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RE: INTRA NASAL VERSED

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We use it lots on the ski slopes of Colorado on a lot of Texan's actually

and have found it to work extremely well.

But I agree dosing is a little controversial. One protocol is exactly the

same as IVP 1-2mcg/kg and another mountain's medical direction and

experience has elected to double the normal IV dose with half thru each

nostril.

Jim<

INTRA NASAL VERSED

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ANYONE USING INTRA NASAL VERSED IN ADULTS? IF SO, WHAT DOSAGE AND

FREQUENCY ARE YOU USING? I AM FINDING LITTLE IN THE WAY OF DOSAGE

GUIDELINES. THANKS HT

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Arlington EMS System uses intranasal Versed.

The dosage for pedi patients 13 years and up and adult patients is 5 mg,

with half the dose delivered to each nostril. May repeat once in 10

minutes. The maximum allowable dose is 10 mg.

The doesage for pedi patients younger than 13 yrs is 0.4 mg/kg, with

half the dose delivered to each nostril. May repeat in 10 minutes to

max allowable dose of 5 mg.

For all drugs in our protocols, if the pedi patient's weight results in

a dose larger than the dose allowed for adult patients we use the adult

doseage.

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MedStar EMS in Ft. Worth uses it. Our protocol is for .3mg/kg IN with a max

single dose of 5 mg. May be repeated once in 5 minutes if pt. does not stop

seizing.

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> ANYONE USING INTRA NASAL VERSED IN ADULTS? IF SO, WHAT DOSAGE AND

> FREQUENCY ARE YOU USING? I AM FINDING LITTLE IN THE WAY OF DOSAGE

> GUIDELINES. THANKS HT

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Intranasal Administration

1. This procedure is utilized if IV access has not been obtained or

attempts are not feasible.

2. Only Certain medications (Versed, Narcan, Fentanyl and Glucagon)

may be given via the Intranasal route as specified in protocols.

3. Draw medication into 1 cc or 5 cc Syringe.

4. Attach MAD (Mucosal Atomizer Device) to syringe, place into

nostril and administer medication rapidly. Half dose into each nostril

occluding opposing nare.

5. Document the time the medication was administered.

6. Properly dispose of the contaminated equipment.

7. Monitor the response of the patient to the medication.

PROTOCOL126

PSYCHIATRIC PROTOCOL

Please be aware that physically and/or chemically restraining a patient

is a high-risk activity. It is imperative that law enforcement be

present. Restraint is performed to prevent and/or minimize the risk of

injury to the patient and caregivers. Scene safety and prevention of

escalating a situation are essential.

1. SCENE SAFETY

2. Assess ABCs

3. Obtain a history

4. If patient is unwilling or unable to fully cooperate, initiate

physical restraints.

Note: No " hog-tying " , " hobble restraints " , prone positions, or

placing anything on the anterior surface of the patient.

5. Perform blood glucose level test. If below 70, initiate Altered

Mental Status protocol.

6. If Violent behavior continues, Consider Versed 2-5mg and/ or

Haldol 2-5mg deep IM or IN. Patient's over 60 or other chronic illnesses

consider Versed 2mg and/ or Haldol 2mg deep IM or IN.

7. Consider SpO2, End-Tidal CO2, and Continuous Cardiac Monitoring.

8. Consider Oxygen as appropriate.

9. Consider IV 0.9 NaCl or Saline Lock

10. For overdoses, see appropriate protocol.

11. Transport patient to the closest most appropriate facility.

Note: Be prepared with trauma shears to immediately release restraints

in the event of vomiting or sudden deterioration and proceed with

appropriate protocols.

Note: Minimum measures to assure patient and crew safety are

imperative. This is only to be utilized to insure safe transport and

care.

Note: Be aware that patients with psychiatric conditions or episodes

may not be able to legally refuse treatment.

Lt. Steve Lemming, A.A.S., L.P.

C-Shift

EMS Administration Officer

Azle, Texas Fire Department

This e-mail is confidential and intended solely for the use of the

individual (s) to whom it is addressed. Any views or opinions presented

are solely those of the author and do not necessarily represent those of

The City of Azle or its policies. If you have received this e-mail

message in error, please phone Steve Lemming (817)444-7108. Please also

destroy and delete the message from your computer.

For more information on The City of Azle, visit our web site at:

http://www.cityofazle.org http://www.cityofazle.org>

From: texasems-l [mailto:texasems-l ] On

Behalf Of H.T. FILLINGIM

Sent: Wednesday, March 25, 2009 5:30 PM

To: texasems-l

Subject: INTRA NASAL VERSED

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ANYONE USING INTRA NASAL VERSED IN ADULTS? IF SO, WHAT DOSAGE AND

FREQUENCY ARE YOU USING? I AM FINDING LITTLE IN THE WAY OF DOSAGE

GUIDELINES. THANKS HT

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=hKqi

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