Med – Route – Dose – Time – Site – initials
- Aspirin 325mg PO
- Benadryl (Diphenhydramine) 12.5mg or 25mg or 50mg IM / IV
- Bicillin LA 6 million / 1ml. Give: 3million units (i.e. 1/2ml) or 6million units (i.e. 1ml) or 9million units (1.5ml) IM
- Bicillin LA 1.2 million units / 2ml. Give: 600,000 units (1ml) or 900,000units (1.5 ml) IM
- Cefazolin (Ancef) 1gram IM
- Clonidine 0.1mg PO
- Epinephrine 1mg/ml Give:_________ml SC
- Glucose Gel tube PO
- Ibuprofen 200mg/tablet Give:______ Tabs PO
- Ibuprofen 100mg/5ml Give:______ml PO
- Imitrex (Sumatriptan) 6mg/0.5ml SC. If PO, give 25-100mg PO x1 (Max 200mg/24hr). May repeat po dose x 1 after 2h.
- Insulin (regular) ____________units SC
- Kenalog (triamcinolone acetonide) 40mg/ml Give: 20mg (0.5ml) or 40mg (1ml) or 60mg (1.5ml) or 80mg (2ml)
- MXPB (GI cocktail) – Maalox______ Lidocaine______ Donnatal________ [Mixture is 20ml-20ml-10ml for a total of 50ml. You can also do 10-10-10 for a total of 30ml].
- Maalox 50mg/bottle Give: 15ml or 30ml or 50ml PO
- Nitroglycerin 0.4mg tablet SL
- Phernergan (promethaine) 25mg/ml Give: 12.5mg or 25mg or 50mg IM
- Reglan 10mg/2ml Give: 1ml or 2ml IM / IV
- Rocephin (Ceftriaxone) 125mg or 250mg or 500mg or 1gram IM
- Decadron (Dexamethasone sodium phosphate) 4mg/ml:____________ IM/IV
- Depo-Medrol (Methylprednisolone Acetate) 40mg/ml. Give: 20mg (0.5ml) or 40mg (1ml) or 60mg (1.5ml) or 80mg (2ml) IM
- DHE 45 (Dihydroergotamine Mesylate)1mg/ml IM/SC/IV
- Solu-Medrol (Methylprednisolone sodium succinate) 40mg/ml Give: 40mg (1ml) or 80mg (2ml) IM or IV
- Solu-Medrol 125mg/2ml Give: ________ ml IM or IV
- Toradol (Ketorolac) 30mg/ml Give:____________ml IM or IV
- Toradol 60mg/2ml Give:________ ml IM
- Tylenol (acetaminophen) 500mg/tab Give: 1 tablet or 2 tablets PO
- Tylenol (acetaminophen) suspension 160mg/5ml Give: _____ ml PO
- Vitamin B12 (Cyanocobalamin) 1000 mcg/ml. Give: 1ml IM
- Marcaine 0.5% 5mg/ml
- Lidocaine 1% with or without epinephrine
- Kenalong 40mg or 60mg + Marcaine 2ml + Lidocaine 2ml
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