1. Epinephrine Administration by the EMT Pilot Project for the Administration of Epinephrine by Washington EMTs Tamara Coulter BS, FF/PM Captain/MSO Steven Engle North Kitsap Fire & Rescue Joseph Schweiger FF/PM Central Kitsap Fire & Rescue Bledsoe Chapter 7 Essential of Paramedic 2006

2. Topics Aseptic Technique Aseptic Technique Medication Administration Routes Medication Administration Routes Medication Package Medication Package Anatomy and Physiology Related to Medication Administration Anatomy and Physiology Related to Medication Administration

3. Six Rights of Drug Administration Right person Right person Right drug Right drug Right dose Right dose Right time Right time Right route Right route Right documentation Right documentation

4. Needle Handling Precautions Minimize the tasks performed in a moving ambulance. Minimize the tasks performed in a moving ambulance. Immediately dispose of used sharps in a sharps container. Immediately dispose of used sharps in a sharps container. Recap needles only as a last resort. Recap needles only as a last resort.

5. Medication Administration and Documentation Record all information concerning the patient and medication including: Record all information concerning the patient and medication including: Indication for drug administration Indication for drug administration Dosage and route delivered Dosage and route delivered Patient response to the medication Patient response to the medication Both positive and negative Both positive and negative

6. Kinds of Parenteral Drug Containers Glass ampules Glass ampules Single and multidose vials Single and multidose vials Nonconstituted syringes Nonconstituted syringes Prefilled syringes Prefilled syringes Intravenous medication fluids Intravenous medication fluids

7. Ampules Vials Ampules and Vials

8. Information on Drug Labels Name of medication Name of medication Expiration date Expiration date Total dose and concentration Total dose and concentration

9. Obtaining Medication from a Glass Ampoule

10. Hold the ampule upright and tap its top to dislodge any trapped solution.

11. Place gauze around the thin neck…

12. …and snap it off with your thumb.

13. Draw up the medication.

14. Obtaining Medication from a Vial

15. Confirm the vial label.

16. Prepare the syringe and hypodermic needle.

17. Cleanse the vial’s rubber top.

18. Insert the hypodermic needle into the rubber top and inject the air from the syringe into the vial.

19. Withdraw the appropriate volume of medication.

20. Intramuscular Injection Sites Deltoid Deltoid Dorsal gluteal Dorsal gluteal Vastus lateralis Vastus lateralis Rectus femoris Rectus femoris

21. Intramuscular Injection 90º

22. Intramuscular Injection Sites

23. Check the medication. © Scott Metcalfe

24. Adult Dosing Regimen for Epinephrine Administration Adults - 0.3mg of 1:1,000 via Intramuscular injection Adults - 0.3mg of 1:1,000 via Intramuscular injection Using a 1cc syringe, insert the needle into the vial or ampule, draw the plunger back on the syringe until you reach 0.3cc mark on the syringe. Using a 1cc syringe, insert the needle into the vial or ampule, draw the plunger back on the syringe until you reach 0.3cc mark on the syringe.

25. Pediatric Dosing Regimen for Epinephrine Administration Pediatrics - 0.01mg/kg of 1:1,000 via Intramuscular injection Pediatrics - 0.01mg/kg of 1:1,000 via Intramuscular injection Using a 1cc syringe, insert the needle into the vial or ampule, draw the plunger back on the syringe until you reach the correct dosage for the weight of the patient. Using a 1cc syringe, insert the needle into the vial or ampule, draw the plunger back on the syringe until you reach the correct dosage for the weight of the patient. Weight 4 KG6 KG8 KG10 KG12 KG15 KG19 KG24 KG30 KG Epinephrine.04 mg.06 mg.08 mg.1 mg.12 mg.15 mg.19 mg.24 mg.3 mg

26. Draw up the medication. © Scott Metcalfe

27. Prepare the site. © Scott Metcalfe

28. Insert the needle at a 90-degree angle. © Scott Metcalfe

29. Remove the needle and cover the puncture site. © Scott Metcalfe

30. Summary Aseptic Technique Aseptic Technique Medication Administration Routes Medication Administration Routes Medication Package Medication Package Anatomy and Physiology related to Medication Administration Anatomy and Physiology related to Medication Administration