Page 168 - PJ MED OPS Handbook 8th Ed

Warnings:
○ Use with caution when other medications capable of producing central nervous system
depression are used.
○ Prior to the intravenous administration of midazolam be sure that the immediate avail-
ability of oxygen, resuscitative drugs, age and size-appropriate equipment for bag/valve/
mask ventilation and intubation, and skilled personnel for the maintenance of a patent
airway and support of ventilation are available.
○ Monitor patients continuously for early signs of hypoventilation, airway obstruction, or
apnea.
○ Use with caution in patients with severe fluid or electrolyte disturbances.
○ Oxygen is desirable, but not absolutely required.

Morphine Sulfate (Opioid)

NOTE: This is not a medication that Pararescue forces should be utilizing. It may be seen
when working with partner forces and in 3rd world situations.

GROUNDING medication for personnel on flight status.
• Description: Narcotic analgesic – alters perception of pain and emotional response to pain.
Have naloxone HCI (Narcan) available when using morphine.
• Indications: severe pain, pain from cardiac ischemia
Contraindications: respiratory depression, hypotension, head injury
• Adult Dose: 4–15mg IV/IM slow push (titrate to response)
• Pediatric Dose: 0.1–0.2mg/kg IM/IV (Do not exceed 15mg)
• Side-effects: lower respiratory drive, hypotension, bradycardia, nausea, vomiting, dizziness,
pruritus, skin flushing
• Adverse reactions: seizures with large doses, constipation, ileus, urinary retention

Moxifloxacin (Avelox )
®
Aviation personnel are grounded for the initial 24 hours of antibiotic therapy and until the
medical condition no longer interferes with safely performing aviation duties and the patient is free
of side-effects.
• Description: 4th generation quinolone
• Indications: open wounds, penetrating eye injury, other infections when specific antibiotics
are not available
• Dose: 400mg/day PO
Contraindications: allergy, pediatrics, pregnancy
• Side-effects: photosensitivity, insomnia, vertigo
• Adverse reactions: tendinopathy, abnormal dreams
• Other notes:
○ Oral antacids decrease absorption of the moxifloxacin when taken orally. Visually inspect
any solution of moxifloxacin for particulate matter and discoloration prior to use. Solution
must be clear.
○ IV administration – must be reconstituted prior to administration
○ Do not mix or co-infuse with other medications
○ At cool temperatures precipitation may occur, which will re-dissolve at room temperature

166 n Pararescue Medical Operations Handbook / 8th Edition