Morris Hospital EMS System Medication Administration
Drug Dosage Calculations (Cont d) Working with formulas See Med Math Formulas Taught in Class Handout to review formulas used.
Drug Dosage Calculations Desired dose (DD) Amount of medication patient is to receive Dose on hand (DH) Amount (physical weight) of medication present in medication container (in grams, milligrams, or micrograms) Volume on hand (V) Amount of fluid in medication container in which medication is dissolved (milliliters)
Practice Med Math Formulas
Medical Direction Legal Considerations Federal, state, local laws governing purchasing, distribution, dispensing, administering drugs Medication handling diligence, accounting Medical direction, final word
Medical Direction (Cont d) Protocols: written & online Written, filed with state board of pharmacy Online, radio, cellular phone If fails, follow written protocols If event with no protocol, must get medical direction before proceeding Differ among EMS systems
Principles of Medication Administration Safety considerations & procedures Familiar with drug Require physician order Verify physician s order Concentrate on task Patient properly positioned Assemble, use correct supplies, equipment Handle carefully, avoid dropping, breaking Aseptic technique Carefully calculate drug doses
Principles of Medication Administration Safety considerations & procedures Check drug incompatibility Monitor for overdose signs, take corrective measures Document drug given, dose, time, route, patient s response
Principles of Medication Administration The six rights of drug administration Right drug Right patient Right dose Right time Right route Right documentation
Principles of Medication Administration Medical asepsis Medically clean Source of infections & standard precautions Used for all patients, regardless of diagnosis Gloves when touching patient s blood, body fluid, secretions, excretions, mucous membranes, nonintact skin, soiled materials, equipment Handwashing before/after touching patient, removing gloves Masks, eyewear if exposure to body fluids likely by splashing, spraying N-95 particulate mask for coughs, respiratory illness, history of TB
Principles of Medication Administration Medical asepsis Antiseptics vs. disinfectants Disinfection Process of cleaning vehicle, stretcher, equipment Toxic to body tissue Antiseptic Process used to clean skin before needle puncture Sterilization Makes object free of all forms of life using extreme heat/certain chemicals
Principles of Medication Administration Medical asepsis Proper drug handling Paramedic drug box maintained in clean, neat, orderly state Checked for current date, replaced Narcotics Daily accounting, locked Care of site Cleansed by aseptic technique Site of injection, outward If iodine, check for allergies Dry before injection Do not touch area with anything, including gloves
Prevention of Injuries & Exposures Sharps handling Do not recap needle by hand, dispose in approved container Do not overfill sharps containers No regular trash Retrieve any placed on stretcher Ensure all sharps accounted for before removing patient from ambulance
Oral Administration Enteral medication administration Giving oral medications Patient responsive, cooperative with intact gag reflex 6 rights of drug administration Wash hands, wear gloves Verify patient can swallow Take initial vital signs Ask about allergies Do not touch inside caps, cup Tell patient name of drug, why Take vitals after giving Watch for adverse reaction Document
Sublingual Administration Enteral medication administration Giving sublingual medications Place under tongue with gloved fingers Not swallowed, spit out, or rinsed Advantages, accessibility, rapid onset Nitroglycerin most common
Sublingual Administration When giving nitroglycerin spray, do not shake before use; remove plastic canister cover Hold container upright with index finger on top of grooved button; position close to mouth, without touching Firmly press button to release spray under patient s tongue Release button and ask patient to close mouth and avoid swallowing; replace canister cover
Buccal Administration Enteral medication administration Giving buccal medications Placed in pocket between teeth & cheek Glucose for diabetic
Rectal Diazepam (Valium) Place child on side, facing you; measure for weight Open package, remove syringe, remove cover, lubricate tip Bend child s upper leg forward so knee is close to chest Expose rectum by separating child s buttocks Insert lubricated syringe tip all the way into rectum Slowly count to 3 while pushing plunger in until it stops Slowly count to 3 before removing plunger Slowly count to 3 while holding child s buttocks together, preventing leakage; monitor child s respiratory rate and depth; be prepared to assist breathing as necessary
