Page 151 - PJ MED OPS Handbook 8th Ed

Observe the Following:
• Medications are not always indicated. Weigh the benefits against the potential adverse ef-
fects to patient and mission.
• All medications have the potential for adverse effects and many patients have a history of ad-
verse reactions to medications. For conscious patients, obtain a drug history; for unconscious
patients, search for identification/medical warning tags/bracelets.
• Follow recommended doses.
• When using IV medication, have a reliable IV fluid line running and inject the medication into
the rubber fitting in the IV line.
• When injecting through a saline lock, flush the lock with 10mL of normal saline after admin-
istering the medication.
• In addition to medication, the patient may require maintenance fluids, electrolytes, and nu-
tritional balance.
• For pain meds and sedatives use incremental increase in doses to achieve the desired effect
to avoid hypotension and respiratory depression when the situation permits.
• Give all IV medications by slow IV push.
• Give ertapenem by IV drip over 10 minutes, IV push from a 10mL syringe at rate of 1mL/on
the minute over 10 minutes, or IM with 2mL lidocaine if responsive to pain.
• For medications that come in oral preparations, give them orally if the patient is alert and
can swallow.

General Rules

CAUTION: Be prepared for anaphylactic reactions at all times; follow Anaphylaxis Protocol.

1. Use sterile technique: Alcohol cleaning of injection port or skin.
2. Always aspirate before injecting medication to make sure the needle is not intravascular if IM, or
to insure proper placement in a vein for IV medication.
3. For IVs: Mark on tape the date, time, and needle size.

Routes of Administration:
1. Oral:
Give adequate fluids. Preferred route if med is available PO and patient is conscious, can swallow
without choking/gagging, and does not have abdominal trauma.
2. Subcutaneous (SQ or SubQ) injection:
Gently grasp skin over injection site and pull skin away from underlying muscle, forming a
mound. Insert the needle at a 45° angle. Aspirate before injection.
3. Intramuscular (IM) injection:
Hold needle at 90° to the skin, insert deep into the muscle, aspirate to make sure the needle is
not intravascular, and inject.
Avoid when able in patients with low blood pressure/shock due to variable absorption. However,
immediately battlefield post injury it is often appropriate to give an IM injection of ketamine for
patients with severe pain, if a fentanyl lozenge appears inadequate.

Chapter 9. Pararescue Drug Formulary n 149