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2010 Buncombe, Madison, Yancey Protocol Update

2010 Buncombe, Madison, Yancey Protocol Update. EMT-Basic. Allergic Reactions. Fever/Infection Control Protocol. Buncombe, Madison, Yancey EMS systems are no longer giving ibuprofen for fever prehospital. Acetaminophen will take its place and has multiple uses.

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2010 Buncombe, Madison, Yancey Protocol Update

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  1. 2010 Buncombe, Madison, YanceyProtocol Update EMT-Basic

  2. Allergic Reactions

  3. Fever/Infection Control Protocol • Buncombe, Madison, Yancey EMS systems are no longer giving ibuprofen for fever prehospital. • Acetaminophen will take its place and has multiple uses. • EMT’s can now give Acetaminophen. • Let’s look at Acetaminophen….

  4. Acetaminophen • Classification • Non-narcotic analgesic, antipyretic. • Prehospital Indication • Fever reduction • Pain Control • Any pain

  5. Acetaminophen • Actions • Unlike aspirin, acetaminophen has little effect on platelet junction, does not affect bleeding time, and generally produces no gastric bleeding. Produces analgesia by unknown mechanism, perhaps by action on peripheral nervous system, reduces fever by direct action on hypothalamus heat-regulating center with consequent peripheral vasodilations, sweating, and dissipation of heat.

  6. Acetaminophen • Dosage • Adult • 1000 mg PO {PO = Orally} (1 gram) • Pediatric > 3 months. • 10 mg/kg PO (Max dose of 480 mg per label) • Normal Packaging • Children’s Acetaminophen liquid suspension 160 mg/5 ml or 32 mg/ml

  7. How do I give the correct dose? • First you must have the patient’s weight in kilograms (kg) • For pediatric patients ask the parents how much the child weighs. • They will more than likely tell you the weight in pounds (lbs). • For adults just give 1000 mg (1 gram.) • Might be easiest to use children’s liquid for adults.

  8. How do I give the correct dose? • Take the weight in pounds and divide it by 2.2 • 44 / 2.2 = 20 kgs. • Get out your cell phone and use the calculator • Carry a small calculator in your jump box OR……………… If you don’t have a calculator you may......

  9. How do I give the correct dose? • Take the weight in pounds and divide it in half. • Example 44 lbs. / 2 = 22 • THEN • Take that answer and subtract 10% • Example 10% of 22 is 2.2 or2 • 22 – 2 = 20 kgs

  10. How do I give the correct dose? • Now you want to give 10 mg of acetaminophen per kilogram of weight. • So our 44 lb. patient is 20 kg • Take the 20 kg and multiply it by 10 mg • 20 kg X 10 mg = 200 mg of acetaminophen

  11. Now you know the correct dose what now? • So most of the children’s acetaminophen comes packaged 160 milligrams per 5 milliliters. (Or 32mg/ml) • To give 200 mg you must divide 200 mg by 32 milliters. • 200 mg / 32 ml = 6.25 ml or 6 ml. • The dose for a 44 lb (20 kg) patient is: • 200 mg or 6 ml. (yes that is 192 mg)

  12. Watch Out!! • Never, Ever give a pediatric patient more than 480 mg. • An overdose of Acetaminophen has toxic and deadly effects on the liver. • Make sure you are giving the right amounts.

  13. Acetaminophen • Contraindications/Adverse Reactions • Hypersensitivity to acetaminophen or phenacetin. • Malnutrition can lead to acetaminophen toxicity. • Avoid use in patient with severe liver damage.

  14. Allergic Reactions • EMT’s in the Buncombe, Madison, Yancey EMS system can now give Diphenhydramine (Benadryl) orally for allergic reactions. • EMTs give Diphenhydramine (Benadryl) in an allergic reaction when hives and rash are the only component . NO RESPIRATORY symptoms.

  15. Allergic Reactions • If the patient has respiratory distress Epi Auto-Injector should be used. • Adult injector if over 30 kg (66 lbs). • Pediatric injector if under 30 kg (66 lbs).