Metered-Dose Inhalers Giving inhaled medications Metereddose inhalers
MDI Medication Administration Prep; patient sitting; assemble inhaler, attach spacer if needed; shake inhaler gently before use Position mouthpiece ~2 finger widths from mouth; if using spacer, patient s lips close around mouthpiece Ask patient to inhale deeply and exhale, then inhale slowly while inhaler is activated, hold breath for 10 seconds, and exhale through pursed lips Observe patient; document procedure
Giving inhaled medications Nebulizers Nebulizers
Small Volume Nebulizer Prep; patient sitting; assemble small volume nebulizer; attach mouthpiece to large end of T-shaped piece Attach extension tubing to small end of T-shaped piece Unscrew cap Fill base of cup with correct medication; if a bronchodilator, additional liquid (i.e., normal saline) may be added, if ordered
Small Volume Nebulizer Attach cap; shake to mix medication and diluent (if used); attach oxygen supply to nebulizer cup, then to oxygen source Attach cup to bottom of T-shaped piece; adjust oxygen rate 6-10 L/min to create fine mist Patient sitting; if able, patient may hold mouthpiece alone, if not, hold it for patient; ask patient to inhale slowly, pause 2-3 seconds, exhale through pursed lips; continue until medication is gone; observe patient; document procedure
Skill Practice Nebulizers
Injectable medications Equipment Needles, syringes Injectable Medications
Withdrawing From An Ampule Prep: medical director s orders, PPE, six rights Check medication clarity; verify drug not expired; check concentration Clear contents from top by holding upright and gently tapping container s top with finger or gently swirl ampule to displace medication from container s top
Withdrawing From An Ampule Wrap ampule neck/top Snap off top away from body Replace syringe s sterile needle with filter needle to keep out glass particles Place needle into ampule solution, withdraw dose of medication; if needle is not long enough to reach bottom of ampule, invert to withdraw desired dose; do not touch ampule outer surface/rim; do not inject air in ampule Tap syringe to remove air bubble, push plunger to expel air; replace sterile needle; properly dispose sharps
Skill Practice Drawing from Ampule
Withdrawing From A Vial Prep: medical director s orders, PPE, six rights; check medication clarity; verify drug not expired; check concentration Remove protective cover on vial s stopper, if present; cleanse rubber stopper with alcohol; let dry Hold vial with thumb/forefinger, insert needle into vial; with needle tip above solution, push syringe plunger to inject air equal to desired dose to prevent vacuum Invert vial/syringe; hold at eye level with needle below level of solution in vial; if syringe does not fill automatically, pull down plunger to desired dose
Withdrawing From A Vial Tap syringe to remove air bubble, push plunger to expel air; adjust plunger for desired dose Remove needle from vial; reverify dose; properly dispose sharps
Skill Practice Drawing from Vial
Techniques of Medication Administration (Cont d) Injection routes A, intramuscular (IM) B, subcutaneous (Sub-Q) C, intradermal (ID) D, intravenous (IV)
Subcutaneous Injections Injectable medications Subcutaneous injections Fat, loose connective tissue just under dermis Select site with few sensory nerve endings, away from large blood vessels, major nerves, bony prominences Maximal volume, 2 ml for adults Maximal volume, 0.5-1.0 ml for children
Subcutaneous Injection Prep; prepare correct medication dose; select injection site; cleanse site with alcohol wipe using circular motion from center out; allow to dry Gently pinch skin and lift subcutaneous tissue away from muscle Insert needle at 45-degree angle with quick, darting motion Release skin; pull back plunger, check for blood; if blood present, remove needle; if no blood, press plunger, inject medication; withdraw needle; massage area; apply bandage if bleeding; observe patient; properly dispose sharps; document
Skill Practice Subcutaneous Injections
Intramuscular Injections Injectable medications Intramuscular injections Into muscle layer Rapid onset Complications Deltoid site Dorsogluteal site Ventrogluteal site Vastus lateralis, rectus femoris sites
Techniques of Medication Administration (Cont d) Deltoid Site
Techniques of Medication Administration (Cont d) Dorsogluteal Site
Techniques of Medication Administration (Cont d) Ventrogluteal Site
Techniques of Medication Administration (Cont d) Vasrus Lateralis & Rectus Femoris Sites
