Medication Administration and Injections Quiz

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Questions and Answers

What are the signs of a true allergy to a medication?

Rash, shortness of breath, and swelling (correct)

Fatigue and muscle pain

Dizziness and headache

Nausea and vomiting

Which IM injection needle gauge and length is appropriate for adults?

22 gauge, 1 inch needle

21-23 gauge, 1.5 inch needle (correct)

25 gauge, 2 inch needle

20 gauge, 3 inch needle

Which sites are appropriate for intraosseous (IO) access in both adults and pediatric patients?

Proximal Humerus, Distal Femur, Proximal Tibia (correct)

Distal Humerus, Proximal Radius, Distal Femur

Lateral Femur, Proximal Fibula, Distal Humerus

Proximal Femur, Distal Tibia, Proximal Pelvis

In pediatric patients, what is the maximum volume allowed for an IM injection at a single site?

1 mL Signup and view all the answers

What is the preferred method of vascular access during pediatric cardiac arrest?

Intraosseous (IO) administration Signup and view all the answers

What defines male puberty according to the guidelines?

Development of underarm, chest, or facial hair Signup and view all the answers

Which medications can be delivered via a mucosal atomization device (MAD)?

Versed and Narcan Signup and view all the answers

What is the maximum dose per nostril when using a mucosal atomization device?

1 mL per nostril Signup and view all the answers

What must be done if the sending facility physician refuses to administer paralytics for an intubated interfacility transfer?

Follow the Delayed Sequence Intubation protocol. Signup and view all the answers

Which type of patient should be transported to the closest OB Emergency Department?

Unstable OB patients. Signup and view all the answers

Which condition does NOT qualify a stable patient for transport to a free-standing emergency department?

Traumatic injuries likely needing urgent surgical intervention. Signup and view all the answers

For pediatric patients categorized under Priority 1, where should patients in respiratory or cardiac arrest be transported?

To the closest Pediatric ED. Signup and view all the answers

What is the maximum acceptable on-scene time for TRAUMA ALERT patients?

10 minutes. Signup and view all the answers

Which of the following is NOT included in the transport inclusion criteria for free-standing emergency departments?

Severe abdominal pain. Signup and view all the answers

Who must accompany a TRAUMA ALERT patient in the back of the rescue during transport?

Two paramedics if available. Signup and view all the answers

What is required for pediatric patients considered under the trauma transport category?

Children aged 15 and younger. Signup and view all the answers

What should be done for Baker Act patients requiring medical clearance?

Transport to the closest emergency department. Signup and view all the answers

Which statement correctly describes the criteria for transporting pediatric patients with general medical complaints?

Transport to a Pediatric facility if no serious signs are present. Signup and view all the answers

What is the appropriate insertion of a nasopharyngeal airway (NPA)?

In semi-conscious patients with an intact gag reflex Signup and view all the answers

When should you perform a surgical cricothyrotomy?

On patients age 13 years or older who cannot be ventilated Signup and view all the answers

What is the recommended ventilation rate for patients without a pulse?

1 breath every 10 seconds Signup and view all the answers

In which situation should you NOT withhold oxygen?

When the patient is hypoxic and shows signs of distress Signup and view all the answers

What is the proper airway intervention for an unresponsive patient without a gag reflex?

Insert an oropharyngeal airway Signup and view all the answers

What rate of breaths should a pediatric patient with a pulse receive?

1 breath every 3 seconds Signup and view all the answers

What ventilation rate should be maintained for patients with increased intracranial pressure (ICP)?

Maintain EtCO2 levels between 35-45 mm Hg Signup and view all the answers

What is the appropriate action for a conscious patient experiencing foreign body airway obstruction?

Apply abdominal thrusts until they are unresponsive Signup and view all the answers

Which patients should receive 15 LPM oxygen via non-rebreather mask (NRB), regardless of SpO2?

All third trimester pregnancy trauma patients Signup and view all the answers

What is the guideline for transporting pregnant trauma alert patients?

They should be transported to Broward Health Medical Center by air when possible Signup and view all the answers

What is the recommended action for patients showing signs of bronchospasm?

Accept high EtCO2 levels and manage symptomatically Signup and view all the answers

What should be documented if on-scene times for trauma alert patients exceed 10 minutes?

Reason for the delay must be documented Signup and view all the answers

At what age is a patient classified as a neonate?

Birth to 1 month Signup and view all the answers

Which age group is classified as children in pediatric assessments?

1 year to puberty Signup and view all the answers

What should be done if a patient exhibits unresponsiveness?

Continue assessing the respiratory status Signup and view all the answers

What does the acronym AVPU stand for in mental status assessment?

Alert, Verbal, Pain, Unresponsive Signup and view all the answers

When should a 12 lead ECG be performed?

