INDEX

Pharmacy

Table of Contents:

• Vancomycin Dosing

• Antibiogram

• Anticoagulant Reversal

• ED Omnicell Formularies

• GED Intranasal Pediatric Medications

Cross References:

• None

• For stable patients, give 1 gram regardless of weight.

• For unstable patients meeting the criteria below, use the ED-specific vancomycin orders based on the chart below.

  • Systolic BP < 90

  • Map < 60

  • Requiring vasopressors

• Please see the anticoagulant reversal guidelines below.

• Note that there is also a PowerPlan called Oral Anticoagulant Reversal.

• Additional Considerations:

  • Order a early Thrombin Time to assess dabigatran (Pradaxa)

Intranasal administration of fentanyl and midazlolam are available at the GED for pediatric patients. These medications can be used for a variety of indications including acute pain control, laceration repair, abscess drainage, splinting, and fracture reduction. They work well and at the appropriate doses carry a low risk of respiratory or CNS depression. The doses in our system mirror those of Children’s ED. Please review the following recommendations:

Consent:

• All patients should have a consent form signed by a parent or guardian after discussion of the risk and benefits as well as potential complications of these medications prior to administration.

Administration:

• Intranasal atomizers are located in the med room. These can be attached to the end of a medication-filled syringe containing the appropriate dose.

• When administering, the plunger should be pushed briskly to achieve proper particle size and the tip should be directed away from the nasal septum to facilitate delivery to vascularized areas of the nasal cavity.

• Patients should not inhale deeply with administration to prevent medication losses to the GI tract and to minimize aspiration. Patients should be sitting up during administration if possible.

Dosing:

• Active in the order search are several “baby” order sentences. Intranasal route options are active for both midazolam and fentanyl with appropriate weight based pediatric doses. 

• These medication doses can be repeated as needed to achieve the desired effect but after multiple doses close monitoring for respiratory depression is indicated and recommended.

Monitoring:

• All patients are recommended to be on pulse ox after administration.

• If multiple doses or agents are administered, end tidal CO2 monitoring and formal procedural sedation protocols are recommended.

• If these agents are utilized as a monotherapy with small volume dosing, formal procedural sedation documentation does not have to be utilized.

KEYWORDS: vanc, vancomycin, dosing, antibiotics, antibiogram, sensitivities, anticoagulant anticoagulation reversal, formulary, warfarin coumadin