NYC REMAC – Protocol Review – Narcotics

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November 22nd, 2009 by RH-111

Accurate as of 11/22/09

Standing orders

513 Seizures

lorazepam 2mg IVP or IN, IM if no IV access – repeat once after 5 minutes if persists – OR

diazepam 5mg IVP – repeat once after 5 minutes if persists – OR

midazolam 10mg IM or IN if No IV access available

(med control options – repeat any of above

528 – Burns & 529 – Isolated Extremity Injury

Patients in severe pain with systolic BP >110. Morphine Sulfate – 0.1mg/kg IVP up to 5mg. Repeat every 5 minutes up to max dose of 10mg (Have naloxone on hand)

Medical Control Options

504a – Myocardial Ischemia

Morphine Sulfate 0.1mg/Kg IVP – up to 5mg per dose. Repeat up to total of 15mg (5mg max per dose) use caution in patients with RVI and/or hypotension

506 Acute Pulmonary Edema

Option A: Morphine Sulfate 0.1mg/Kg IVP – up to 5mg per dose. Repeat up to total of 15mg (5mg max per dose) use caution in patients with RVI and/or hypotension

Option B: lorazepam IVP/IN OR midazolam 1-2mg IVP/IN

530 – Emotionally Disturbed Person

Chemical restraint – diazepam 5-10mg IVP or

midazolam 1-2mg IVP or 10mg IM/IN if no IV access

lorazepam 2-4 mg IVP or 4mg IM/IN if no IV access

557 – Seizures – Pediatrics

lorazepam 0.05mg/kg IV/IN/IO – Slowly over 2 minutes – repeat doses may be given if seizure persist – (refer to length based device)OR

diazepam 0.1/mg/kg IV/IO, slowly over 2 minutes – repeat if seizure persists – (refer to length based device) OR

If no IV or IO has been established – midazolam 0.1mg/kg IM/IN – max dose 5mg – (refer to length based device) OR diazepam 0.5mg/kg via rectum – (refer to length based device)

GOP – Sedation Policies

Conscious patients requiring intubation

diazepam 5-10mg IVP – repeat up to max dose of 20mg – OR

midazolam 1-2mg IVP/IN – repeat doses of 1mg up to max dose of 5mg OR

etomidate 0.3mg/kg IVP over 30-60 seconds – max dose is 20mg. After intubation administer diazepam 5mg IVP or lorazepam 2mg IVP/IM

Conscious patients requiring cardioversion or pacing

diazepam 5-10mg IVP – repeat up to max dose of 20mg OR

midazolam 1-2mg IVP/IN – repeat doses of 1mg up to max dose of 5mg

One Response

NYC REMAC – Protocol Review – Narcotics | Paramedic Class Notes EMedic writes:

November 22nd, 2009 at 5:50 pm

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