  16. Diphenhydramine • Classification • Antihistamine • Pre-hospital Indications • Hives / Rash without respiratory distress in suspected allergic reaction.

  17. Diphenhydramine • Actions • Acts by competing with histamines for the H1 receptor site • Decreases allergic reaction by blocking histamine

  18. Diphenhydramine • Dosage • Adult 50 mg PO • Pediatrics 1 mg/kg • NOT TO BE GIVEN UNDER 3 MONTHS OLD • NO MORE THAN 25 mg TOTAL CAN BE GIVEN TO A PEDIATRIC PATIENT! • (Normal packaging of diphenhydramine only allow for 10 ml of children’s diphenhydramine to be give max)

  19. Diphenhydramine • Normal Packaging • 12.5mg/5 ml or 2.5mg/ml

  20. Contraindications • Hypersensitive to antihistamines • Acute asthma attack • Lower respiratory disease

  21. Side Effects • Are not contraindications to giving a medication. • Side effects are…………..

  22. Diphenhydramine • Diphenhydramine side effects are: • Drowsiness, dizziness, poor coordination, fatigue. • Increased secretions in the chest • Respiratory depression • Monitor for respiratory rate, rhythm, increased bronchial secretions.

  23. Giving the Correct Dose of Diaphenhydramine • You have a 36 lb patient who has been outside playing and is now experiencing itching all over with a rash on his chest and neck. You have confirmed they have no allergies to medications and have elected to give Diaphenhydramine by mouth. • What is the correct dose for this patient?

  24. Giving the Correct Dose • 36 lbs / 2.2 = 16.36 kg or 16 kg • You want to give 1mg/kg of Diphenhydramine. • 1mg X 16kg = 16mg of Diphenhydramine • You know that Diphenhydramine comes normally packages 2.5mg/ml. • How many ml do you give?

  25. Giving the Correct Dose • 16 mg / 2.5mg/ml = 6.4 ml of children’s diaphenhydramine. • Adult dose is 50 mg orally (PO) • 50 mg / 2.5 mg/ml = 20 ml or children’s diaphendydramine.

  26. Chest Pain • EMT Basic level providers should now give Aspirin to a adult patient who is experiencing chest and is not allergic to Aspirin (ASA). • EMT-Basics in the Buncombe, Madison, Yancey EMS Systems are NOT giving Nitroglycerin for chest pain.

  27. Aspirin • Classification • Non-narcotic analgesic, antipyretic, anti-inflammatory agent. • Actions • Impedes clotting action and platelet aggregation.

  28. Aspirin • Pre-hospital Indication • Chest Pain • Action • Inhibits platelet aggregation • Dosage • 324 mg Orally

  29. Aspirin • Normal Packaging for EMS • Low dose chewable tablets 81 mg each • 324 mg / 81 mg tab = 4 tablets • Normal dose is four 81 mg tablets.

  30. Aspirin • Contraindication/Adverse Reactions • May not be given to pediatrics • Know Allergy to Aspirin or Acetylsalicylic Acid. • Any known or suspected internal bleeding

  31. Epistaxis (nosebleed) • EMT-Basics can now give Afrin (Otrivin) nasal spray for a nosebleed not controlled with: • Compressing the nostrils. • Ice Packs • Tilt of the head forward while compressing the nostrils.

  32. Afrin (oxymetazoline nasal) • Classification • Decongestant • Pre-hospital Indication • Epistaxis • Actions • It works by constricting (shrinking) blood vessels (veins and arteries) in your body. The nasal formulation acts directly on the blood vessels in your nasal tissues.

  33. Dosage • Adults • 1 to 2 Sprays in the affected nostril • Pediatrics • 1 spray in the affected nostril if less than 30 kg • 2 sprays in the affected nostril if greater than 30 kg

  34. Afrin (oxymetazoline nasal) • Normal Packaging • Single use “spray bottle” • Must discard the remaining medication after administration to a patient. • Contraindications • Hypertension • Patients with blood pressure greater than 110 diastolic. • Known coronary artery disease.

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