October 2011 CE

Site code # 107200E-1211

Region X SOP New Medications & Equipment

Objectives/Packet by Sharon Hopkins, RN, BSN, EMT-P

To view on the Advocate Condell website visit: www.advocatehealth.com/condell/body.cfm?id=422

Date of CE presentation: October 2011

Topic: Region X SOP New Medications & Equipment

Behavioral Objectives:

Upon successful completion of this module, the EMS provider will be able to:

Review the changes to the Region X SOP’s Discuss the action, indications, contraindications, dosing, and side effects of Atrovent

(Ipratropium), Etomidate, Fentanyl, and Zofran (Ondansetron) Given equipment, demonstrate appropriate use of the humeral site for IO insertion Given equipment, demonstrate placement of the King airway Actively participate in case scenario presentations Complete the 10 question pre-quiz

References:

Hodgson, B., Kizior, R. Saunders Nursing Drug Handbook 2009. Elsevier. 2009.

centegra.org/emergency-medical-services/ems-news/

www.co.bonner.id.us/EMS/BonnerCountyEMSTrainingDivision.htm

dailymed.nlm.nih.gov/…/drugInfo.cfm?id=18810

www.ems/.com/.../video/449861-Vidacare-EZ-IO/

emsstaff.bincombecounty.org/inhousetraining/ez_io_Update/img/Pro

emsstaff.buncombecounty.org/…/kinglt_info.asp

www.medclip.com/index.php?page=videos&c=21

http://www.westyadkinvfd.com/KingLTDInserviceGuide.pdf

Region X SOP’s November 1, 2011

Medication Additions to Region X SOP’s

Med Action Indications Contraindica-

tions

Dosing Side Effects Drug

Interaction Atrovent

(Ipratropium

Bromide)

Dilates bronchial

smooth muscle

decreasing bronchial

spasms. Prevents

wheezing, difficulty

breathing, chest

tightness, and

coughing.

Dries up excessive

secretions.

Onset – 5-15 minutes

Duration 4-6 hours

Used for

persistent

bronchospasm in

asthma, COPD

and wheezing

Albuterol used for

the rescue effect,

Atrovent helpful

more long term

effects

Hypersensitivity

to Ipratropium,

atropine, alkaloid,

soybean protein.

Note: Peanut

allergies a

concern with

metered dose

inhalers, not

nebulizer product

Adult and peds:

0.5 mg in 2.5 mL

Supplied as 0.5 mg/2.5

ml vials.

Mix with Albuterol for

1st dose administration

only

Nausea/vomiting,

dizziness, headache,

tachycardia, dry

mouth, blurred

vision. Avoid getting

drug into eyes (may

cause narrow angle

glaucoma). Neb

mouthpiece preferred

over the face mask if

possible.

None

Etomidate Nonbarbiturate

hypnotic, anesthetic

Short acting drug to

produce rapid

anesthesia.

Minimal

cardiovascular

effects.

Onset – within 1-2

minutes

Duration brief 3-5

minutes

Premedication for

tracheal

intubation to

relieve

apprehension or

impair memory.

Note: Has been

used in other

areas (i.e.:

hospitals, EMS

systems) for

sedation related to

cardioversion

Hypersensitivity

to the medication;

active labor

(weigh risks vs

benefit to the

fetus)

(insufficient data

to support its use

in labor)

Adult & Peds:

0.3 mg/kg IVP/IO

(max 20 mg).

Give slowly over 30-

60 seconds (too rapid

may cause hypotension

(treat with fluid) or

myoclonic muscle

twitching – short term)

Supplied as 40

mg/20mL (2 mg/mL)

Nausea/vomiting,

dysrhythmias,

breathing difficulties,

hypotension,

hypertension,

transient involuntary

muscle movement,

pain at injection site

(less when larger

more proximal sites

used).

Effects may be

prolonged in patients

with renal failure and

hepatic cirrhosis.

Effects may

be enhanced

when given

with other

CNS

depressants

Med Action Indications Contraindica-

tions

Dosing Side Effects Drug

Interaction Fentanyl

Synthetic Opioid;

narcotic analgesic.

100 times more

potent than morphine.

Increases pain

threshold, alters pain

perception.

Rapid, fast onset;

short duration of

action

Onset – minutes

Duration: ½ - 1 hour

Pain control,

analgesia and

euphoria, to

reduce anxiety,

sedation for select

procedures

Resp depression,

hypotension, head

injury, cardiac

dysrhythmias,

myasthenia

gravis,

hypersensitivity

to opiates

FYI -Myasthenia

gravis is an

autoimmune

disease causing

muscle weakness.

Fentanyl can

induce muscle

rigidity that may

need to be

reversed.

Adult & Peds:

0.5 mcg/kg slow (over

2 minutes) IVP/IO/IN

May repeat 0.5 mcg/kg

slow IVP/IN/IO in 5

minutes as needed

Note: IN route must be

rapid to create a mist

Adult & peds max 200

mcg

Supplied as 100 mcg/2

mL

Major: Diarrhea,

constipation, dry

mouth, confusion,

sweating, nausea

(less than morphine)

Also hypoventilation

with resp depression,

constricted pupils

Effects may

be increased

when given

with other

CNS

depressants or

skeletal

muscle

relaxants.

Crosses

placental

barrier; has

been used

safely in

labor. May

prolong labor

if given in

first stage of

labor.

Zofran

(Ondanse-

tron)

Antiemetic

Selective antagonist

used for the

prevention of nausea

& vomiting.

Onset: unknown

Duration: Unknown

Prevention/treat-

ment of nausea &

vomiting

Hypersensitivity

to med

Adult: 4mg IVP/IO

over 30 seconds

Peds: < 40 kg - 0.1

mg/kg IVP/IO over 30

seconds

>40 kg – 4 mg

IVP/IO

over 30 seconds

May repeat once in 10

minutes.

Supplied as 4 mg/2mL

Most commonly:

Headache, dizziness,

constipation,

diarrhea.

Also noted: urine

retention, injection

site reaction, fatigue.

Drowsiness

especially noted in

the pediatric

population.

A 9/15/11

FDA

Medwatch

Safety Alert

was issued for

patients with

long QT

syndrome

receiving this

med – watch

for tachydys-

rhythmia (i.e.:

Torsades)

File: CE, EMS; CE Packets; 2011; Sept New Meds Region X SOP’s; rev 9.20.11; 10.12.11; 10.13.11

Pre-Quiz Paramedic Level

From October 2011 CE Material

Region X SOP Medications & Equipment Review

Name_________________________________Date___________

1. Why is Atrovent added to the first dosing of Albuterol? 2. What properties of Etomidate make it beneficial? 3. What is the benefit of Zofran (Ondansetron)? 4. How do I size the King airway? 5. What difference is there from the tibial IO site vs humeral IO site? 6. How should Lidocaine be administered to be most beneficial for IO as an IV access site?

Pre-quiz Oct 2011 Region X SOP Meds & Equipment

7. When do you check pulses when performing CPR? 8. What 2 drugs are alternated during resuscitation of ventricular fibrillation (VF) in the adult and pediatric populations? 9. Why is Atropine administered as a premedication for intubation in the pediatric population? 10. What features of Versed give it an advantage over Valium?

File: CE, EMS; CE Packets; 2011; Quizzes; October Pre-quiz Region X SOP Meds & Equipment