Tylenol

tylenol

I rank Tylenol 28 out of 33 in my drug kit.

First, let me say, I am speaking only of the Tylenol in my kit and not my own personal stash. If I were rating my own personal stash of Tylenol, then I would have to add Tylenol and Ibuprofen to my as yet unrevealed list of Eight Essential Drugs, making it The Essential Ten.

The Tylenol I carry in my kit is restricted to pediatrics with fevers. We can give it to pediatrics greater than 6 months old if they have a temperature 101.5°F (38.5°C) or greater or if the patient is believed to be febrile (with no thermometer available) and they have not had Tylenol within the last four hours.

These are some of our PEARLS:

· This Guideline is NOT to be used for patients suffering from environmental hyperthermia
· If the patient is vomiting, suppositories are more appropriate and oral acetaminophen should be
withheld.
· Administer once the patient is in the ambulance to avoid patient/parent refusal after treatment.
· Concentrated infant drops (80 mg per 0.8 mL) are recommended and may be dispensed using a
needless syringe.
· Do not administer acetaminophen if the patient has received greater than 15 mg/kg dose in
the last 6 hours.

Tylenol is an awesome drug for kids with fevers, but in the short time we have had it in our guidelines, I rarely have occasion to use it. My town is more old people than young families and the young families tend to have Tylenol on hand.

While as a parent I gave Tylenol quite a bit this last year, as a Paramedic, I did not give it at all.

***

Acetaminophen (Tylenol)

Class: Antipyretic; Analgesic

Action: Antipyretic effect via direct action on the hypothalamus heat-regulation center; Unknown mechanism of analgesia

Indications: Pediatric fever; Minor pain

Contraindication: Hypersensitivity to acetaminophen

Adverse effects: Hepatotoxicity in overdose
Nausea

Pedi Dose: 15 mg/kg every 4 – 6 hours as needed

Route: PO; PR

Note: Concentrated infant drops (80 mg per 0.8 mL) are recommended and may be dispensed using a needless syringe.

6 Comments

  • Greg Friese says:

    Timely post as I have been working on an article about pediatric febrile seizures and have been looking for US paramedic services that carry Acetaminophen. Does your protocol include a max patient age? If possible could you email me a copy of the protocol or a URL to your service’s protocol. Thanks.

  • Matt says:

    Peter,

    I’ve been loving this series of articles–keep it up.

    A few questions about your protocol:
    -Is there maximum single dose, like where the weight maxes out?
    -While I don’t think the action has been fully described, acetamenophen inhibits specific prostoglandins, yes? Any idea why the analgesia action is listed as unknown?
    -How long have you carried it?
    -What was the impetus for adding it to the drug box?

    Thanks,
    Matt

    • medicscribe says:

      Does your protocol include a max patient age?

      Not really, it just falls under pediatrics, which can either be considered 13 and under or 18 and under. The minimum age is 6 months.

      If possible could you email me a copy of the protocol or a URL to your service’s protocol.

      Here’s the link (Look under pediatric fever:)

      NorthCentral EMS 2009 Guidelines
      -Is there maximum single dose, like where the weight maxes out?

      No, not listed. we are supposed to follow the maximum dosing on the product, which iafter two is done more by age rather than weight.

      -While I don’t think the action has been fully described, acetamenophen inhibits specific prostoglandins, yes? Any idea why the analgesia action is listed as unknown?

      No

      -How long have you carried it?

      Its been in the guidleines a couple years, but it took us awhile to get it on board.

      -What was the impetus for adding it to the drug box?

      Our guidelines are done regionally, so while there is not a great need in my town, in the city a pretty regular call is a baby with a fever and a mom without tylenol. Rather than sitting them with a fever in a hospital waiting room for hours waiting to be seen, we can give them the medicine and break the fever right much quicker. A paramedic suggested adding tylenol and the doctors, including the ones from the local children’s hospital thought it was a good idea and went along.

      Thanks for all the questions and comments,

      Peter C

  • totwtytr says:

    I like the idea of this series of articles. So far, your list approximates my own, although you carry some drugs that we don’t. Tylenol is one of them. I can’t think of an emergent use for Tylenol, that is if you accept that paramedics should be treating emergent situations. Which seems to be a source of some contention, if not confusion, in EMS. I certainly don’t see it’s use in febrile seizures, but I’m just so EMS 1.0, I guess.

  • The only problem with acetominophen/paracetamol is its relatively small theraputic window. Using it as per your protocol will not do harm, but in the UK we have tracic cases of suicide by paracetamol. I’m sure you have the same.

    Overdose can cause liver failure some days later. The patient may, by then, have come round and decided that life is better than death, but it’s too late.

    However, as an antipyrretic it’s great.

