Title: Maryland Medical Protocols for EMS 2021
Tags: BLS Maryland medication pharmacology protocols airway albuterol breathing respiratory-distress dosage pain acetaminophen pediatric adult contraindications precaution abbreviations adverse-effects alert preparation terminology device trade-name indications mnemonic

Q: Trade name(s) for [...] include [...].
A: acetaminophen; Tylenol^®

Q: What are the indication(s) for acetaminophen:
A: Indications for this medication:
Patients aged ≥2 judged to be in mild to moderate discomfort
(e.g., 1–5 on FACES scale)

Q: What are the adverse effect(s) of acetaminophen:
A: Adverse effects of this drug:
not clinically significant

Precaution(s) for acetaminophen: administration of acetaminophen for mild to moderate pain does not eliminate the need for transport of the patient to the hospital to receive a comprehensive evaluation of the cause of the pain and appropriate definitive treatment.

Q: Contraindications for [...]:
[...].
A: acetaminophen; 1.   head injury
2.   hypotension
3.   administration of acetaminophen or medications containing
acetaminophen within the previous four (4) hours
4.  inability to swallow or take medications by mouth
5.   respiratory distress
6.   persistent vomiting
7.   known or suspected liver disease (including patients suspected of current alcohol ingestion)
8.   allergy to acetaminophen
9.   patients less than 2 years of age

Q: What is an important consideration with the contraindication(s) of acetaminophen?
A: Many common cold preparations contain this medication.

Q: Mnemonic for the contraindications of acetaminophen:
A: AAA HH RSVP or AHAHA RSVP:
Acetaminophen with previous 4 hours
Allergic
Alcohol/liver disease
Head injury
Hypotensive
Respiratory distress
Swallowing difficulty
Vomiting
Pediatric (< 2 years old)

Acetaminophen dosage for children (i.e. <13 years old):
<2 years of age: not indicated
2–4 years: 1 unit dose 160 mg/5 mL
5–12 years: 2 unit doses of 160 mg/5 mL each for a total of 320 mg/10 mL

Acetaminophen dosage for children (i.e. < 13 years old):
< 2 years of age: not indicated
2--4 years: Unit dose 160 mg/5 mL
5–12 years: 2 unit doses of 160 mg/5 mL each for a total of 320 mg/10 mL

Acetaminophen dosage for adults (i.e. ≥13 years):
4 unit doses of 160 mg/5 mL each for a total of 640 mg/20 mL or
325 mg pill or tablet x2 for a total of 650 mg.

Q: What is the acetaminophen dosage for adults?
A: Administering acetaminophen for this group:
four (4) unit doses of 160 mg/5 mL each for a total of 640 mg/20 mL
OR
two (2) 325 mg pill or tablet for a total of 650 mg

Q: What is the acetaminophen dosage for children?
A: Administering acetaminophen for this group:
< 2 years of age: not indicated
2–4 years: one (1) unit dose 160 mg/5 mL
5–12 years: two (2) unit doses of 160 mg/5 mL each for a total of 320 mg/10 mL

Q: What is the acetaminophen dosage for children <2 years of age?
A: Administering acetaminophen for this group:
not indicated

Q: What is the acetaminophen dosage for children 2–4 years?
A: Administering acetaminophen for this group:
One (1) unit dose 160 mg/5 mL

Q: What is the acetaminophen dosage for children 5–12 years?
A: Administering acetaminophen for this group:
Two (2) unit doses of 160 mg/5 mL each for a total of 320 mg/10 mL

Q: Many [...] contain [...].
A: common cold preparations; acetaminophen

For preparing acetaminophen use the unit dose only; do not use multidose bottle of liquid.

Q: One (1) unit dose of [...] is [...] or [...].
A: acetaminophen; 160 mg/5 mL liquid; 325 mg pill/tablet

Q: What are some trade name(s) for acetaminophen?
A: Trade names for this medication include Tylenol^®.