Intramuscular Injection Prep; prepare correct medication dose; select injection site; cleanse site with alcohol wipe using circular motion from center out; allow to dry Spread skin at site; hold skin taut, insert needle at 90-degree angle with quick, darting motion Pull back plunger slightly, check for blood; if blood present, remove needle; if no blood, inject medication with slow, continuous motion, withdraw needle; massage area; apply pressure with gauze if bleeding, apply bandage if needed; observe patient; properly dispose sharps; document
Skill Practice Intramuscular Injection
Vascular Access Vascular access Venous access Intravenous cannulation Venipuncture Intravenous therapy
Vascular access Peripheral venous access Intravenous catheters Saline lock Over-the needle Through-theneedle Hollow needle Vascular Access
Vascular Access Vascular access Peripheral venous access Factors in selection Purpose of infusion Amount, type of fluid, medication to be infused Accessibility, size, condition of vein Patient s age, size, general health, hand dominance, mobility Presence of disease, injury, prior surgery Presence of shunt, graft Experience, skill at venipuncture
Vascular Access Peripheral intravenous sites
Vascular Access Peripheral intravenous sites
Vascular Access Peripheral intravenous sites
Peripheral Venous Access PPE; assemble supplies; use appropriate fluid; check expiration date; check solution clarity; check bag for leaks; select appropriate select catheter length/gauge/microdrip/ macrodrip as appropriate; clamp tubing Insert spiked end of tubing into bag Squeeze drip chamber until chamber fills halfway; loosen protective cap over needle adapter to allow air to escape; open clamp slowly; flush air from tubing; flick tubing with finger to remove air bubbles; close clamp; retighten cap
Peripheral Venous Access Apply tourniquet ~4 inches above injection site, tight enough to restrict venous blood flow without restricting arterial circulation; if vein not distended, ask patient to open and close fist several times; cross ends of tourniquet and apply tension Fold middle of one end of tourniquet under opposite end to form loop; leave distal portion of folded end free to allow onehanded release of tourniquet Cleanse site; allow to dry
Peripheral Venous Access With nondominant hand, anchor vein by pressing thumb ~2 inches directly below insertion site; hold skin taut Puncture vein (direct or indirect method); use dominant hand to hold IV catheter; once punctured, quickly lower IV catheter until hub is nearly parallel to skin When blood is seen, advance catheter 2-3 mm more to be sure of vein, then advance catheter over the needle to catheter hub Apply light pressure to vein proximal to catheter tip to slow blood escape
Peripheral Venous Access Remove needle portion of cannula with dominant hand; properly dispose needle Attach syringe to IV catheter; withdraw blood if samples needed Release tourniquet; connect administration set to catheter; check connection is secure Slowly open clamp on tubing; look for swelling or fluid leakage at site; if patent, adjust flow of infusion to prescribed rate Secure catheter in place
Skill Practice Peripheral Venous Access
Intravenous Med Admin Vascular access Intravenous medications Bolus Piggyback Infusion pumps
IV Bolus Medication Six rights; ask patient about allergies; check medication concentration, clarity, expiration date; calculate, prep dose, fill syringe with correct dose Check site for infiltration; once certain that catheter is in vein, cleanse injection port closest to patient with alcohol swab; recheck medication, dose Connect syringe to injection port; pinch tubing above port; give correct dose at proper push rate Remove syringe; release tubing; allow IV solution to flow at prescribed rate; properly dispose sharps; observe patient; document
Skill Practice IV Bolus Medication
IVPB Medication Six rights; check allergies; select correct medication; check clarity, expiration dates of medication and IV solution Calculate, draw up, medication into syringe; calculate flow rate of piggyback medication in drops per minute; cleanse port on bag with alcohol swab; inject correct dose into solution; gently shake bag Connect secondary admin set to medication solution; fill drip chamber and flush air from tubing; connect secondary admin set to primary solution tubing
IVPB Medication Check site for infiltration; raise piggyback solution until higher than primary solution; tape connection Recheck medication dose; open clamp on piggyback tubing; adjust flow rate to calculated desired dose; properly dispose sharps; observe patient; label piggyback solution (date, time, name, amount of medication added to bag, preparer s initials); document
Skill Practice IVPB Medication
Complete Quiz Thank You!!! 60