Emergencies Table of Contents on text to go directly to section) CLINICAL PROTOCOLS 1 2 3 4 6 7 8 Naloxone Narcan Auto Injector……………………………………………………………………….10 Naloxone Intranasal……………………………………………………………………………………14 MEDICAL EMERGENCIES LHDs should be prepared for medical emergencies, particularly, life-threatening drug reactions. Established procedures, adequate and properly maintained equipment, and appropriately trained staff are essential. Protocols for emergency care for anaphylactic reactions, and management of vasovagal reactions and syncope should be signed by a local physician and a copy kept with the emergency supplies. If the LHD stocks an Automated External Defibrillator (AED) device, it must develop and maintain local policies on its use and maintenance. LHD prepared for more extensive emergency measures should have a locally developed protocol in place to guide staff. Emergency equipment, supplies, and medications should be maintained on a crash cart or emergency tray. An inventory list is to be kept with the crash cart or emergency tray and monitored monthly according to an established schedule to ensure that they are not depleted or expired. Emergency supplies should be sealed when not in use. All physicians, clinicians, and nurses should be certified in CPR. All should be offered the opportunity to participate in CPR training. At a minimum, all staff must know their role in an emergency situation. All staff should have access to the Poison Control phone number, 1-800-222-1222, and it should be posted in a prominent place.
Table 1: Dosages for Epinephrine Administered Intramuscularly The recommended dose of epinephrine is 0.01 mg/kg body weight. Repeat 5–15 min. up to 3 doses, depending on patient’s response. Age Range of Weight (Pounds)* Range of Weight (Kilograms)* Epinephrine Dose: 1 mg/mL injectable (1:1000 dilution) intramuscular (IM) Minimum dose: 0.05 mL Epinephrine Auto-Injector (EpiPen) Infants and Children 1 - 6 months 9 - 19 lbs 4 - 8.5 kg 0.05 mL (or mg) Off label 7 - 36 months 20 - 32 lbs 9 - 14.5 kg 0.1 mL (or mg) Off label 37 - 59 months 33 - 39 lbs 15 - 17.5 kg 0.15 mL (or mg) 0.15 mg 5 - 7 years 40 - 56 lbs 18 - 25.5 kg 0.2 - 0.25 mL (or mg) 0.15 mg 8 - 10 years 57 - 76 lbs 26 - 34.5 kg 0.25 - 0.3 mL† (or mg) 0.15 mg or 0.3 mg Teens 11 - 12 years 77 - 99 lbs 35 - 45 kg 0.35 - 0.4 mL (or mg) 0.3 mg 13 - 18 years 100+ lbs 46+ kg 0.5 mL (or mg)‡ 0.3 mg Adults 19 & older 100+ lbs 46+ kg 0.5 mL (or mg)‡ 0.3 mg Note: If body weight is known, then dosing by weight is preferred. If weight is not known or readily available, dosing by age is appropriate. *Rounded weight for infants, children, and teens at the 50th percentile for each age range † Maximum dose for children ‡ Maximum dose for teens and adults
Table 2: Dosages for Diphenhydramine HCL (Benadryl®) Administered Orally The recommended dose of diphenhydramine HCL is 1 – 2 mg/kg body weight. Age Group: of Weight (Pounds)* Range of Weight (Kilograms)* Benadryl Dose, given orally: 12.5 mg/5 mL liquid, 12.5 mg/5 mL liquid Dose, orally, mL Infants and Children 1 - 6 months DO NOT GIVE TO THIS AGE GROUP 7 - 36 months 20 - 32 lbs 9 - 14.5 kg 10 mg – 20 mg 4 mL – 8 mL 37 - 59 months 33 - 39 lbs 15 - 17.5 kg 15 mg – 30 mg 6 mL – 12 mL 5 - 7 40 - 56 lbs 18 - 25.5 kg 20 mg – 30 mg 8 mL – 12 mL 8 - 12 years 57 - 99 lbs 26 - 45 kg 30 mg† 12 mL† Teens 13 - 18 years 100+ lbs 46+ kg 50 mg‡ 20 mL‡ Adults 19 years & older 100+ lbs 46+ kg 50 mg‡ 20 mL‡ Note: If body weight is known, then dosing by weight is preferred. If weight is not known or readily available, dosing by age is appropriate. *Rounded weight for infants, children, and teens at the 50th percentile for each age range † Maximum dose for children ‡ Maximum dose for teens and adults Table 3: Dosages for Diphenhydramine HCL (Benadryl®) Administered Intramuscularly The recommended dose of diphenhydramine HCL is 1 – 2 mg/kg body weight. Age Group: Benadryl Dose, given by injection: