PRINCIPLES OF EMERGENCY CARE

An emergency can happen at any time or at any place. An emergency is a situation demanding
immediate action. The goal of this section is to introduce you to the basics of First Aid and
Emergency Care that will help you recognize and respond to any emergency appropriately.
Your response may help save a life.
By definition, emergency care is care that must be rendered with-out delay. In a hospital
Emergency Department, several patients with diverse health problems—some life-threatening,
some not—may present to the Emergency Department simultaneously. One of the first
principles of emergency care is triage.
TRIAGE
The word triage comes from the French word trier, meaning “to sort.” In the daily routine of the
Emergency Department, triage is used to sort patients into groups based on the severity of their
health problems and the immediacy with which these problems must be treated.
Hospital Emergency Departments use various triage systems with differing terminology, but all
share this characteristic of a hierarchy based on the potential for loss of life. A basic and widely
used system uses three categories: emergent, urgent, and non-urgent (Berner, 2001).
Emergent patients have the highest priority—their conditions are life threatening, and they must
be seen immediately.
Urgent patients have serious health problems, but not immediately life- threatening ones; they
must be seen within 1 hour.
Non-urgent patients have episodic illnesses that can be addressed within 24 hours without
increased morbidity (Berner, 2001). These patients require simple first aid or basic primary care.
They may be treated in the Emergency Department or safely referred to a clinic or physician’s
clinic.
COMMON EMERGENCY CONDITIONS
What is First Aid?
First Aid is the giving by a layperson (a bystander or the victim himself) of immediate care to a
victim of injury or illness, usually done within a limited skilfulness and using little or no medical
equipment. It is usually performed until the patient’s feeling of illness is reduced, or the threat of
worsening the injury has been lessened, or until the next level of care, such as an ambulance
arrives, or the victim has been brought to a medical facility.
Goals of First Aid
The key guiding principles and goals of first aid can be remembered as the “3
Ps”. These three points dictate all your actions as a first aid provider:
●Prevent further injury
●Preserve Life
●Promote Recovery
First Steps in First Aid
Scene size-up - When you are called upon to help a victim, you must always remember to
safeguard yourself, and then assess the situation. Only after these steps are completed can
treatment of the victim begin.
Primary Assessment- After assessing the scene, assess the victim. Your goal in this primary
assessment is to identify and start treatment of immediate or potential life threats. In short, you
must first find out the most urgent problem the victim has (especially if life threatening), and
treat it immediately.
You can get major information about life-threatening condition by checking the victim’s
circulation, airway, and breathing (CAB). In all situations, your assessment of the victim’s CABs
will tell you the extent of the help that the victim needs. Always put the CABs first to guarantee
life-saving care.
The CABs
● Circulation- You must check the victim’s circulation, or blood flow, to find out whether the
heart is working properly and if blood is being delivered to all body parts. This is done by
examining the victim’s skin, and checking the rate of the victim’s pulse, along with how strong it
is. Problems in circulation will cause the victim’s skin to change color. Look at the skin whether it
is reddish (flushed), whitish (pale), or bluish. Also feel whether the victim’s skin is clammy,
sweaty, or very dry. Check for the victim’s pulse at the wrist on the side of the base of the
thumb. If a pulse cannot be felt at the wrist, feel for the pulse at the neck beside the Adam’s
apple. If you cannot feel a pulse, begin giving chest compression (You will learn about chest
compression in Basic Life Support)
● Airway- Always be alert for signs of a blocked airway. Whatever the cause, a blocked airway
will interfere with the flow of air into and out of the lungs. This lack of air can cause damage to
the brain, heart, and lungs, and death. If the victim (of any age) can still talk or cry despite the
injury, he or she has an open airway. However, watching and listening to how he or she speaks-
especially those with airway problems- may provide important clues about whether the airway is
open enough, or if he or she is breathing as much as necessary. For example, if there are
harsh, high-pitched crowing sounds (stridor), a foreign object may be partially blocking the
airway. If the patient is awake but cannot speak or cry, his airway is most likely completely
blocked. If the victim has an airway problem, stop the assessment process and open the airway
at once using the head-tilt + chin-lift technique or by removing foreign objects in the mouth.
● Breathing- After making sure that the victim’s airway is open, check for breathing. Place your
cheek in front of the victim’s mouth (about 3-5cm away) while looking at his chest. If you
observe the following in the victim, he is able to breathe:
- You can feel the flow of air on your cheek
