1. IV Therapy and Medication
Administration
CFD April QA Training
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2. Intravenous Therapy
 Fluid/electrolyte administration
 Normal blood volume is 4.5-5L
 IV fluids do not replace blood or carry O2
 Introduce medications
 Immediate drug absorption and effects
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3. Crystalloids-Fluids used in the field
 Normal Saline (1000 cc)
 0.9% Sodium Chloride
 Isotonic solution
 Lactated Ringers (1000cc)
 Isotonic solution containing electrolytes such as
NaCl, KCl, CaCl, and sodium lactate
 D5W (250cc)
 Hypotonic solution containing glucose to provide
calories for metabolism
 Glucose moves into cells rapidly
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4. Equipment needed
 IV solution
 Medical—NS; Trauma—LR and/or NS; Med drip—
D5W
 Administration set with extension tubing
 Macro drip (10-15 gtts/cc) for all IV’s
 Micro drip (60 gtts/cc) for medication drip
 Catheter
 Age >12 and need for fluid resus—16 or 18 g
 Age <12 and/or no need for fluid resus—20-24 g
 Age <6—may consider Intraosseous
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5. Equipment needed (cont)
 Gloves
 Tape and bioclusive dressing
 Tourniquet
 Alcohol/betadine pad
 Use betadine in cases of suspected ETOH use
where a crime may be involved (DUI)
 Ensure no allergies when using betadine
 Arm board
 Sharps container
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6. IV Complications
 Infiltration
 Fluid outside vessel causing swelling, pain, little or
no IV flow
 Catheter shear
 Piece of catheter separates
 Air embolism
 Air enters blood stream (10-100 cc have been
fatal)
 Infection
 Localized or systemic Home

7. Saline lock vs. IV
 Saline lock
 Potential need for single med
administration
 IV
 Multiple meds and/or D50, fluid admin
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8. Acceptable IV sites
 Arm
 Multiple veins in hand and arm
 Neck
 External jugular
 Leg
 Long saphenous vein*
 Anteromedial aspect of the tibia (IO)
*Leg and foot veins involve a very high incidence of complications and
should only be used cautiously as a last resort.
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9. Fluid bolus
 Maintain blood pressure between 90-
100 mmHg systolic
 Give 250 cc boluses one at a time
 Closely monitor blood pressure, lung
sounds and patient status prior to giving
additional boluses
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10. Medication Administration
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11. Five Right’s
1. Right patient
2. Right dose
3. Right medication
4. Right route
5. Right time
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12. IV medication packaging
 Vials (Single or Multi-dose)
 Draw equal amount of air into proper syringe
 Inject air into vial and withdraw medication
 Ampules
 Tap neck area to drain fluid
 Using alcohol prep or 4X4, snap neck of vial
 Withdraw proper amount of medication and
dispose of ampule pieces in sharps container
 Remember, always use aseptic technique and remove
air from syringe prior to injecting! Home

13. IV medication packaging (cont)
 Prefilled syringes
 Tubex (glass syringe without plunger)

attach to plastic plunger based on device

dispel air and use as standard syringe
 Prepackaged (style with two pieces)

remove caps and screw pieces together

dispel air and use as standard syringe
 Dry powder meds (lose efficacy when pre-mixed)

Depress plunger in vial to mix with prepackaged saline or
add saline to vial and mix thoroughly
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14. Med Math
 The basics…
 use like units
 use common sense
 find a formula/system that works for you
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15. 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
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16. 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
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17. 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
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18. 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

19. 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
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20. 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
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21. Drip calculations
“Clock” method (used only for 4:1 ratio)
4
3 1
60
15
30
45
2
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

22. 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.
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23. Routes to administer medications
 Enteral (via digestive tract)
 Oral (by mouth, PO)

10-90 minutes to begin working

Affected by digestion and absorption
 Sublingual (under the tongue, SL)

3-5 min
 Rectal (via the rectum, RE)

5-30 minutes
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24. Med routes (cont)
 Parenteral
 Inhalation (IH)
 Endotracheal (ET)
 Transdermal (TD)

Time for effects variable based on medication
 Subcutaneous (SQ)
 Intramuscular (IM)
 Intravenous/Intraosseous (IV/IO)
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25. Medication delivery through the airway
 Inhalation
 Takes effect in 2-3 min
 Given by hand held nebulizer (HHN) or
metered dose inhaler (MDI)
 Endotracheal
 Takes effect in 2-3 min
 Must double IV dose and flush with saline
 Narcan, Epinephrine, Lidocaine, Atropine
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26. Intramuscular and Subcutaneous
 Intramuscular
 Takes effect in 10-20 min
 Delivery

90 degree angle, 1 ½ inch minimum needle
 Subcutaneous
 Takes effect in 15-30 min
 Delivery

45 degree angle, 1/2-1 inch needle
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27. Standing Orders vs. Physician Order
 Standing Order
 Able to give med or start procedure if patient
meets certain preset criteria
 Physician Order
 Must request med or procedure from on line
doctor

