Common Meds Made Into Drips

[cannonball88]

The option to dose medications in a drip form for more accurate need-based infusion (no more than necessary, that is) has peaked my interest lately, and I'm wondering what experiences you have had setting up drips for commonly bolused medications in the field.

Specifically, I'm looking at Narcan, Dextrose (diluting an amp, that is), Benadryl, etc.

Questions I have:

1. Which meds have you done this with?
2. Do you typically mix them in with the primary bag (250 or 1000) or do you piggyback them in, say, a 100?
3. How do you titrate? As in what increments?

Example: If you mix 2mg Narcan in a 100 mL bag, you have 20 mcg/mL. What drip dose would you use (mcg/min) and at what increments would you increase?

Thanks in advance for your the benefit of your experience. I realize that many of you work in hospitals, so if you could try and tailor your responses to field use on an ALS ambulance, it would be very useful.

 

[Summit]

25mg D50 Amp diluted into a 250 NS makes D10NS (but you pull out 50mL of NS) but that is hypertonic, so I cannot really think of a good reason for that in the field. Do you have IV water for mixing?

You could also use 500 of D5W + 25mg D50 and you get D9W

Narcan is typically more like 1mg in a 250 or 2mg in a 500, but why are you mixing a narcan drip in the field?

Benadryl is never given as a drip.

You can make epinephrine drips from your epi 1:1000 vial, 1mg in 250mL of D5W (or NS) gives you 4mcg/mL... but if you are doing that, it is because you don't have norepi and don't want dopamine or need something more than dopamine, so what is going on and do you have a pump?

You could put 1mg lidocaine into 250mL D5W (or NS) as an alternative to amio...

What is the nature of this question? It is kind of an odd question...

 

[Carlos Danger]

It's funny....I do the exact opposite and give boluses of pretty much everything, even the drugs that can *only* be given by Infusion.

 

[Summit]

It's funny....I do the exact opposite and give boluses of pretty much everything, even the drugs that can *only* be given by Infusion.

I like anesthesia service. Push a little more phenylephrine please!

 

[VFlutter]

I like anesthesia service. Push a little more phenylephrine please!

Always keep a few of these in my pocket

 

[dutemplar]

25mg D50 Amp diluted into a 250 NS makes D10NS (but you pull out 50mL of NS) but that is hypertonic, so I cannot really think of a good reason for that in the field. Do you have IV water for mixing?

You could also use 500 of D5W + 25mg D50 and you get D9W
.

On an irrelevant note, we use small bags of premixed D10. The D10 is less hypertonic and less "bad" if it infiltrates than the D50. Much easier to drip through a small vein than to try and push it. But we don't have D50 to wing it. I imagine D10NS would still, in the quantity given, be pretty "meh" for overall tonicity. It's too early, need more coffee. If tonicity wasn't a word, it is now.

 

[Underoath87]

I'll inject the amp of D50 into a 250 ml NS bag and flow it wide open (maybe squeeze it a bit too).
Same goes for mag sulfate, since apparently the slow IV push (2g in 20ml NS) causes patients to feel like they're on fire :/

 

[NomadicMedic]

I'll inject the amp of D50 into a 250 ml NS bag and flow it wide open (maybe squeeze it a bit too).
Same goes for mag sulfate, since apparently the slow IV push (2g in 20ml NS) causes patients to feel like they're on fire :/

I do the same.

 

[TransportJockey]

I'll inject the amp of D50 into a 250 ml NS bag and flow it wide open (maybe squeeze it a bit too).
Same goes for mag sulfate, since apparently the slow IV push (2g in 20ml NS) causes patients to feel like they're on fire :/

Thats generally my practice too. Otherwise i use push dose pressors primarily in the field.

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[Underoath87]

I'd also like to share a cool method for mixing the D50 in the saline bag that I tried today. Instead of trying to inject it into the drug port using an 18g needle, I placed a 14g IV cath in the drug port and pushed the D50 through that.

 

[Tigger]

On an irrelevant note, we use small bags of premixed D10. The D10 is less hypertonic and less "bad" if it infiltrates than the D50. Much easier to drip through a small vein than to try and push it. But we don't have D50 to wing it. I imagine D10NS would still, in the quantity given, be pretty "meh" for overall tonicity. It's too early, need more coffee. If tonicity wasn't a word, it is now.

We did this when there was an issue getting D50. I liked it, but then they got D50 back and now people look at me funny for making my own.

 

[CANMAN]

Ketamine. We give a bolus dose then hang an infusion. NTG as well.

 

[Tigger]

Ketamine. We give a bolus dose then hang an infusion. NTG as well.

We do NTG drips as well, but they must be on the pump. That makes the calculations real easy, can enter pretty much whatever volume you want but I'm not sure that's advisable...

 

[ParamedicStudent]

Just a side question: Any drug with a long dosage time (like Mag Sulfate for example) can only be given via drip? Like push rate for Mag is 5 to 20-60 minutes depend on use, but we cant do very very very slow IV push?

 

[TransportJockey]

Just a side question: Any drug with a long dosage time (like Mag Sulfate for example) can only be given via drip? Like push rate for Mag is 5 to 20-60 minutes depend on use, but we cant do very very very slow IV push?

Mag can be given very slowly via push, but its easier to just toss it in an underfill and let it run in over a few minutes or more. Same with stuff like rocephin

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