When a patient displays chest pain Signup and view all the answers

Which vital sign is NOT typically monitored for unstable patients?

Hematocrit levels Signup and view all the answers

What does the acronym AEIOU-TIP help to remember?

Causes of altered mental status Signup and view all the answers

What should be assessed first in the circulatory evaluation?

Pulse Signup and view all the answers

Which patient population defines unstable in a medical context?

Patients with hypotension or chest pain Signup and view all the answers

What is the recommended action for monitoring blood pressure after drug administration?

Verify before and after drug administration Signup and view all the answers

Which vital sign is assessed every 5 minutes for unstable patients?

Blood pressure Signup and view all the answers

What is the primary purpose of the Handtevy system length-based tape?

To estimate medication dosages and equipment sizes for children Signup and view all the answers

What is the minimum number of vital sign assessments for all patients?

2 sets if time allows Signup and view all the answers

Which of the following is a primary assessment component?

Assessing vital signs Signup and view all the answers

Study Notes

Medication Administration

Inquire about medication allergies before administering any medication.
A true medication allergy causes a rash, difficulty breathing, swelling of tongue, face, and/or throat.
Follow the 6 Rights of drug administration.

Intraosseous (IO) Access

IO access should be utilized for patients with emergent medical conditions needing vascular access when IV access is not immediately available or deemed insufficient.
Adult Sites: proximal humerus (if surgical neck can be palpated), distal femur, proximal tibia.
Pediatric Sites: proximal humerus (if surgical neck can be palpated), distal femur, proximal tibia.

Intramuscular (IM) Injections

Administer all IM injections in the lateral thigh. Medication can be administered through clothing.
Adults: 21-23 gauge, 1.5-inch needle, maximum 4 mL per site.
Pediatrics: 23 gauge, 1-inch needle, maximum 1 mL per site. If more than 1 mL is needed, split the dose between both thighs.

Mucosal Atomization Device (MAD)

The MAD can be used to administer certain medications. The desired dose is 0.3-0.5 mL per nostril, with a maximum of 1 mL per nostril.
Medications that can be administered via the MAD: Versed, Fentanyl, Glucagon, Ketamine, Narcan.

Pediatric Considerations

Individuals who have not reached puberty are considered pediatric patients and should be treated according to pediatric guidelines.
Patients who have reached puberty should be treated as adults.
IO access is the preferred method of vascular access during pediatric cardiac arrest.
Female Puberty: defined by breast development.
Male Puberty: defined by underarm, chest, or facial hair.

The Handtevy System

The Handtevy system should be used for the resuscitation and treatment of all pediatric patients.
The child's age should be the primary reference point for determining appropriate patient care. If the child appears shorter or taller than their stated age or if the age is unknown, use the Handtevy system length-based tape.
The Handtevy system provides guidance for:
- Medication Dosages/Infusions
- Equipment
- Electrical Therapy
- Vital Signs

Pediatric Age Classifications

Neonates: Birth to 1 month
Infants: 1 month to 1 year
Children: 1 year to puberty

Pediatric Transport Decisions

Trauma Patient: 15 years of age or younger
Medical Patient: 17 years of age or younger

Mental Status Assessment (AVPU)

Alert: Patient is aware of person, place, time, and event (AAOX4).
Verbal: Patient responds only to verbal stimuli.
Pain: Patient responds only to painful stimuli.
Unresponsive: Patient does not respond to any stimuli.

Mental Status Assessment (GCS)

Use the Glasgow Coma Scale (GCS) to assess level of consciousness.

Altered Mental Status (AMS)

When a patient presents with AMS, consider possible causes using the AEIOU-TIP mnemonic:
- Alcohol
- Epilepsy (Seizures)
- Insulin (Hyper-/Hypoglycemia)
- Overdose/Oxygenation
- Uremia (Kidney Failure)
- Trauma
- Infection (Sepsis)
- Psychiatric

Airway/Breathing

Assess the airway. If breathing is present without compromise, continue the assessment.
If spontaneous breathing is present with compromise or the patient is not breathing, provide ventilatory support. Consult the Ventilatory Assistance Protocol.

Circulation

Assess pulse (carotid, brachial, or radial).
Assess capillary refill.
Assess skin (color, condition, and temperature).
For patients found pulseless, refer to the "Cardiac Arrest" algorithm.
For pediatric patients found bradycardic with signs of poor perfusion and AMS, refer to the "Bradycardia" protocol.

Physical Assessment

All patients should receive a physical exam.
Physical exams include primary and secondary assessments.
When injuries or abnormalities are found, conduct a focused exam and refer to the specific protocol.

