Page 139 - Journal of Special Operations Medicine - Spring 2017

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Pharmacology 85% renal clearance; 7%–10% bile/stool clearance Significantly reduced clearance in renal failure Hepatic metabolism (active metabolites) Renal excretion (85%, 80% unchanged) Onset: <1 hour PO, 5–10 minutes IV Selective serotonin 5-HT 3 receptor antagonist Specific benzodiazepine receptor antagonist Resedation may occur 20–60 minutes after initial dose,

Onset <5 minutes. Active metabolites. Duration of action: 1–4 hours IM dose variable and delayed Oxycodone Hepatic metabolism Active metabolites Urinary excretion Duration of effect: 4–6 hours Acetaminophen (see below) Onset: 1–5 minutes Duration of effect: 1–4 hours Renal excretion Anticholinergic Rapid onset Duration of effect: 2–6 hours Duration of effect: 4–6 hours Hepatic metabolism Renal excretion Hepatic metabolism Excreted in the u

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Side-Effects and Notes Respiratory/cardiac/mental status depression Anticholinergic like effects, particularly urinary Respiratory/cardiac/mental status depression Liver toxicity (acetaminophen) at high doses or if compromised liver function at baseline Respiratory/cardiac/mental status depression Personnel and equipment needed for standard respiratory resuscitation should be available during midazolam administration. Increased serum transaminases A

Nausea/vomiting Pruritus (itching) Constipation retention Nausea/vomiting Pruritus (itching) Constipation Hypersensitivity (rare) Amnestic Nausea/vomiting Hypotension Constipation Tachycardia/palpitations Nausea/vomiting Flushing Urinary retention Not to exceed 4 doses/d Hypersensitivity (rare) Nausea/vomiting (IV) to 4,000mg Constipation Dizziness/
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Purpose/Dose Breakthrough pain in hemodynamically stable patient: IV/IO/ IN: dose every 5 minutes until goal achieved or RR Nonintubated: 2.5–10mg IM: not preferred; can give 5–10mg IM if necessary Contains oxycodone (5mg) AND acetaminophen (325mg) PO/enteral (may be crushed): 1–2 tabs every 4–6 hours. DO NOT exceed 4,000mg total acetaminophen per day. Sedation (includes anxiety or agitation): IV/IO: dose every 5 minutes until goal achieved or RR < An

Appendix D Cont. Name < 10/min. • Intubated: 5–10mg • Morphine** Background pain • Percocet 10/min. Nonintubated: 0.5–2mg • Intubated: 1–4mg • (Versed) Midazolam IM: not recommended ketamine) SC/IM/IV/IO: 0.1–0.2mg every 4 hours • (Robinul) Glycopyrrolate For mild to moderate pain: (Tylenol) Acetaminophen For nausea and vomiting: • • are not improved (Zofran) Odansatron • Flumazenil (Romazicon)

Guidelines: Analgesia and Sedation During PFC 115