1. Drug Administration Formula methods in drug dose calculation ( for paramedics )
Dr. Maha Khalid
Lecture 10

2. Learning objectives
Understand the 3 formula for drug doses calculation in the pre hospital sitting :
Calculate IV push medication.
calculating infusions/piggyback type drips .
IV fluid flow rates, (no medications involved) .

3. FINDING THE ORDERED DOSE
The ordered dose is the most simple dosage calculation for the prehospital care provider. In this type of problem, the paramedic is given an order to administer to a patient. There are five (5) components to locate in this type of problem:

4. the concentration of the drug
the desired dose
the concentration of the drug
volume on hand
a weight conversion needed,
unit to administer
SmartArt custom animation effects: vertical picture list
(Intermediate)
To reproduce the SmartArt effects on this slide, do the following:
On the Home tab, in the Slides group, click Layout, and then click Blank.
On the Insert tab, in the Illustrations group, click SmartArt. In the Choose a SmartArt Graphic dialog box, in the left pane, click List. In the List pane, double-click Vertical Picture List (fourth row, first option from the left) to insert the graphic into the slide.
To create a fourth shape in the graphic, select the third shape from the top, and then under SmartArt Tools, on the Design tab, in the Create Graphic group, click the arrow next to Add Shape, and then click Add Shape Before. Repeat this process to create a fifth shape.
Select the graphic. Under SmartArt Tools, on the Format tab, click Size, and then do the following:
In the Height box, enter 6.38”.
In the Width box, enter 7.91”.
Under SmartArt Tools, on the Format tab, click Arrange, click Align, and then do the following:
Click Align to Slide.
Click Align Middle.
Click Align Center.
Select the graphic, and then click one of the arrows on the left border. In the Type your text here dialog box, click each of the second-level bullets and then press DELETE until there are only three first-level bullets remaining (one for each shape). Enter text for each shape into the first-level bullets.
On the slide, select the graphic. On the Home tab, in the Font group, select 14 from the Font Size list.
Under SmartArt Tools, on the Design tab, in the SmartArt Styles group, click More, and then under Best Match for Document click Moderate Effect (fourth option from the left).
On the Design tab, in the Themes group, click Colors, and then click Civic. (Note: If this action is taken in a PowerPoint presentation containing more than one slide, the theme colors will be applied to all of the slides.)
Under SmartArt Tools, on the Design tab, in the SmartArt Styles group, click Change Colors, and then under Colorful click Colorful Range – Accent Colors 3 to 4 (third option from the left).
Click each of the five picture placeholders in the graphic, and then in the Insert Picture dialog box, select a picture and click Insert.
Press and hold CTRL, and then select all five of the pictures on the slide. Under SmartArt Tools, on the Format tab, in the Shapes group, click Change Shape, and then under Rectangles click Round Diagonal Corner Rectangle (ninth option from the left).
Under SmartArt Tools, on the Format tab, in the Shape Styles group, click Shape Effects, point to Glow, and then do the following:
Under Glow Variations, select Accent color 1, 5 pt glow (first row, first option from the left).
Point to More Glow Colors, and then under Theme Colors click White, Background 1 (first row, first option from the left).
Press and hold CTRL, and then select all of the larger rounded rectangles. Under SmartArt Tools, on the Format tab, in the Shapes group, click Change Shape, and then under Rectangles click Round Diagonal Corner Rectangle (ninth option from the left).
To reproduce the animation effects on this slide, do the following:
On the Animations tab, in the Animations group, click Custom Animation.
On the slide, select the graphic. In the Custom Animation task pane, do the following:
Click Add Effect, point to Entrance, and then click More Effects. In the Add Entrance Effect dialog box, under Subtle, click Fade, and then click OK. Under Modify: Fade, in the Speed list, select Fast.
Click Add Effect, point to Motion Paths, and then click Right. Under Modify: Right, do the following:
In the Start list, select With Previous.
In the Speed list, select Fast.
On the slide, right-click the right motion path and then click Reverse Path Direction.
Press and hold CTRL, and then select the two animation effects in the Custom Animation task pane. Click the arrow to the right of one of those effects, and then click Effect Options. In the Effect Options dialog box, on the SmartArt Animation tab, in the Group Graphic list, select One by One.
Also in the Custom Animation task pane, do the following:
Click the double arrows under each effect to expand the list of effects.
Select the first animation effect (fade effect for the first rectangle). Under Modify: Fade, in the Start list, select With Previous.
Also in the Custom Animation task pane, select the 11th animation effect (motion path for the first picture). On the slide, point to the starting point (green arrow) of the selected motion path until the cursor becomes a two-headed arrow. Press and hold SHIFT to constrain the path to a straight horizontal line, and then drag the starting point to the left of the endpoint (red arrow).
Drag the 11th effect until it is second in the list of effects.
Drag the 12th effect (motion path for the first large rectangle) until it is fourth in the list of effects.
Also in the Custom Animation task pane, select the 13th animation effect (motion path for the second picture). On the slide, point to the starting point (green arrow) of the selected motion path until the cursor becomes a two-headed arrow. Press and hold SHIFT, and then drag the starting point to the left of the endpoint (red arrow), into the same position as the green arrow for the first picture motion path.
Drag the 13th animation effect until it is sixth in the list of effects. Under Modify: Right, in the Start list, select With Previous.
Drag the 14th animation effect (motion path for the second large rectangle) until it is eighth in the list of effects.
Select the 15th animation effect (motion path for the third picture). On the slide, point to the starting point (green arrow) of the selected motion path until the cursor becomes a two-headed arrow. Press and hold SHIFT, and then drag the starting point to the left of the endpoint (red arrow), into the same position as the starting point for the first picture motion path.
Drag the 15th animation effect until it is 10th in the list of effects. Under Modify: Right, in the Start list, select With Previous.
Drag the 16th animation effect (motion path for the third large rectangle) until it is 12th in the list of effects.
Select the 17th animation effect (motion path for the fourth picture). On the slide, point to the starting point (green arrow) of the selected motion path until the cursor becomes a two-headed arrow. Press and hold SHIFT, and then drag the starting point to the left of the endpoint (red arrow), into the same position as the starting point for the first picture motion path.
Drag the 17th animation effect until it is 14th in the list of effects. Under Modify: Right, in the Start list, select With Previous.
Drag the 18th animation effect (motion path for the fourth large rectangle) until it is 16th in the list of effects.
Select the 19th animation effect (motion path for the fifth picture). On the slide, point to the starting point (green arrow) of the selected motion path until the cursor becomes a two-headed arrow. Press and hold SHIFT, and then drag the starting point to the left of the endpoint (red arrow), into the same position as the starting point for the first picture motion path.
Also in the Custom Animation task pane, drag the 19th animation effect until it is 18th in the list of effects. Under Modify: Right, in the Start list, select With Previous.
To reproduce the background effects on this slide, do the following:
Right-click the slide background area, and then click Format Background. In the Format Background dialog box, click Fill in the left pane, select Gradient fill in the Fill pane, and then do the following:
In the Type list, select Radial.
Click the button next to Direction, and then click From Corner (fifth option from the left).
Under Gradient stops, click Add or Remove until two stops appear in the drop-down list.
Also under Gradient stops, customize the gradient stops as follows:
Select Stop 1 from the list, and then do the following:
In the Stop position box, enter 0%.
Click the button next to Color, and then under Theme Colors click White, Background 1 (first row, first option from the left).
Select Stop 2 from the list, and then do the following:
In the Stop position box, enter 100%.
Click the button next to Color, and then under Theme Colors click White, Background 1, Darker 25% (fourth row, first option from the left).