Vital Signs

All patients should receive a minimum of 2 sets of vital signs if time allows.
Patients being cared for over an extended period of time should also have the appropriate number of vital sign assessments.
Vital Signs to Assess:
- Pulse (rate, rhythm, and quality).
- Respirations (rate and quality).
- Skin (color, temperature, condition).
- Temperature.
- Lung Sounds
- Pulse Oximetry
- Blood Pressure (capillary refill).
- Pupillary Response
- EtCO2
- Blood Glucose Level (BGL)
Unstable Patients: Receive vitals every 5 minutes. Unstable can be defined as hypotension, chest pain, AMS, and/or SOB.
Hypotension for Adults: Defined as Systolic BP < 90 mm Hg.
Blood Pressure: Check before and after administering a drug.
Manual Blood Pressure: Should be taken to confirm any abnormal or significant changes in an automatic blood pressure cuff reading.

End Tidal Carbon Dioxide (EtCO2) Monitoring

EtCO2 monitoring should be utilized for the following patients:
- Patients requiring ventilatory support (e.g., BVM, ET tube, SGA, CPAP).
- Patients in respiratory distress.
- Patients with Altered Mental Status.
- Patients who have been sedated.
- Patients who have received pain medication.
- Seizure patients.
- Suspected Sepsis.
- Cardiac arrest.

Blood Glucose Level (BGL)

Document a BGL for the following patients:
- History of diabetes.
- Altered mental status.
- General weakness.
- Seizure.
- Syncope/lightheadedness.
- Dizziness.
- Poisoning.
- Stroke.
- Cardiac arrest.

Electrocardiogram (ECG) Monitoring

All ALS patients should be continuously monitored in Lead II.
Perform a 12-lead ECG on the following patients:
- Chest/arm/neck/jaw/upper back/shoulder/epigastric pain or discomfort.
- Palpitations.
- Syncope, lightheadedness, general weakness, or fatigue.
- CHF, SOB, hypertension, or hypotension.
- Unexplained diaphoresis or nausea.
- Any heart rate less than 50 or greater than 150.
Repeat 12-lead ECGs every 10 minutes and upon ROSC.
When transporting, leave the cables connected until the patient is turned over to the Emergency Department (ED) staff.

Patient History

Obtain the following information:
- Chief Complaint: Why did the person call 911?
- SAMPLE History:
  - Signs & Symptoms
  - Allergies
  - Medications (Prescribed, over-the-counter, or not prescribed to patient)
  - Past Medical History (patient’s and immediate family’s)
  - Last Oral Intake
  - Events Preceding
- History of the Present Illness (OPQRST.A):
  - Onset: Did the symptoms appear gradually or suddenly?
  - Palliative: What makes the symptoms better?
  - Provoke: What makes the symptoms worse?
  - Previous: Previous similar episodes?
  - Quality: (What kind of pain?) pressure, squeezing, aching, dull, etc.
  - Radiation: Does the pain or discomfort radiate? Where?
  - Severity of Pain: 1-10 scale (utilize “Faces” pain scale for pediatrics)
  - Time: What time did the symptoms begin?
  - Associated: What are the associated signs & symptoms?

Airway Positioning

Medical Patient: Position patient with external auditory meatus (a.k.a. “The Earhole”) on the same external plane as the sternal notch.
Trauma Patient with Suspected Spinal Cord Injury: Modified jaw thrust.

Ventilatory Support

Assist ventilations with a bag-valve mask (BVM) attached to supplemental oxygen at 15-25 lpm.
Suction as needed.
Apply and monitor pulse oximeter / ETCO2.

Ventilatory Rates

Patients with a Pulse:
- Adult: 1 breath / 6 seconds.
- Pediatric: 1 breath / 3 seconds.
Patients without a Pulse:
- Adult: 1 breath / 10 seconds.
- Pediatric: 1 breath / 6 seconds.
Patients with ICP/Herniation: Maintain EtCO2 between 35-45 mm Hg and SpO2 > 94% while continuously monitoring BP.

Oxygen Administration

DO NOT withhold oxygen if the patient is dyspneic or hypoxic.
SpO2: Maintain SpO2 of 94% for all patients. Exception: Maintain SpO2 of 90% for COPD & Asthma.
The following patients, regardless of SpO2, shall receive 15 LPM via NRB:
- All 3rd trimester pregnancy trauma patients.
- All head injury patients.
- Decompression sickness.
- Carbon Monoxide exposure.
- Cyanide exposure.