- You can hear the flow of air
- You can see the victim’s chest rise and fall
History
Getting the victim’s history is all important as this information can tell you a lot about the injury
sustained, the extent of injury and what suitable actions can be done. The victim’s history is also
passed on to the emergency or hospital personnel as soon as they are available. If the victim is
conscious and cooperative, he is the best source of information. Otherwise, ask helpful
witnesses about the incident.
The following are the important things to ask for when taking a history:
- Chief Complaint: What is the problem?
- History of chief complaint: How did this happen? Has it happened before?
- Pain assessment: Is anything painful? Where is it painful? How does the pain feel? How
severe is it? Does it spread? Is the pain constant? For how long? What makes it feel
better/worse?
- Onset: When did your symptoms start? What were you doing?
- Allergies: Are you allergic to anything?
- Medical history and medications: Do you have any medical conditions? Do you take any
medications?
- Important Information: Name, age, address
- Next of kin: Is there anyone you would want to have us contact?
Secondary Assessment
The secondary assessment is done to continually observe the victim’s condition and find any
non-life-threatening conditions that must be treated. Do this after finishing the primary
assessment- when you are sure that the victim has good circulation, an open airway, and is
breathing sufficiently. It is important to always ask permission before doing the examinations
and to explain the purpose of the procedure.
Perform a head-to-toe check of the victim to identify specific injuries or illness, and to find out
their extent. Look for abnormalities that point to an injury or an illness. Abnormalities can be in
the form of uneven appearance, deformity, bruising, tenderness, or bleeding. Examine each of
the following six areas of the body to see if there are abnormalities:
- Head and neck
- Shoulders, chest and back
- Arms and hands
- Abdomen
- Hips
- Legs and feet
BURNS
Burns are caused by large amounts of heat energy or chemicals absorbed by the skin. They are
often very painful and can cause scarring. Severe burns can cause death. Your first aid care will
vary depending on the type of burn that the victim has. Recognizing the type of burn is the
critical step in order to give the correct care and prevent complications.
Types of Burns
Thermal burns- are caused by sun exposure and direct or indirect contact with fire, very hot or
very cold objects, liquids, and gases, or by blasts or fireballs.
Electrical burns- result from direct contact with live high-voltage or low- voltage electrical
currents or lightning.
Chemical burns- are caused by direct contact with corrosive chemicals.
Depth of burns
The seriousness of burn injury partly depends on how deep the affected area is.
● First-Degree Burns (superficial burns) affect only the top layer of the skin.
Sunburn is a common example of a first-degree burn. The affected area is
- red, but has no blisters
-painful
-can be swollen
What to do for a victim of a first-degree burn:
1. Quickly remove the victim from the source.
2. Immerse the affected body part immediately in room temperature water with 30 minutes of
injury to reduce pain. Apply burn ointment. DO NOT apply anything else.
3. Make sure the victim drinks plenty of water.
WHAT NOT TO DO:
DO NOT use ice or ice water- this will cause more damage.
● Second-Degree Burns (partial-thickness burns) reach up to the second layer of the skin, but
do not destroy the entire thickness. The affected area is usually
- moist
- red
- swollen
- with blisters
- very painful
What to do for a victim of a second-degree burn:
1. Quickly remove the victim from the source of burn.
2. Cut and gently lift away any clothing covering the burned area, without pulling clothing over
the burn. Leave in place any clothing that is stuck to the burn.
3. Immerse the affected body part immediately in room temperature water within 30 minutes of
injury to reduce pain.
4. Apply burn ointment. DO NOT apply anything else.
5. Make sure the victim drinks plenty of water.
6. Elevate the affected area and bring the victim to the nearest hospital.
WHAT NOT TO DO:
DO NOT use ice or ice water- this will cause more damage.
DO NOT open or pick the blisters.
● Third- Degree burns (full- thickness burns) extend through all layers of the skin and may also
affect the muscles, bone, or internal organs. The burned area is
- dry and leathery
- may appear white, dark brown, or even charred
- feel hard to the touch
-numb
The surrounding areas that are less severely burned may be extremely painful.
What to do for a victim of a third-degree burn:
1. Quickly remove the victim from the source of burn.
2. Assess the victim’s circulation, airway, and breathing (CAB), and administer the
corresponding intervention. Always check the nose and oral cavity of the patient. if there is soot
and ash, advanced airway interventions (such as intubation) in the hospital are needed.
3. Cover the burned body part with a clean, moist cloth.
4. When possible, elevate the affected part higher than the heart.
5. Bring the victim to the nearest hospital immediately.
WHAT NOT TO DO:
DO NOT remove burned clothing.
DO NOT immerse body parts with large burns in cold water.