5. The desired dose
The desired dose is an order from the doctor and includes the amount of the medication and should also include the route of administration.
Orders can be verbal or written as a standing orders in your protocol.
Example (2.5 mg IV Push) .

6. Concentration
The second item to identify is the concentration. The paramedic is given the concentration of a vial, an ampule, a prefilled syringe, or a tablet. Concentration can be listed as common fractions, percentages solutions, or by mass (e.g., grams and milligrams). Example: 10 mg/ml

7. Volume on hand
The volume on hand refers to the amount of liquid that the drug is in. In the example: 10 mg/ml, there is a 10 mg concentration of drug in 1 ml of liquid.

8. a weight conversion needed ( Lb to Kg )
Look at the Doctor’s basic order. Is it directly tied to the patient’s weight?
Example: Give 5 mg/kg of drug X, Patient weights 220 lb. Remember, not all drug orders are based on weight.

9. UNIT TO ADMINISTER
It is essential to look at the doctor’s order and identify the unit of measurement that will be administered to the patient. Some texts refer to the unit to administer as “what you are looking for.” Example: How many ml will you administer?

10. Lets have some fun with math

11. EXAMPLE PROBLEM
Doctor orders 2.5 mg of morphine to be administered IV to a patient with substernal chest pain. You have 1 ml vial that contains 10mg of morphine (10 mg/ml). How many milliliters are you going to have to draw up into a syringe and push IV into your patient’s IV line port?

12. NOTE: Some problems may not ask, “How many milliliters
NOTE: Some problems may not ask, “How many milliliters?” You will have to deduce “milliliters” from the context of the problem
The KEY to solving dosage calculation problems consistently and accurately, you must be ORGANIZED. Developing the habit of organization early will make drug dosage problems much-MUCH easier. So, before starting any calculations, organize all of the key components to the problem.

13. Desired Dose: 2.5 mg of morphine IV
Concentration: 10 mg \ ml
Volume on Hand: 1 ml
Lb to Kg: None
Looking for: ml to be given

14. Now that you have identified the components of the doctor’s order, you can now fill-in the formula and solve the problem. There are several books and methods used to calculate drug dosages and this is what confuses most Paramedic Student, (Multiple Methods). For the purpose of this class, we will be using the Formula Method
TOP
BOTTOM
Cancel any like units (g, mg) and/or (zeros).