Foreign Body Airway Obstruction (FBAO)

Conscious Patient: Apply abdominal thrusts until unresponsive.
Unresponsive Patient: Receives chest compressions.
Infants: Apply chest compressions and back blows.
If unable to relieve the FBAO, visualize it with a laryngoscope and extract the foreign body with Magill forceps.
If unable to extract FBAO or adequately ventilate, perform a surgical cricothyroidotomy (age > 13 y/o) or needle cricothyroidotomy on Pediatrics (age < 12 y/o).
If air exchange is adequate with a partial airway obstruction, DO NOT interfere, instead encourage the patient to cough up the obstruction.

Delayed Sequence Intubation Protocol

If spontaneous breathing is not present after the removal of FBAO; there is failure to ventilate; failure to maintain airway patency, or rapid deterioration of clinical presentation, refer to the Delayed Sequence Intubation Protocol.

Transport Destinations

Priority 1 Patients

Cardiac or Respiratory Arrest: Transport to the closest ED, considering STEMI facilities for Cardiac Arrest patients with ROSC.
Trauma Alerts (Level 1 ONLY): Transport to the closest Trauma Center. If on bypass, transport patient to the next closest Trauma Center.
Trauma patients who arrest in the presence of Fire Rescue personnel: Transport to the closest Trauma Center.
Pregnant Trauma Alert (Level 1): Transport to BHMC by air when possible.

Priority 2 Patients

Unstable Patients with Immediate Life-Threatening Conditions: Transport to the closest appropriate ED.
Level 2 Trauma Patients: Transport to the closest Trauma Center. If on bypass, transport patient to the next closest Trauma Center.
Pregnant Level 2 Trauma, visibly or by history of gestation > 20 weeks: Transport to Broward Health Medical Center by air whenever possible.
STEMI Alerts: Transport to the closest STEMI facility.
Stroke Alerts: Transport to a Comprehensive Stroke Center.
Sepsis Alert: Transport to the closest ED (excluding free-standing ED’s).

Priority 3 Patients

Stable Patients with no Immediate Life-Threatening Conditions: Transport to the closest appropriate ED.
Free Standing ED’s: Transport to a “Free Standing ED” after determining that the patient meets Free Standing ED transport criteria:
- Stable patients with medical or trauma complaints not likely to require emergent admission or acute surgical intervention.
- Minor respiratory complaints without abnormal breath sounds and/or SaO2.
- Fever, chills, cough, congestion, flu-like symptoms.
- Non-medical chest pain (without other profound signs and symptoms, abnormal EKG, multiple or complicated pre-existing medical conditions).
- Isolated musculoskeletal or orthopedic injuries.
- Urinary symptoms.
- Nausea/vomiting/diarrhea complaints without signs of shock.
- Isolated head trauma in adults without acute neurological deficits or a high index of suspicion of a more complex problem.
- General abdominal or flank pain without signs of acute abdomen or surgical emergency.
- Traumatic injuries not likely to require urgent surgical intervention.
- Soft tissue injuries, lacerations, puncture wounds.
- Minor gynecological complaints (pelvic pain without signs of shock or severe pain or symptoms consistent with acute abdomen).
- Pediatric patients with general medical complaints without significant signs and symptoms of shock, cardiac symptoms, impending respiratory failure, altered mental status, or have complicated pre-existing conditions likely to require admission to a pediatric facility.
Obstetrical (OB) Patients: Defined as gestation > 20 weeks. Unstable OB patients should be transported to the closest OB ED. Stable OB patients should be transported to the OB ED of their choice.
Baker Act Patients: Transport to the closest ED for medical clearance (except for cardiac, stroke, sepsis, etc.).

Pediatrics

For the purpose of medical transports, a pediatric patient is 17 years old or younger.
For trauma transports, a pediatric patient is considered 15 years old or younger.

Priority 1 Patients

Respiratory Arrest: Transport to the closest Pediatric ED.
Cardiac Arrest with/without ROSC: Transport to the closest Pediatric ED.
Trauma Alert (Level 1):
- Transport to the closest Pediatric Trauma Center. If on bypass, transport patient to the next closest Pediatric Trauma Center.
- A minimum of 2 paramedics must accompany a TRAUMA ALERT patient in the back of the rescue, provided it does not cause a significant delay in transport.
- On-scene times for TRAUMA ALERT patients should be < 10 minutes. On-scene times > 10 minutes shall have the reason for the delay documented in the ePCR report.
- If ground transport is > 20 minutes, transport by air, if available.

Priority 2 Patients

Level 2 Trauma Patients (< 16 Years Old):
- Transport to the closest Pediatric Trauma Center. If on bypass, transport patient to the next closest Pediatric Trauma Center.

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Description

Test your knowledge on medication administration, including the importance of checking for allergies and the 6 Rights of drug administration. Additionally, explore intraosseous (IO) and intramuscular (IM) injection techniques for adults and pediatric patients. This quiz provides vital information for healthcare professionals.