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Rx Injectable Medication Module
Nubain 20 mg/ml, 10 ml multiuse vial (pain)
Lidocaine 1%, 10 ml multiuse vial (local anesthetic)
3.5 ml syringes with 25-gauge. 5/8-inch needles
Decadron 4 mg/ml, 5 ml multiuse vial (steroid), 1 vial per trip for allergy.
3 vials per climber at risk for acute mountain sickness
Rocephin 500 gm vials (antibiotic)
Vistaril 50 mg/ml, 10 ml multiuse vial (many uses)
EpiPen, EpiPen Jr, or epinephrine vials and syringe (bee stings, anaphylactic shock, asthma)
NUBAIN (NALBUPHINE) 20 MG/ML, 10 ML VIAL
A strong, synthetic narcotic analgesic, this is available only by pre scription but it is not a controlled narcotic. It is equal to morphine in strength. Normal adult dose is 10 mg (0.5 ml) given intramuscularly every 3 to 6 hours. The maximum dose is 20 mg (1 ml) every 3 hours. Can be mixed with 25 to 50 mg of Vistaril in the same syringe for increased analgesia in severe pain problems.
LIDOCAINE 1%, 10 ML VIAL
Injection for numbing wounds. Maximum amount to be used in a wound in an adult should be 15 ml. This fluid is also used to mix Rocephin. See the package insert that comes with Rocephin.
Many types are available, but generally I find the 3.5 ml with the attached 25-gauge, 5/8-inch needle to be the most universally useful.
DECADRON (DEXAMETHASONE) 4 MG/ML, 5 ML VIAL
For use in allergic reactions, give 4 mg daily for 5 days IM. For acute mountain sickness, give 4 mg (1 ml) every 6 hours until well below the altitude where symptoms started. See pages 151 and 266.
ROCEPHIN (CEFTRIAXONE), 500 MG VIAL
A broad-spectrum antibiotic of the cephalosporin class, the inject able medication has a wide range of bactericidal activities, including for pneumonia and bronchitis, skin infections, urinary tract and kid ney infections, gonorrhea, pelvic infection, bone and joint infections, intra-abdominal infections, and some types of meningitis. Each vial will require 0.9 ml of lidocaine 1% to mix the contents. The reconsti tuted medication is stable at room temperature for 3 days.
VISTARIL 50 MG/ML, 10 ML VIAL
A brand name of hydroxyzine hydrochloride, uses and dosages are the same as indicated for Atarax in the Rx Oral/Topical Medication Module (page 287). Obviously, in the treatment of profound vomiting, injections of medication will work better than oral administration.
This solution can be mixed in the same syringe as the Nubain for administration as one injection.
EPIPEN, EPIPEN JR, SYMJEPI
The EpiPen and EpiPen Jr are automatic injection syringes. Use only on one person. The EpiPen delivers 0.3 ml (0.3 mg) of 1:1000 epinephrine; the EpiPen Jr delivers 0.3 ml (0.15 mg) of 1:1000 epinephrine. The EpiPen devices automatically give the medication intramuscularly (IM). Due to the high cost of auto-injection syringes, I suggest that your physician order several vials of epinephrine 1:10,000 solution for injection, and the appropriate syringes for administration. See page 292. The Symjepi is a manually injected prefilled syringe in 0.3 and 0.15 mg strengths, approved in 2019 by the FDA and avail able commercially in early 2020.