reflex. Do not give if the ingestion involves caustics, hydrocarbons or heavy metals)

35. Intrarectal-ALOC Patient
The human rectum represents a body cavity in which drugs can be easily introduced and retained and from which absorption is well possible. The mechanism of drug absorption from the rectum is probably no different to that in the upper part of the gastrointestinal tract
Consider rectal administration of oral glucose if unable to establish an IV (before placing an IO in a known diabetic)

36. Peripheral Venous Access.

37. Venous Medications:

38. Adenosine (6mg/2mL)
Slows conduction time through the AV node. This results in an interruption in the AV nodal reentry pathways. It can restore NSR in patients with PSVT and Tachycardia with unknown etiology to determine underlying dysrhythmia .
Contraindicated in patients with 2nd or 3rd degree AV block or sick sinus rhythm.
It has a short half-life (< than 10 seconds) if administration is not rapid followed by a fluid push it may no effect simply because it’s been metabolized.

39. Initial dose-6mg rapid IV push followed by 20ml saline flush
Initial dose-6mg rapid IV push followed by 20ml saline flush. (ONLY if rhythm is regular and monomorphic- the shape of each beat looks the same)
2nd dose-after 1-2 minutes if necessary 12mg rapid IV push followed by 20ml saline flush.
(ONLY if rhythm is regular and monomorphic- the shape of each beat looks the same)
(Peds 0.2 mg/kg max dose 12mg)

40. Side effects and special notes:
At the time of conversion may patients will have flushing, dyspnea, chest pain or apprehension. These symptoms are transient but can be frightening. The cardiac rhythm can undergo various dsyrhythmias prior to converting. A brief period of asystole, bradycardia or transient ectopy is common.

41. Amiodarone (150mg/3mL)
It is an antiarrhythmic agent used for various types of cardiac dysrhythmias, both ventricular and atrial that are otherwise difficult to treat.
It is useful both in supraventricular arrhythmias and ventricular arrhythmias.
Consult Med Control if the patient is hemodynamically stable but demonstrating mild to moderate signs or symptoms related to the tachycardia prior to administration.

42. Adult Cardiac Arrest:
300 mg IO/IV bolus; may repeat 150 mg IO/IV once in 3-5 minutes
Peds-5mg/kg every 3-5 minutes up to two times

43. Atropine
The main action of the vagus nerve of the parasympathetic system on the heart is to decrease heart rate.
Atropine blocks this action and, therefore, may speed up the heart rate.

44. Dosing
In the hemodynamatically or clinically unstable bradycardia patient:
0.5 to 1 mg IV push, may repeat every 3 to 5 minutes up to a maximum dose of 3 mg.

45. Dextrose D50
Glucose is the bodies basic fuel, it produces most of the bodies quick energy.
Indication for use-Hypoglcemia
Adult dose-50ml ampule 50% dextrose

46. Epinephrine 1:10,000 In the Cardiac Arrest Patient (Asystole/PEA)
1 mg (10 cc of 1:10,000) every 3-5 minutes (no max dose) or
40 Units Vasopressin

47. Fentanyl
Fentanyl is a fast-acting narcotic analgesic and sedative used for pain control.
Fentanyl has several potential advantages for out-of-hospital analgesia, including rapid onset, short duration

48. Dosing
Adults: 50 – 200 mcg slow IV/IO push or IM or IN. May repeat 25 – 100 mcg every 10 minutes as needed to a max. of 200 mcg.
Peds (over age 2): 1 – 2 mcg/kg slow IV/IO push or IM or IN. May repeat x1 after 10 minutes.
Reassess patient’s pain after each injection
Recheck blood pressure before each additional dose; withhold Fentanyl if SBP < 90 mmHg

49. Furosemide (Lasix)
Used to treat excessive fluid accumulation and swelling (edema) of the body caused by heart failure
Furosemide mg IV In CHF

50. Intraosseous
EZ IO device. WITH Different sized needles bariatric needle (yellow) Standard adult needle (blue) pediatric needle (red).
Any medication that can be introduced via IV can be introduced via IO.