15. Formula #1
Desired Dose X Volume on Hand = ___ml to be given
Concentration
2.5 mg X 1 ml = 2.5 ml or ( 2.5 ÷ 10 ) = 0.25 ml to be given
10 mg

16. Finding the units per kilogram
Finding the units per kilogram adds a new dimension to the previous problem. Instead of the basic order, the doctor will order a certain number of units (e.g., gram, milligrams, micrograms) of the drug to be administered based on the patients weight, almost always given in kilograms. This is referred to as an order based on patient’s weight. Look at the following example.

17. The Doctor orders 5 mg/kg of Bretylium IV to be administered to your patient. You have premixed syringes with 500 mg/10ml. Your patient weights 176 lb. How many milliliters will you administer?
Look at the Doctor’s order again. It is directly tied to the patient’s weight
(5 mg/kg). Put another way, the order is saying, “For every kilogram of patient, give 5 mg of Bretylium.”
First Things First!!! Convert lb to kg and then apply kg to the basic order to obtain the Desired Dose. Now, organize the other key components in the order.

18. Desired Dose: 400 mg 􀃆 (176 lb ÷ 2.2 = 80 kg 􀃆 80 X 5 mg = 400 mg, this is the Desired Dose)
Concentration: 500 mg
Volume on Hand: 10 ml
Lbs to Kg: (Yes) 􀃆 176lb = 80 kg
Looking for: ml to be given

19. **USE THE SAME FORMULA AS BEFORE**
TOP
BOTTOM
Cancel any like units (g, mg) and/or (zeros)
Formula #1
Desired Dose X Volume on Hand = ___ml to be given
Concentration
400 mg X 10 ml = 40 ml = 8 ml to be given
500 mg

20. Any problem ?

21. Calculate an iv drip infusion
In many cases, patients require medication to be infused on a continual base. Paramedics will receive orders to administer a certain number of units (usually milligrams or micrograms) of a medication per minute to a patient through an IV. Known as an infusion, it is also referred to as an IV drip because it involves calculating the number of drops that “drip” and are delivered intravenously each minute to deliver the amount of drug the doctor is ordering.

22. Formula #2 The Doctor orders 2 mg/min of Lidocaine 1% to be infused to a patient who is experiencing an arrhythmia. Your ambulance carries only 250 ml bags of D5W. You have a 60 gtt/mL microdrip setup. How many drops per minute will you adjust your administration set to drip?
Before starting any drug calculation, organize the key information just as you’ve been doing, but, there will be a couple of new categories in this formula and set up a little differently.

23. Formula #2 Desired Dose: 2 mg Lidocaine IV
Concentration: 1 g Lidocaine
IV Bag in ml: 250 ml D5W
Lbs to Kg: None
Admin. Setup: 60 gtt/ml
Looking for: gtt/min
Formula #2
IV bag volume (ml) Desired Dose Admin Setup (gtt)
X X = gtt/min
Concentration of Drug min ml

24. 250 ml 2 mg 60 gtt ------- X -------- X ---------- = gtt/min 1 g 1 min 1 ml

25. Convert the grams you mixed in the bag to match the milligrams in the Doctor’s order:
250 ml 2 mg 60 gtt gtt
X X = ---- X ---- X ---- = 300 ÷ 10 = 30 gtt/min
1000 mg 1 min 1 ml min 1 ml

26. Milliliters per hour for IV fluids
Often, doctor’s order or protocols state that you are to run an IV in milliliters per hour of over a specific period of time. To set an IV’s administration set, the mL must be converted to drops per minute. This section shows how to convert that type of order. This may sound confusing but a simple conversion formula is all that is needed.

27. Example problem
The Doctor orders you to start an IV of normal saline to run at 100 ml/hr. You have a macrodrip set of 15 gtt/ml. How many drops per minute will you set your administration set to drip?

28. Formula #3:
volume to be infused X drip rate = gtt/min
infusion time in minute 1ml
100 ml X 15 gtt =____ gtt/min ml X 15 gtt = ____ gtt/min
1 hr 1 ml min 1 ml
10 X 15 gtt = 150 gtt = 150 ÷ 6 = 25 gtt/min
6 min min

29. Remember we have 3 formulas be careful when you select 1 of them for solving the problem

30. Formula #1 􀃆 Used for calculating IV push medications, (draw up into syringe)
Desired Dose X Volume on Hand = ___ml to be given
Concentration
Organize The Info:
Desired Dose:
Concentration:
Volume on Hand:
Lb to Kg:
Looking for:

31. Formula #2 􀃆 Used for calculating infusions/piggyback type drips
IV Bag Volume (mL) XDesired Dose X IV Drip Set (gtt) = ____ gtt/min
Concentration of Drug Time in (min) 1 ML
Organize The Info:
Desired Dose:
Concentration:
IV Bag in ml:
Lbs to Kg:
IV Drip Setup:
Looking for:

32. Formula #3 􀃆 Used for simple IV fluid flow rates, (no medications involved)
Volume to be infused X IV Drip Set (gtt) = ____ gtt/min
Time in (min) ml

33. More practical examples will be in the next 3 lecture