When giving report, ask for doctor before beginning

Give report and paint clear picture of patient status

Specifically request the medication and dose you want to
give
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28. Things to look for…
 Onset of Action-time between administration and first effects
seen
 Duration of Action-time after administration until effects are last
seen
 Side effect-undesirable and often unavoidable effect that
occurs. Effects are not the original reason for administering the
drug.
 Interaction-good or bad effects that occur with administration of
multiple drugs. Can increase or decrease effects of one or both
meds.
 Synergism-action of a combination of drugs that is greater than
one drug alone
 Allergy-systemic reaction to a drug involving the immune
response
 Untoward effect-side effect that becomes harmful to the patient
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29. Documentation
 Medication
 Dose
 Time
 Route
 Person who administered
 Effects
 List good, bad, expected, and unexpected effects
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30. 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
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31. 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
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32. 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
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33. 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.
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34. 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
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35. 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
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36. 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!
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37. 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
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38. 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.
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39. 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
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40. 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
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41. 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.
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42. Thiamine (Betaxin, Vitamin B1)
 Physician Order: ST
 Standing Order: CT, PM
 Dose: 100 mg IV or IM
 Action: Combines with ATP to form a coenzyme necessary in
the metabolism of carbohydrates
 Indications: Prior to the administration of D50 as part of the
unconscious protocol, Wernicke’s encephalopathy
 Contraindications: None
 Side Effects: Hypotension from rapid admin, anxiety, nausea
and vomiting, diaphoresis, red streaks following up the vein
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43. 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.
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44. CT and PM Meds
 Adenosine (Adenocard)-narrow complex tachycardias, SVT
 PO: CT and SO: PM
 Dose: 6mg, 12mg, 12mg rapid IV push
 Atropine-asystole (SO: CT, PM)-1mg every 3-5 min up to 3mg
 Bradycardia (PO: CT and SO: PM)

0.5mg-1mg every 3-5 min up to a total of 0.04 mg/kg or 3mg
 Bretylium (Bretylol)-Pulseless Vtach/Vfib or Vtach
 PO: CT, PM
 5mg/kg rapid IV push repeated in 5 min at 10mg/kg to a max of 30mg/kg
over 24 hours
 Calcium chloride-Ca channel blocker overdose, crush syndrome,
hyperkalemia, hypocalcemia
 PO: CT, PM
 8-16 mg/kg slow IV push
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45. CT and PM meds (cont.)
 Cardizem (Diltiazem)-Afib or Aflutter
 PO: CT, SO: PM
 Dose: 0.25 mg/kg IV over 2 min
 Diazepam (Valium)-sedation or seizure control
 PO: CT, SO: PM
 2-5 mg IV for adults, 0.2-0.3 mg/kg for peds
 Dopamine (Intropin)-hypotension without hypovolemia
 PO: CT, PM
 5-20 mcg/kg/min IV drip (400 mg/250cc)
 Epinephrine (Adrenalin)-cardiac arrest (IV, ET)
 SO: CT, PM
 1 mg IV every 3-5 min in cardiac arrest, doubled for ET
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46. CT and PM meds (cont.)
 Epinephrine drip-profound symptomatic bradycardia
 PO: CT, PM
 2- 10 mcg/min IV drip (1mg/250cc)
 Epinephrine nebulized-pediatric upper airway obstruction
 PO: CT, PM
 2-3 mg of 1:1000 in nebulizer
 Furosemide (Lasix)-rales, CHF
 PO: CT, SO: PM
 40 mg IV or 0.5-1.0 mg/kg for adult and 1mg/kg for peds
 Lidocaine (Xylocaine)-Vtach, Vfib, wide complex tachycardias
 SO: CT(cardiac arrest only), PM
 1.5 mg/kg initial dose and repeat for cardiac arrest up to 3mg/kg total
 0.5-0.75 mg/kg repeat dose with pulse up to 3mg/kg total
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47. CT and PM meds (cont.)
 Magnesium Sulfate-Torsades de pointes, refractory Vfib, preeclampsia
 PO: CT, PM
 1-2 g in 10cc IV over 1-2 min for arrest and 2-4 g in 50cc NS slow IV push
 Midazolam Hydrochloride (Versed)-sedation, seizures
 PO: CT, SO: PM
 2mg slow IV push titrated to effect
 Morphine Sulfate-pain, CHF
 PO: CT and PM
 1-3 mg slow IV for CHF and chest pain and 2-4 mg IV for burns
 Sodium Bicarbonate (Bicarb)-tricyclic antidepressant overdose, return
of circulation after long arrest, known severe acidosis
 PO: CT and PM
 1 mEq/kg IV push
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48. CT and PM meds (cont.)
 Solumedrol (Methylprednisolone)-anaphylaxis, severe asthma
 PO: CT and PM
 125 mg IV
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