Med Math

The basics

use like units use common sense find a formula/system that works for you

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Making weight..

1 kilogram (kg) = 2.2 pounds (lb)

Actual conversion

Wt: 220 lb 220 divided by 2.2 = 100kg Half of 220 = 110 10% of 110 = 11 Subtract 11 from 110 = 99kg
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10% or Midnight rule

Metric conversions

1 gram (g) = 1000 milligrams (mg) 1 mg = 1000 micrograms (mcg) 1 liter (L) = 1000 milliliters (ml) You need to give 500 mcg. How many mg?

Mg - move decimal 3 places to the left = 0.5 mg OR 500 = half of 1000 so half of 1 = .5 mg

You need to give 100 mg. How many mcg? How many g?

mcg - move decimal point 3 places to the right = 100,000 mcg g - move decimal point 3 places to the left = 0.1 g
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Basic calculations
Desired dose (D) x Unit of measure or volume on hand (Q) Known dose on hand (H) = volume or unit of measure to be administered (X)

D
H

Example

You are ordered to give 5 mg Valium IV. The label states there is 10 mg in 2cc (10mg/2cc). How many ccs will you give? The equation will look like this: 5mg x 2cc = X cc
10 mg 1 x 2 = = 1 cc
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X cc

You will give 1cc!

Calculations based on weight

Desired dose (D) x Weight in kg (W) Known dose on hand (H) X Unit of measure or volume on hand (Q)

= volume or unit of measure to be administered (X)

H
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Example

You are to give 0.5 mg/kg IV push. Your patient weighs 80 kg. The drug comes packaged: 100mg/10cc. How many mg will you give? How many ccs will you deliver? Your equation to determine mg will look like this: 0.5 mg/kg x 80 kg = 40 mg to be given Your equation to determine cc will look like this: 40 mg x 10 cc = 4cc 100 mg
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Drip calculations
Clock method (used only for 4:1 ratio)
60 4 45 3 2 30 1 15

If your dose is 1 mg/min, your drip rate is 15 gtt/min. If the order is greater than 4 mg/min, add them together. A dose of 6 mg/min is 90 gtt/min (4 + 2 Hom =6 so 60 + 30 = 90)

Drip calculations
Desired dose x Size of bag x Amount of drug on hand gtt set = gtt/min The order is for 5 mg/min. You have a 500 cc bag of NS, a 60 gtt/cc administration set, and 2 g of drug on hand. How many gtt/min will you administer? x 500 cc x 2000 mg 60 gtt/cc = 75 gtt/min

5 mg/min

Note: If the dose is weight based, determine the total dose prior to beginning the equation or multiply everything by the number of kg.
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Glossary of Terms

Absorption-process of drug moving from site of introduction into circulation Contraindication-factor that does not allow administration of drug Dependence-state where absence or less of drug causes physical or emotional effects Excretion-elimination of drug or toxins Half life-time it takes for a drug level to reduce by half Loading dose-large amount of drug given to temporarily increase blood levels Home

Glossary (cont.)

Maintenance dose-amount of drug needed to maintain steady blood levels Peak level-highest blood level from any given dose Therapeutic action-wanted and intended effects of a drug Tolerance-decreased response to drug after repeated administration. May require increased dose. Toxic level-blood levels are such that they may produce adverse effects
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Prehospital Medications

The following is a list of drugs given in the TEMS region. Limited information is included for a number of the drugs but due to space constraints, everything could not be listed. Please review all medications you are responsible for administering
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Oxygen

Standing order: EMT, ST, CT, PM Dose: 2-15 LPM via nasal cannula, nonrebreather, bag-valve-mask Indications: Any patient with reduced oxygen levels or increased need for oxygen.

