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

Recent Posts
Categories
  • ems-health-safety (7)
  • ems-topics (697)
  • hazmat (1)
  • Uncategorized (407)
  • Comments
    Mark J. Tenerowicz
    Patient Handover
    I am an ED doc and EMS medical director and I expect but don't demand that my crews leave their run form before clearing. Failure to do so should be the exception, not the rule. I realize services operate in the real world of limited resources and unpredictable calls. If it being done at the…
    2014-07-16 19:57:46
    David
    Patient Handover
    The techie in me dreams there may be a technological solution, with seamless integration of pre-hospital and inpatient charts, live updating, maybe even voice recognition that would be almost like dictation, getting everything in the correct fields in the software ... then I wake up, snort and chuckle a little. Seriously though, does anyone out…
    2014-06-27 23:54:42
    Dan
    Patient Handover
    Make it so I don't have 6 cords to choose from and the driver for the printer works from HH to JMH to Children's to RGH and maybe I won't fax every single runform in. But I have been saying that for years.
    2014-05-24 18:05:52
    KellyCormier
    Patient Handover
    Peter, This is a fight that I, just like yourself and so many others have looked at in my EMS history of 25 years.I'm in a pretty unique situation as a former provider, a wife of a firefighter and someone who works with medic and firefighters across the country. I have developed a different type…
    2014-05-15 21:39:31
    Vincent
    Old Paramedics
    Hi all, I have been in well above average fitness level all my life. Three years ago, while following an EMR class, I developed the taste for First Aid work. Since then I have work in the Oil/Gas industry, and volunteer to sport events and concerts now trying to finish my PCP-IV. I have to…
    2014-05-01 00:41:50
    New Leaders: JFK's Nightmare
    New Leaders: JFK's Nightmare
    It's OK.
    It's OK.
    Welcome to the Club
    Welcome to the Club
    Author Unknown
    The Part We Forget
    The Part We Forget

    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