Chemical burns
Most chemical burns are caused by strong acids or strong alkali. When they react with
chemicals on the skin, they release a large amount of heat energy that causes the burn injury.
What to do for a victim of chemical burn:
1. Quickly remove the victim from the source of burn.
a. Wet/Liquid Chemicals- remove liquid chemicals by flushing the affected body part with water
for at least 15 to 20 minutes.
b. Dry/ Powder Chemicals- remove dry chemicals by brushing them off the skin using a piece of
cloth. Flush the affected area with water for at least 15 to 20 minutes.
2. Remove all contaminated clothing from the victim, making sure that you are not contaminated
in the process.
3. Continue flushing the affected body part for 25 to 20 minutes even after the victim says the
burning pain has stopped. Make sure that the victim does not become too cold in the process.
4. Bring the victim to the nearest hospital immediately.
WHAT NOT TO DO:
DO NOT use anything but water to flush liquid chemicals.
DO NOT use the bare surface of your hand to brush off dry chemicals.
DO NOT flush the affected area at all if there is not enough water available- small amount of
water applied to a dry chemical can cause a reaction that can cause more damage.

Electrical burns
An electrical burn injury appears where the electricity enters (an entrance wound) and exits (an
exit wound) the body. The entrance wound may be small, but the exit wound can be large and
deep. The tissues between the entrance and exit wounds are injured as well. There are two
dangers specifically seen in electrical burns: there may be a large amount of deep tissue injury,
and the victim’s heart may stop because of electric shock.
What to do for a victim of an electrical burn:
1. Quickly separate the victim from the source of the electric current. Turn off the electrical
current. DO NOT attempt to turn off the current if the source of the electricity is not accessible. If
the current cannot be turned, wrap any nonconductive material (dry rope, clothing, wood)
around the victim’s back and shoulders and drag the victim away from the electrical source,
making sure you DO NOT make body-to-body contact with the victim or with any wires.
2. Assess the victim’s circulation, airway, and breathing (CAB), and administer the
corresponding intervention.
3. Give the appropriate first aid care to any open wound.
4. Bring the victim to the nearest hospital immediately.

