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

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Peter Canning

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  • Comments
    Don
    STEMI Call
    Thank you for a good honest post. I think those classic or "typical" presentations we learn in school are the exceptions really.
    2014-10-18 17:34:21
    Ezio
    STEMI Call
    Someone has rearranged the position of the leads for a quicker reading, personally I would use that format because I read the leads in groups (II III AvF, I AvL, AvR)
    2014-10-16 05:22:59
    medicscribe
    STEMI Call
    Hi Alex, feel free to use. Peter
    2014-10-16 00:02:25
    Alex
    STEMI Call
    Fantastic case for education. Would you mind if I shared with some colleagues at med school (will give credit of course)?
    2014-10-15 23:02:25
    medicscribe
    STEMI Call
    Great, thanks, Christopher. Mystery solved. Best, Peter
    2014-10-15 02:37:40

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