  • Keep posting stuff like this i really like it

Leave a Reply

Your email address will not be published. Required fields are marked *

background image Blogger Img

Peter Canning

JEMS Talk: Google Hangout

Recent Posts
copy-medicscribeheader.png Patient Follow-up June 21, 2015
medicscribeheaderbg Paramedic Students June 12, 2015
Lights and Sirens June 7, 2015
mortal men_KINDLE Mirrors June 4, 2015
Categories
  • ems-health-safety (7)
  • ems-topics (709)
  • hazmat (1)
  • Uncategorized (423)
  • Archives
  • June 2015
  • May 2015
  • April 2015
  • March 2015
  • February 2015
  • January 2015
  • December 2014
  • October 2014
  • September 2014
  • May 2014
  • March 2014
  • February 2014
  • January 2014
  • December 2013
  • November 2013
  • October 2013
  • September 2013
  • August 2013
  • July 2013
  • June 2013
  • May 2013
  • April 2013
  • March 2013
  • February 2013
  • January 2013
  • December 2012
  • November 2012
  • October 2012
  • September 2012
  • August 2012
  • July 2012
  • June 2012
  • May 2012
  • April 2012
  • March 2012
  • February 2012
  • January 2012
  • December 2011
  • November 2011
  • October 2011
  • September 2011
  • August 2011
  • June 2011
  • May 2011
  • April 2011
  • March 2011
  • February 2011
  • January 2011
  • December 2010
  • November 2010
  • October 2010
  • September 2010
  • August 2010
  • July 2010
  • June 2010
  • May 2010
  • April 2010
  • March 2010
  • February 2010
  • January 2010
  • December 2009
  • November 2009
  • October 2009
  • September 2009
  • June 2009
  • May 2009
  • April 2009
  • March 2009
  • February 2009
  • January 2009
  • December 2008
  • November 2008
  • October 2008
  • September 2008
  • August 2008
  • July 2008
  • June 2008
  • May 2008
  • April 2008
  • March 2008
  • February 2008
  • January 2008
  • December 2007
  • November 2007
  • October 2007
  • September 2007
  • August 2007
  • July 2007
  • June 2007
  • May 2007
  • April 2007
  • March 2007
  • February 2007
  • January 2007
  • December 2006
  • November 2006
  • October 2006
  • September 2006
  • August 2006
  • July 2006
  • June 2006
  • May 2006
  • April 2006
  • March 2006
  • February 2006
  • January 2006
  • December 2005
  • November 2005
  • October 2005
  • September 2005
  • August 2005
  • July 2005
  • June 2005
  • May 2005
  • April 2005
  • March 2005
  • February 2005
  • January 2005
  • December 2004
  • November 2004
  • October 2004
  • September 2004
  • August 2004
  • Comments
    Christy
    Paramedic Students
    Enjoyed reading this. I am an EMT-B who is in Paramedic school and I have been on the receiving end of working with a few medics who seemed to have forgotten that they were just like me once upon a time. And there are medics who I have cherished my time working with as they…
    2015-06-19 23:10:13
    karl
    Paramedic Students
    Thank you for your openness. I am a paramedic who works full time in a busy ER and rides with my volunteer squad in my hometown. It is a study in proficiency evaluation to observe the amount of respect and/or validity the receiving RN gives the EMT/paramedic who is giving her report on their pt.…
    2015-06-19 06:34:13
    Jim
    Paramedic Students
    I retired from EMS after 25 plus years. Although I was never a Paramedic, I was for the last few years an EMT-I. I remember the feelings that I had near the end of my road time. Tired and grumpy all the time from working 2 jobs and putting in usually 77 plus hours a…
    2015-06-19 03:53:22
    Michael
    Paramedic Students
    Good read. I appreciate the frankness of the author in relating his attitude towards his partners. I was a paramedic for seven years, and I found myself being the guy you described more than once. It's easy to forget that we were all new once I guess.
    2015-06-18 19:09:14
    Dennis Dudley
    Paramedic Students
    I did read the book, and it gave me more respect for paramedics than I once had. The book gave me an idea of all the training they have to go through. The book made me focus on being a better EMT-B. I will pick up the book and re-read it again every so often…
    2015-06-18 18:36:40

    Now Available: Mortal Men

    Mortal Men is available as an electronic book for Kindle, Nook or any other e-reader. Here is a link to some of the places to buy it. The book sells for $3.99. Barnes and Noble Amazon Smashwords Scribd Also Available from iBooks

    Order My Books

    Support EMS Bloggers, Buy Their Books

    Google

    Order Books and Movies

    FireEMS Blogs eNewsletter

    Sign-up to receive our free monthly eNewsletter

    LATEST EMS NEWS

    HOT FORUM DISCUSSIONS