Emergency Medications Available in the Village

From Guide to YKHC Medical Practices
Revision as of 18:00, 20 July 2021 by JenniferH (talk | contribs) (Naloxone 1mg/ml injectable solution)
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NOTE: Health Aides can NOT give any medications via IV route, even if ordered by a physician.

Remember to use the Pediatric Critical Care Guide for weight-based dosing if available

Epinephrine 1mg/ml Ampule

NOTE: In the absence of standard IV/IO route of administration, epinephrine may be given IM if it does not compromise CPR. Efficacy is unknown for this route in humans.

Resuscitation

  • Adult Dose=1mg IM
  • Pediatric Dose 0.01 mg/kg IM = 0.01 ml/kg (using1mg/ml concentration epinephrine)

Anaphylaxis

  • Adults and peds > 30kg = 0.3mg IM anterolateral thigh (0.3ml)
  • Pediatric <30kg = 0.01mg/kg IM anterolateral thigh (0.01ml/kg using 1mg/ml concentration epinephrine) (Max 0.3mg=0.3ml)

Croup

  • If no racemic epinephrine available, mix 1 ampule of epinephrine 1 mg/ml with 3 mL NS bullet and then nebulize.

Ceftriaxone 1gm vials

  • Adult Dose=2 grams IM
  • Pediatric Dose = 100mg/kg IM (max dose= 2grams)

Midazolam (Versed) 10mg/2ml

NOTE: If dosing intranasal, divide dose equally between both nares

  • Adults 0.2mg/kg IM or IN
  • Pediatric 0.2 mg/kg IM or IN

Dosing Chart

Weight Range in pounds Intranasal midazolam dose
less than 17 lbs Ask provider for dose
17-20 lbs 2 mg = 0.4 mL =0.2 mL/naris
21-24 lbs 2.5 mg = 0.5 mL = 0.3 mL ro one naris and 0.2 mL to other naris
25-31 lbs 3 mg = 0.6 mL = 0.3 mL/naris
32-40 lbs 4 mg = 0.8 mL = 0.4 mL/naris
41-51 lbs 4.5 mg = 0.9 mL = 0.5 mL to one naris and 0.4 mL to other naris
52-64 lbs 5.5 mg = 1.1 mL = 0.6 mL to one naris and 0.5 mL to other naris
>65 lbs 6.5 mg = 1.3 mL = 0.7 mL to one naris and 0.6 mL to other naris

Diazepam (Valium) 10mg/2ml (on drug shortage, removed from village formulary January 2021)

  • Adult Dose=10mg rectally or IM. (total max dose = 20 mg)
    • May repeat once in 10-15 minutes
  • Pediatric Dose=0.5mg/kg rectally or IM. (total max dose = 20 mg)
    • May repeat q 5-10 minutes prn

Fosphenytoin

  • Pediatric Dose=20mg/kg IM
    • Given for seizure activity that does not resolve after two doses of Midazolam

Phenobarbital 130mg/ml (1 ampule)

  • Adult Dose=10-20 mg/kg IM q 20 min prn
  • Pediatric Dose=20mg/kg IM
    • May give another 5-10mg/kg q 15-30 min prn up to a total dose of 40mg/kg
    • Pay close attention to respiratory rate if repeating phenobarb doses

Instaglucose 24 grams in a tube

NOTE: Use care in administering to an unconscious patient to prevent aspiration. Use small amounts in the buccal area bilaterally or smear on gums and cheeks. Glucose is not rectally absorbed.

  • Adult Dose: 15-20 gm
  • Pediatric Dose:
Weight (lbs) Dose
Less than 11 lbs 1 ml
11-20 lbs 4 ml
21-30 lbs 8 ml
31-40 lbs 12 ml
> 41 lbs 20 ml

Glucagon 1mg/ml (one ampule)

Note: Glucagon is only effective if hypoglycemia is due to hyperinsulinism-either because of insulin administration or endogenous insulin production. It is not rectally absorbed

  • Adults and Peds > 20kg Dose=1mg SC/IM. May repeat q15 minutes
  • Pediatric Dose= 0.5mg SC/IM. May repeat q15 minutes

Morphine 10mg/ml (one ampule)

  • Adult Dose=10-30mg PO, 2 to 10 mg IM
  • Pediatric Dose=0.05-0.2mg/kg IM (max dose=10 mg)

Naloxone 1mg/ml injectable solution

  • Dose
    • Adult Dose=0.4-2mg IM/SQ or 2-4mg intranasal-may repeat q2-3 minutes
    • Pediatric Dose=0.1mg/kg IM/SQ (Max dose=2 mg IM or 2-4mg intranasal) May repeat q2-3 minutes
  • Reminders:
    • INTRAMUSCULAR naloxone works faster than intranasal naloxone. It is located in the code carts.
    • When choosing a naloxone route of administration, the fastest option should be chosen. If the patient has an intranasal naloxone spray on their person, use that! If the patient is in the clinic, the intramuscular route is probably appropriate. Give whatever you have as fast as you can!

Dexamethasone 10mg/ml

  • Adult Dose=depends on condition IM
  • Pediatric Dose
    • Croup/Stridor 0.6 mg/kg IM or PO. (Max 10mg)
    • Congenital Adrenal Hyperplasia 0.7 mg/kg/dose IM (1.5-2 mg/m2/dose)
      (Home supply of emergency Solu Cortef should be given preferentially (if available) according to directions OR use the following table)
      Solu Cortef Emergency Injection. CHOP (video)
Solu Cortef Act-O-Vial 100mg/2ml IM dose
Under 4yo 25mg = 0.5ml
4-12 yo 50mg = 1ml
Over 12yo 100mg = 2ml (whole vial)

May repeat in 12-24 hrs (give sooner if sicker) if not able to get to a higher level of care

Prednisone 10mg tablets

  • Adult Dose=40-60mg PO
  • Pediatric Dose=2mg/kg PO (tablets crushed and mixed with palatable substance)

Albuterol 2.5 mg/3mL

  • Adult Dose=1 unit dose
  • Pediatric Dose=1 unit dose

Duo-nebs (ipratropium 0.5 mg and albuterol 3mg per 3 mL)

  • Adult Dose=1 unit dose
  • Pediatric Dose=1 unit dose

Racemic Epinephrine 2.25%

  • Adult Dose=1 unit dose in nebulizer (0.5ml) diluted with 3 mls NS bullet
  • Pediatric Dose= Give nebulized racemic epinephrine:

<10 kg: 0.25 mL mixed with 3 mL NS

>10 kg: 0.5 mL mixed with 3 mL NS

Note: Monitor pulse during and after administration.

If no racemic epinephrine available, mix 1 ampule of epinephrine 1 mg/ml with 3 mL NS bullet and then nebulize.


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