POISONING
A poison is any substance (solid, liquid or gas) that causes illness or death when it enters the
body or when it comes in contact with the surface of the skin.
There are four ways in which poisons can enter the body:
- by ingesting (swallowing)
- by inhaling (breathing)
- by absorbing (through unbroken skin)
- by injecting ( usually stings or bites)
Ingested poisons
Examples of swallowed poisons include:
-overdose of alcohol or medicines (usually sleeping pills or pain relievers)
- Insecticides or pest control products
- Kerosene
- Denatured alcohol
- Acids
-Toxins from poisonous plants
- Contaminated food or water
How do we know a person is a victim of ingested poison?
- Abdominal pain and cramping
- Desire to vomit, with or without actual vomiting
- Diarrhea
- Presence of burns, odors, or stains around and in the victim’s mouth
- Drowsiness and loss of consciousness
- Container of poison found near the victim
What to do for the victim of ingested poison?
● Make sure you know the following critical information:
- WHO is the victim? What is the age and size (or weight) of the victim?
- WHAT poison was swallowed?
- HOW MUCH poison was swallowed (estimate) ?
- HOW did it happen? (Intentionally? Accidentally?)
- WHEN did it happen? What time?
●If the victim is responsive:
- Observe the victim while waiting for transport to a medical facility.
●If the victim is unresponsive:
- Check that his airway is clear and that he is breathing
- Place the victim in a side-lying position
●Save and bring poison containers, plants, and material vomited by the victim to help medical
personnel identify the poison and administer the appropriate treatment.
●Contact a poison control center and bring the patient to the nearest hospital.
WHAT NOT TO DO:
DO NOT make the victim vomit.
DO NOT give the victim any food or liquids by mouth unless advised by a medical authority.
Alcohol Intoxication
Alcohol intoxication happens when the amount of alcohol a person takes in is more than what
his body can tolerate. This produces changes in the body that decrease his mental and physical
abilities.
How do we know if a person is suffering from alcohol intoxication?
-Odor of alcohol on the victim’s breath/ clothing
-Sleepiness or confusion
-Poor balance and coordination of movements
- Numbness of body
- Slurred Speech
- Desire to vomit with or without actual vomiting
-Seizures (convulsions) may occur
What to do if a person is intoxicated and responsive
-Look for any injuries
- Protect the intoxicated person from injuring himself.
-Protect yourself.
-If the intoxicated person becomes violent, leave the scene and call for
police and medical assistance.
-Keep at a safe distance until help arrives.
What to do if a person intoxicated and unresponsive?
- Seek medical assistance immediately
- Make sure the airway is clear and that the person is breathing
- Place the person in a side-lying position
- Assume there is spinal injury if there are signs of injury
- Regulate the person’s body heat
- Bring the person to the nearest hospital
WHAT NOT TO DO:
DO NOT give the victim anything by mouth.

Inhaled Poison
These poisons enter by being breathed into the body. Inhaled poisons can include smoke,
fumes from household cleaning fluids and industrial products, among others.
Carbon monoxide is an example of a poisonous gas. It is produced by any engine (car or
generator). It cannot be smelled or seen, and has no taste. Carbon monoxide takes the place of
oxygen in the blood so that blood carries the poison instead of oxygen. Carbon monoxide in the
blood will make one feel sleepy and drowsy. People are poisoned in the matter of minutes.
How do we know a person is a victim of inhaled poison?
● A quick scan of the environment can give you a clue of whether there are possible gas
poisons in the area. These environmental “clues”, together with the following signs/symptoms,
may help you presume that victims have inhaled poisons.
-Difficulty of breathing
-Chest pain
-Cough
- Hoarseness
-Burning sensation in the throat
-Bluish discoloration of the skin, lips, and walls of the mouth (cyanosis)
-Dizziness
-Headache
-Seizures (in the advanced stage)
-Unresponsiveness (in the advanced stage)
What to do for the victim of inhaled poison?
-Immediately remove the victim from the toxic environment.
-Keep the victim’s airway open, and make sure that he/she is breathing fresh air.
-Take the victim to the hospital.