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Activated Charcoal (Actidose)

Physician order: EMT, ST, CT, PM Dose: Adult (50 g), Pediatrics (25-30 g) given by mouth Action: Binds and absorbs ingested toxin and is then excreted. Indication: Overdose or poisoning when induction of vomiting is not indicated Contraindications: Unable to swallow or maintain airway. Not useful in cyanide, methanol, caustic acids or alkalis, heavy metals, or lithium poisonings. Side Effects: None
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Oral Glucose

Standing Order: EMT, ST, CT, PM Dose: One tube Action: Increases blood glucose Indication: Consider if patient has an altered level of consciousness and/or known hypoglycemia Contraindications: Difficulty swallowing or unable to protect own airway. Side Effects: None
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Epinephrine-SQ (Adrenalin)

Patient Assisted Med: EMT Physician Order: ST Standing Order: CT, PM Dose: 0.01 mg/kg (up to .3 mg) SQ 1:1000 Action: Improves force of ventricular contractions and heart, bronchdilatation, peripheral vasoconstriction, and histamine antagonist Indication: Anaphylaxis, severe asthma Contraindications: Hypovolemic shock, hypertension, cardiac insufficiency Side Effects: Anxiety, restlessness, hypertension, dysrhythmias Note- Physician order for any patient over 40 years of age and or cardiac history!
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Albuterol (Proventil, Ventolin)

Patient Assisted Med: EMT Standing Order: ST, CT, PM Dose: PAM (1-2 puffs from MDI only), 2.5 mg HHN repeated once Action: Relaxes smooth muscle of bronchial tree and peripheral vasculature Indication: Relief of bronchospasm, wheezing Contraindications: Tachycardic dysrhythmias Side Effects: Anxiety, restlessness, palpitations, increased blood pressure
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Nitroglycerin (NTG)

Patient Assisted Med: EMT Physician Order: ST Standing Order: CT, PM Dose: 0.4 mg SL every 3-5 min up total of 3 Action: Dilation of arterioles and peripheral veins causing decreased workload of the heart and decreased oxygen demand by decreasing preload and afterload. Indications: Chest pain, CHF Contraindications: Viagra use in past 24 hours, systolic BP<100, head injury, cerebral hemorrhage Side effects: Headache, hypotension, nausea and vomiting, dizziness, burning sensation under the tongue Note-Monitor blood pressure closely in-between tablets.
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Aspirin (ASA)

Physician order: ST Standing Order: CT, PM Dose: 324 mg (four 81mg chewable) Action: Antiplatelet and vasodilatory actions allowed to occur through alterations in enzyme production. Indication: Chest pain Contraindications: ASA intake in past 24 hours Side effects: Bleeding, GI upset

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Diphenhydramine HCl (Benadryl)

Physician Order: ST Standing Order: CT, PM Dose: 50mg IV or IM (adult) 1-2 mg/kg (peds) Action: Binds to histamine receptor sites blocking the histamine response Indications: Allergic and EPS/dystonic reactions Contraindications: Acute asthma attack, taking MAO inhibitors, narrow angle glaucoma Side Effects: Drowsiness, hypotension, drying of secretions, sedation
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Naloxone (Narcan)

Physician Order: ST Standing Order: CT, PM Dose: 2-4 mg IV titrated to effect Action: Reverses effects of narcotics by competing for receptor sites Indications: Narcotic overdose, altered level of consciousness or unconsciousness with unknown origin Contraindications: Use cautiously in drug dependant patients as administration can cause withdrawals Side Effects: projectile vomiting and/or cardiac dysrhythmias with rapid admin, withdrawals, diaphoresis Note-Narcans effects are shorter acting than the narcotics so monitor patient closely.
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Dextrose 50% (D50)

Physician order: ST Standing Order: CT, PM Dose: 25 g in 50 cc for adult 0.25 g/kg of 25% solution for peds Action: Increases blood glucose. Indication: Blood glucose level <60 mg/dl, altered level of consciousness and/or seizure of unknown origin Contraindications: Intercranial hemorrhage Side Effects: No systemic effects but may develop necrosis from infiltration locally.