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Med Math

Med Math. The basics… use like units use common sense find a formula/system that works for you. Home. Making weight…. 1 kilogram (kg) = 2.2 pounds (lb) Actual conversion Wt: 220 lb 220 divided by 2.2 = 100kg 10% or “Midnight” rule Half of 220 = 110 10% of 110 = 11

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Med Math

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  1. Med Math • The basics… • use like units • use common sense • find a formula/system that works for you Home

  2. Making weight….. • 1 kilogram (kg) = 2.2 pounds (lb) • Actual conversion • Wt: 220 lb • 220 divided by 2.2 = 100kg • 10% or “Midnight” rule • Half of 220 = 110 • 10% of 110 = 11 • Subtract 11 from 110 = 99kg Home

  3. Metric conversions • 1 gram (g) = 1000 milligrams (mg) • 1 mg = 1000 micrograms (mcg) • 1 liter (L) = 1000 milliliters (ml) • You need to give 500 mcg. How many mg? • Mg - move decimal 3 places to the left = 0.5 mg • OR 500 = half of 1000 so half of 1 = .5 mg • You need to give 100 mg. How many mcg? How many g? • mcg - move decimal point 3 places to the right = 100,000 mcg • g - move decimal point 3 places to the left = 0.1 g Home

  4. Basic calculations Desired dose (D) Known dose on hand (H) x Unit of measure or volume on hand (Q) = volume or unit of measure to be administered (X) D X Q = X H Home

  5. Example • You are ordered to give 5 mg Valium IV. The label states there is 10 mg in 2cc (10mg/2cc). How many cc’s will you give? • The equation will look like this: 5mg x 2cc = X cc 10 mg 1 x 2 = X cc 2 X = 1 cc You will give 1cc! Home

  6. Calculations based on weight Desired dose (D) x Weight in kg (W) Known dose on hand (H) X Unit of measure or volume on hand (Q) = volume or unit of measure to be administered (X) D x W x Q = X H Home

  7. Example • You are to give 0.5 mg/kg IV push. Your patient weighs 80 kg. The drug comes packaged: 100mg/10cc. How many mg will you give? How many cc’s will you deliver? • Your equation to determine mg will look like this: • 0.5 mg/kg x 80 kg = 40 mg to be given • Your equation to determine cc will look like this: • 40 mg x 10 cc = 4cc 100 mg Home

  8. Drip calculations “Clock” method (used only for 4:1 ratio) 60 4 1 15 45 3 2 30 If your dose is 1 mg/min, your drip rate is 15 gtt/min. If the order is greater than 4 mg/min, add them together. A dose of 6 mg/min is 90 gtt/min (4 + 2 =6 so 60 + 30 = 90) Home

  9. Drip calculations Desired dose x Size of bag x gtt set = gtt/min Amount of drug on hand • The order is for 5 mg/min. You have a 500 cc bag of NS, a 60 gtt/cc administration set, and 2 g of drug on hand. How many gtt/min will you administer? 5 mg/min x 500 cc x 60 gtt/cc = 75 gtt/min 2000 mg Note: If the dose is weight based, determine the total dose prior to beginning the equation or multiply everything by the number of kg. Home

  10. Glossary of Terms • Absorption-process of drug moving from site of introduction into circulation • Contraindication-factor that does not allow administration of drug • Dependence-state where absence or less of drug causes physical or emotional effects • Excretion-elimination of drug or toxins • Half life-time it takes for a drug level to reduce by half • Loading dose-large amount of drug given to temporarily increase blood levels Home

  11. Glossary (cont.) • Maintenance dose-amount of drug needed to maintain steady blood levels • Peak level-highest blood level from any given dose • Therapeutic action-wanted and intended effects of a drug • Tolerance-decreased response to drug after repeated administration. May require increased dose. • Toxic level-blood levels are such that they may produce adverse effects Home

  12. Prehospital Medications • The following is a list of drugs given in the TEMS region. Limited information is included for a number of the drugs but due to space constraints, everything could not be listed. Please review all medications you are responsible for administering Home

  13. Oxygen • Standing order: EMT, ST, CT, PM • Dose: 2-15 LPM via nasal cannula, non-rebreather, bag-valve-mask • Indications: Any patient with reduced oxygen levels or increased need for oxygen. Home