Absorbed Poisons
Absorbed poisons enter the body by passing through unbroken skin. Some examples are
household cleaning fluids, agricultural chemicals or insecticides, industrial products, creams,
ointments, and secretions of poisonous plants such as the giant pitcher plant of Central
Palawan.
How do we know a person is a victim of absorbed poison?
-Redness, rash, and/or blisters on the skin
-Hot, dry skin and lips
-Burns
-Itching, skin irritation
-Presence of liquid or powder on the skin
-Blurring of vision
-Dizziness
-Headache
-Seizures (in advanced stage)
-Unresponsiveness (in the advanced stage)
What to do for the victim of absorbed poison?
-Remove the victim’s clothing
-BLOT (not wipe) the poison from the skin using a dry piece of cloth. If the poison is a dry
powder, BRUSH it off.
-Wash the exposed area with running water. Ask the victim to take a bath, especially if he has
been exposed to agricultural chemicals.
-Monitor the victim’s condition.
- Bring the victim to the nearest hospital.
WHAT NOT TO DO: DO NOT wipe off poison to remove it from the skin.
FRACTURES
A fracture is a broken bone. Fractures are either closed or open. If the skin over the bone is
undamaged, the fracture is a closed fracture. When the skin is broken due to the same force
that fractured the bone, or by the broken bone ends lacerating the skin, the fracture is an open
fracture
Recognizing fractures
● Tenderness: the affected area is painful when it is pressed. This is the most reliable sign of a
fracture.
● Deformity: the affected area may look shorter, rotated, or bent abnormally
●Swelling: if swelling is rapid, there may be bleeding underneath
● Pain
● Discoloration
● Crepitus: a grating or grinding sensation felt or heard when the fractured bone ends rub
together
● False Motion: movement at a point in the limb where there is no joint
● Guarding: the inability to use or move the affected body part, this is the victim’s way to
minimize the pain
● In open fractures, the bone ends may stick out through the skin or are visible within the
wound.
What to do for a victim of fracture:
● Immobilize the affected body part using a splint.
● If there is an open wound, control the bleeding by applying a dressing.
● Apply the RICE procedure to help control swelling, pain and bleeding:
a. Rest- keep the victim as still as possible
b. Immobilize- using a splint
c. Cold- place an ice/cold pack on the injured area for up to 20 minutes.
d. Elevation- elevate the injured part just above the level of the victim’s heart, taking care not to
worsen the injury.
● Bring the victim to the nearest hospital.
WHAT NOT TO DO:
DO NOT attempt to straighten or re-align the deformed body parts.
DO NOT attempt to push exposed bone ends back into the skin.
DO NOT massage the affected part.
DRUG CLASSIFICATION
Drugs can be categorized in a number of ways. In pharmacology, a drug can be classified by its
chemical activity or by the condition that it treats.
- In general, drugs are classified based on:
a. Therapeutic classification
b. Pharmacologic classification (based on mechanism of action and mode of action)
c. Chemical Classification
d. Legal Classification (Teratogenic Risks)
THERAPEUTIC CLASSIFICATION
- Based on their
therapeutic
usefulness in
treating particular
diseases.
PHARMACOLOGIC CLASSIFICATION
Refers to the way a drug works at the molecular, tissue, and body system levels. The
pharmacologic classification addresses a drug’s mechanism of action, or how a drug produces
its physiological effect in the body.
PHARMACOLOGIC CLASSIFICATION
PHARMACOTHERAPY FOR HYPERTENSION
Drug Classification -Mechanism of Action
Diuretic- Lowers plasma volume
Calcium channel blocker- Blocks heart calcium channels
Angiotensin-converting enzyme inhibitor- Blocks hormonal activity
Adrenergic antagonist- Blocks physiological reactions to stress
FACTORS INFLUENCING DRUG ACTION
Body Size- influences the concentration of drug attained at the site of action.
Pregnancy- most drugs can cross the placenta and expose the developing embryo and fetus to
their pharmacologic and teratogenic effects. As a rule try to avoid giving any drug during
pregnancy, if possible.For example: Thiopental, drug used for Ceasarian Section (CS) crosses
the placenta almost immediately and can produce sedation or apnea in newborn. Highly ionized
drugs like Succinylcholine, also used for CS, crosses the placenta slowly and achieves very low
concentration in fetus.
Lactation- Most drugs are detectable in breastmilk. If there is a need to take drugs during
lactation, timing should be 30 to 60 minutes after nursing, 3-4 hours before the next feed. Most
antibiotic in milk are 70% of maternal serum concentration and present a risk for permanent
tooth staining in infant. Mothers taking anticancer therapy should avoid breast feeding.
Age (Pediatric and Geriatric)- Infants and children are not small adults in the way their bodies
handle drugs. A knowledge of age-related changes in drug absorption, distribution and
clearance is essential to optimize drug efficacy and to avoid toxicity.
Genetic Factors-Racial differences may influence drug action. Blacks require higher and
Mongols require lower concentration of Atropine and Ephedrine to dilate the pupil.
Routes of Drug Administration- Governs the speed and intensity of drug response.
Environmental Factors- Exposure to insecticides, carcinogens, tobacco smoke, charcoal broiled
meat induce drug metabolism. Type of diet can alter drug absorption. Set up in which drugs
affects hypnotic drugs, it works better when taken at night in quiet surroundings.
Psychological Factors- Drugs efficacy can be affected by patient’s expectations and attitude.
Anxious patients require more general anaesthetic.
Tolerance and Resistance- By repeated use of a drug in an individual who was initially
responsive. A continuous presence of drugs in the body leads to tolerance.
Effects of Drugs
Mental health- Studies show that drug use increases your risk of mental health issues such as
anxiety, depression and psychosis. People with mental health issues also have a higher rate of
drug use problems.
Financial issues- Some drugs can be very expensive — the street price of illicit drugs depends
on availability and demand. If you have become dependent on a drug, you could end up in
financial trouble.
Relationships- Because drugs can change your behavior, they can affect your relationships with
family and friends. There is an increased risk of injury and/or assault to both yourself and other
people.
Legal issues- Many drugs are illegal and you can be fined, or sent to prison, for having them.
Drugs and driving-Alcohol and other drugs can seriously affect your driving skills. You are more
likely to have an accident, injuring yourself and/or others. The crash could be fatal.The
different types of drugs affect your driving ability in the following ways:
stimulants — driving too fast or erratically, being aggressive behind the wheel, reduced vision,
you can feel overconfident
depressants — driving too slowly, falling asleep at the wheel, veering out of your lane, your
reactions are slower
hallucinogens — distorted vision, hard to correctly judge distances, seeing things that aren’t
there
Mixing drugs, including alcohol, only increases your risk of having a crash.

