Transport Medications Role 1

For Role 1 Transport, the focus will be on delivering medications for 4 purposes.

  • Antiemetic

  • Analgesia

  • Antibiotic

  • Hemostasis (highest priority)

  1. Antiemetic

  • Oral options include Ondansetron (Zofran).

    • The standard adult dose is 8 mg every 6-8 hours.

      • Available in pill and preferrred ODT (Oral Dissolving Tablet)

  • Parenteral options include Promethazine (Phenergan).

    • DO NOT ADMINISTER IV; IM USE ONLY

    • The standard dose is 12.5 to 25 mg IM every 6-8 hours.


2. Analgesia

  • Oral options include Paracetamol/Acetaminophen and NSAIDs.

    • MOAS is administering a combination dose pack of Paracetamol + NSAID to any patient who can take medication by mouth. The choice of NSAID varies with availability

    • Analgesic Oral Single Dose Packs have been prepared.

      • Example

        • Paracetamol 1000 mg + Meloxicam 15 mg

  • Parenteral analgesics available include Ketorolac, an NSAID, and possibly an opioid analgesic based upon availability.

    • NSAID

      • Ketorolac 15-30 mg IV; 30-60 mg IM

    • Narcotic

      • Nalbuphine (synthetic mixed agonist-antagonist opioid)

        • The usual recommended adult dose is 10-20 mg for a 70 kg individual, administered subcutaneously, intramuscularly, or intravenously; this dose may be repeated every 3 to 6 hours as necessary. Individual dose not to exceed 20 mg. Start low and go slow to minimize adverse effects

      • Morphine

      • Hydromorphone

3. Antibiotic

  • Given to ALL patients with open or penetrating trauma or in whom emergency surgery is anticipated (surgical antibiotic prophylaxis).

  • Oral single-dose options (emergency surgery is NOT anticipated) include the following.

    • Cephalexin 2000 mg + Doxycycline 200 mg PO

OR

    • Moxifloxacin 400 mg + Doxycyline 200 mg PO

  • Parenteral single-dose (Emergency Surgery IS anticipated) options include the following.

    • Standard

      • Ceftriaxone 2000 mg IV

      • Intra-abominal Injury

      • Ceftriaxone 2 gm IV + Metronidazole 500 mg IV

OR

      • Cefazolin 2 gm IV + Metronidazole 500 mg IV


4. Hemostasis

  • Tranexamic Acid given within 3 hours of hemorrhagic trauma has been shown to decrease mortality by 30%.

    • It is the highest priority to administer Tranexamic Acid AS SOON AS POSSIBLE.

  • May be administered IM/IV/PO.

    • IM dose is 10 ml and as a consequence is considered the last option

  • MOAS protocol is to administer an oral dose of 1950 mg (650 mg x 3) as soon as possible to ALL patients with hemorrhagic trauma.

    • These are pre-packed for ease of administration.

  • Bioequivalent dose IM/IV 1000 mg = Oral 1950 mg