Q: What are the adverse effect(s) of Albuterol:
A: Adverse effects of this medication:
1.   tachycardia/palpitations
2.   hypertension
3.   angina
4.   nervousness/anxiety
5.   tremors
6.   dizziness
7.   headache
8.   sweating
9.   nausea/vomiting
10. sore throat

Q: What are the indication(s) of Albuterol?
A: Indications for this medication:
1.   signs and symptoms of respiratory distress
2.   bronchospasm/wheezing associated with:
      a.   asthma
      b.   chronic bronchitis
      c.   emphysema
      d.   allergic reactions (anaphylaxis)

Q: What is the Albuterol dosage for adults?
A: The dosage for this group:
Inhaler: maximum of two (2) doses (four (4) puffs) over a 30-minute period
Nebulizer: 2.5 mg by nebulized aerosol connected to 6–8 lpm of oxygen; may repeat
one (1) time

Q: What is the Albuterol dosage for children?
A: The Albuterol dosage for this group:
Inhaler: maximum of two (2) doses (four (4) puffs) over a 30-minute period
Nebulizer:
May repeat one (1) time; connect to 6–8 lpm of oxygen:
<2 years: 1.25 mg by nebulized aerosol
≥2 years: 2.5 mg by nebulized aerosol

Q: What is the Albuterol dosage for children (<2 years old)?
A: The Albuterol dosage for this group:
Inhaler: maximum of two (2) doses (four (4) puffs) over a 30-minute period
Nebulizer:
1.25 mg by nebulized aerosol.
May repeat one (1) time; connect to 6–8 lpm of oxygen:

Q: What is the Albuterol dosage for children (≥2 years old)?
A: The Albuterol dosage for this group:
Inhaler: maximum of two (2) doses (four (4) puffs) over a 30-minute period
Nebulizer:
2.5 mg by nebulized aerosol.
May repeat one (1) time; connect to 6–8 lpm of oxygen

Q: What are some trade name(s) for Albuterol?
A: Trade names for this medication include Proventil^®, Ventolin^®.

Q: Trade name(s) for [...] include [...].
A: Albuterol; Proventil^®, Ventolin^®

Q: What are the precaution(s) for acetaminophen?
A: Precautions for this medication are:
Administration of acetaminophen for mild to moderate pain does not eliminate
the need for transport of the patient to the hospital to receive a comprehensive
evaluation of the cause of the pain and appropriate definitive treatment.

Q: What are the precaution(s) for Albuterol?
A: Precautions for this medication are:
May cause severe bronchospasm from repeated excessive use.

Q: Precaution(s) for [...]: [...]
A: Albuterol; may cause severe bronchospasm from repeated excessive use.

Q: What are the contraindication(s) of acetaminophen?
A: The contraindications of this medication are:
1.   head injury
2.   hypotension
3.   administration of acetaminophen or medications containing
acetaminophen within the previous four (4) hours
4.  inability to swallow or take medications by mouth
5.   respiratory distress
6.   persistent vomiting
7.   known or suspected liver disease (including patients suspected of current alcohol ingestion)
8.   allergy to acetaminophen
9.   patients less than 2 years of age}}.

Q: What are the contraindication(s) of Albuterol?
A: The contraindications of this medication are:
Known hypersensitivity

Q: Contraindication(s) for [...]:
[...].
A: Albuterol; known hypersensitivity

For preparing Albuterol you need either a hand-held (unit dose) aerosol inhaler (aka a(n) MDI) or a(n) ampule for nebulizer.

Q: For preparing [...] you need [...].
A: Albuterol; either a hand-held (unit dose) aerosol inhaler (MDI) or ampule for nebulizer

Q: [...] dosage for [...]:
[...].
A: Albuterol; children; Inhaler: Patient may receive a maximum of 2 doses (4 puffs) over a 30 minute period.
Nebulizer:
<2 years: 1.25 mg by nebulized aerosol
≥2 years: 2.5 mg by nebulized aerosol
For both: May repeat one (1) time; connect to 6–8 lpm of oxygen

Albuterol dosage for children <2 years old:
Inhaler: Patient may receive a maximum of 2 doses (4 puffs) over a 30 minute period.
Nebulizer: 1.25 mg by nebulized aerosol
May repeat one (1) time; connect to 6–8 lpm of oxygen.

