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.

  • Administer 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

    • 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-abdominal 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.

  • IV/IM 1000 mg

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

• The Oral protocol (when IV access is not available) 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