  14. Activated Charcoal (Actidose) • Physician order: EMT, ST, CT, PM • Dose: Adult (50 g), Pediatrics (25-30 g) given by mouth • Action: Binds and absorbs ingested toxin and is then excreted. • Indication: Overdose or poisoning when induction of vomiting is not indicated • Contraindications: Unable to swallow or maintain airway. Not useful in cyanide, methanol, caustic acids or alkalis, heavy metals, or lithium poisonings. • Side Effects: None Home

  15. Oral Glucose • Standing Order: EMT, ST, CT, PM • Dose: One tube • Action: Increases blood glucose • Indication: Consider if patient has an altered level of consciousness and/or known hypoglycemia • Contraindications: Difficulty swallowing or unable to protect own airway. • Side Effects: None Home

  16. Epinephrine-SQ (Adrenalin) • Patient Assisted Med: EMT • Physician Order: ST • Standing Order: CT, PM • Dose: 0.01 mg/kg (up to .3 mg) SQ 1:1000 • Action: Improves force of ventricular contractions and heart, bronchdilatation, peripheral vasoconstriction, and histamine antagonist • Indication: Anaphylaxis, severe asthma • Contraindications: Hypovolemic shock, hypertension, cardiac insufficiency • Side Effects: Anxiety, restlessness, hypertension, dysrhythmias • Note- Physician order for any patient over 40 years of age and or cardiac history! Home

  17. Albuterol (Proventil, Ventolin) • Patient Assisted Med: EMT • Standing Order: ST, CT, PM • Dose: PAM (1-2 puffs from MDI only), 2.5 mg HHN repeated once • Action: Relaxes smooth muscle of bronchial tree and peripheral vasculature • Indication: Relief of bronchospasm, wheezing • Contraindications: Tachycardic dysrhythmias • Side Effects: Anxiety, restlessness, palpitations, increased blood pressure Home

  18. Nitroglycerin (NTG) • Patient Assisted Med: EMT • Physician Order: ST • Standing Order: CT, PM • Dose: 0.4 mg SL every 3-5 min up total of 3 • Action: Dilation of arterioles and peripheral veins causing decreased workload of the heart and decreased oxygen demand by decreasing preload and afterload. • Indications: Chest pain, CHF • Contraindications: Viagra use in past 24 hours, systolic BP<100, head injury, cerebral hemorrhage • Side effects: Headache, hypotension, nausea and vomiting, dizziness, burning sensation under the tongue • Note-Monitor blood pressure closely in-between tablets. Home

  19. Aspirin (ASA) • Physician order: ST • Standing Order: CT, PM • Dose: 324 mg (four 81mg chewable) • Action: Antiplatelet and vasodilatory actions allowed to occur through alterations in enzyme production. • Indication: Chest pain • Contraindications: ASA intake in past 24 hours • Side effects: Bleeding, GI upset Home

  20. Diphenhydramine HCl (Benadryl) • Physician Order: ST • Standing Order: CT, PM • Dose: 50mg IV or IM (adult) 1-2 mg/kg (peds) • Action: Binds to histamine receptor sites blocking the histamine response • Indications: Allergic and EPS/dystonic reactions • Contraindications: Acute asthma attack, taking MAO inhibitors, narrow angle glaucoma • Side Effects: Drowsiness, hypotension, drying of secretions, sedation Home

  21. Naloxone (Narcan) • Physician Order: ST • Standing Order: CT, PM • Dose: 2-4 mg IV titrated to effect • Action: Reverses effects of narcotics by competing for receptor sites • Indications: Narcotic overdose, altered level of consciousness or unconsciousness with unknown origin • Contraindications: Use cautiously in drug dependant patients as administration can cause withdrawals • Side Effects: projectile vomiting and/or cardiac dysrhythmias with rapid admin, withdrawals, diaphoresis • Note-Narcan’s effects are shorter acting than the narcotic’s so monitor patient closely. Home

  22. Dextrose 50% (D50) • Physician order: ST • Standing Order: CT, PM • Dose: 25 g in 50 cc for adult 0.25 g/kg of 25% solution for peds • Action: Increases blood glucose. • Indication: Blood glucose level <60 mg/dl, altered level of consciousness and/or seizure of unknown origin • Contraindications: Intercranial hemorrhage • Side Effects: No systemic effects but may develop necrosis from infiltration locally. Home

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