Q: [...] dosage for [...]:
[...].
A: Albuterol; children ≥2 years old; Inhaler: Patient may receive a maximum of 2 doses (4 puffs) over a 30 minute period.
Nebulizer: 2.5 mg by nebulized aerosol
May repeat one (1) time; connect to 6–8 lpm of oxygen

Albuterol dosage for children ≥2 years old:
Inhaler: Patient may receive a maximum of 2 doses (4 puffs) over a 30 minute period.
Nebulizer: 2.5 mg by nebulized aerosol
May repeat one (1) time; connect to 6–8 lpm of oxygen.

Albuterol dosage for adults:
Inhaler: Patient may receive a maximum of 2 doses (4 puffs) over a 30 minute period.
Nebulizer: 2.5 mg by nebulized aerosol
May repeat one (1) time; connect to 6–8 lpm of oxygen.

Q: [...] dosage for [...]:
[...].
A: Albuterol; adults; Inhaler: Patient may receive a maximum of 2 doses (4 puffs) over a 30 minute period.
Nebulizer: 2.5 mg by nebulized aerosol
May repeat one (1) time; connect to 6–8 lpm of oxygen

Q: [...] dosage via [...]:
[...]
A: Albuterol; inhaler; Adult: Patient may receive a maximum of 2 doses (4 puffs) over a 30-minute period
Pediatric: Patient may receive a maximum of 2 doses (4 puffs) over a 30-minute period

Q: [...] dosage via [...]:
[...]
A: Albuterol; nebulizer; Adult: 2.5 mg by nebulized aerosol
one time
Pediatric:
(<2 years old): 1.25 mg by nebulized aerosol
(≥2 years old): 2.5 mg by nebulized aerosol
For all: may repeat one (1) time; connect to 6–8 lpm of oxygen

Albuterol dosage via nebulizer:
Adult: 2.5 mg by nebulized aerosol.  May repeat one (1) time; connect to 6–8 lpm of oxygen
Pediatric: 
(<2 years old): 1.25 mg by nebulized aerosol
(≥2 years old): 2.5 mg by nebulized aerosol.
May repeat one (1) time; connect to 6–8 lpm of oxygen

Albuterol dosage via inhaler:
Adult: Patient may receive a maximum of 2 doses (4 puffs) over a 30-minute period
Pediatric: Patient may receive a maximum of 2 doses (4 puffs) over a 30-minute period

Q: What are the dosage(s) for Albuterol via inhaler?
A: The dosages for this medication via this method:
Adult: Patient may receive a maximum of 2 doses (4 puffs) over a 30-minute period
Pediatric: Patient may receive a maximum of 2 doses (4 puffs) over a 30-minute period

Q: What are the dosage(s) for Albuterol via MDI?
A: The dosages for this medication via this route:
Adult: Patient may receive a maximum of 2 doses (4 puffs) over a 30-minute period
Pediatric: Patient may receive a maximum of 2 doses (4 puffs) over a 30-minute period

Q: What does MDI stand for?
A: metered-dose inhaler

Q: What is a MDI?
A: This device delivers a consistent amount of medication using a short burst of aerosolized medicine via inhalation.

Q: What is a metered-dose inhaler?
A: This device delivers a consistent amount of medication using a short burst of aerosolized medicine via inhalation

Q: What are the dosage(s) for Albuterol via nebulizer?
A: The dosages for this medication via this method:
Adult: 2.5 mg by nebulized aerosol
Pediatric:
(<2 years old): 1.25 mg by nebulized aerosol
(≥2 years old): 2.5 mg by nebulized aerosol
For all patients: May repeat one (1) time; connect to 6–8 lpm of oxygen

Q: Adverse effect(s) of [...] include
[...]
A: Albuterol; 1.   tachycardia/palpitations
2.   hypertension
3.   angina
4.   nervousness/anxiety
5.   tremors
6.   dizziness
7.   headache
8.   sweating
9.   nausea/vomiting
10. sore throat

Q: Adverse effect(s) of [...] include
[...]
A: acetaminophen; nothing clinically significant