Types of medical order

Medication order is written directions provided by a prescribing practitioner for a specific
medication to be administered to an individual. The prescribing practitioner may also give a
medication order verbally to a licensed person such as a pharmacist or a nurse.

Examples of some different types of medication orders are:

• Copy of a written prescription
• Written order on a consultation form, signed by the practitioner
• Written list of medication orders, signed by the practitioner
• Copy of a pharmacy call-in order, given to you by the pharmacist*
• A verbal order given to a licensed person*
• Electronic prescriptions signed electronically via a secured system

What do we mean when we use the term “prescribing practitioner”? This is a term that describes
the various health care professionals who can give medication orders like physicians, dentists
and optometrist.

Parts of drug order

Client’s Full Name- Using the client’s full name helps to prevent confusion of one client with
another, thereby preventing administration of the wrong medication to a client. Many institutions
use a nameplate to imprint the client’s name and record number on the order sheet; in addition
there is usually a place to indicate allergies. In institutions that use computers, the computer
screen may also show identifying information for the client, such as age and known drug
allergies.
Date and Time the order was written- The date and time of the order include the month, day,
year, and the time the order was written. This will help in determining the start and stop of the
medication order. In many institutions the health care provider (or person legally authorized to
write a medication order) is required to include the length of time the medication is to be given
(e.g., 7 days).
Name of Medication- The medication may be ordered by the generic or brand name.

10 R’s of Medication Administration

1. Right Drug.
The first right of drug administration is to check and verify if it’s the right name and form. Beware
of look- alike and sound-alike medication names. Misreading medication names that look similar
is a common mistake. These look-alike medication names may also sound alike and can lead to
errors associated with verbal prescriptions.
2. Right Patient.
Ask the name of the client and check his/her ID band before giving the medication. Even if you
know that patient’s name, you still need to ask just to verify.
3. Right Dose.
Check the medication sheet and the doctor’s order before medicating. Be aware of the
difference between an adult and a pediatric dose.
4. Right Route.
Check the order if it’s oral, IV, SQ, IM, etc..
5. Right Time and Frequency.
Check the order for when it would be given and when was the last time it was given.
6. Right Documentation.
Make sure to write the time and any remarks on the chart correctly.
7. Right History and Assessment.
Secure a copy of the client’s history to drug interactions and allergies.
8. Drug approach and Right to Refuse.
Give the client enough autonomy to refuse the medication after thoroughly explaining the
effects.
9. Right Drug-Drug Interaction and Evaluation.
Review any medications previously given or the diet of the patient that can yield a bad
interaction to the drug to be given. Check also the expiry date of the medication being given.
10. Right Education and Information.
Provide enough knowledge to the patient of what drug he/she would be taking and what are the
expected therapeutic and side effects.

Route of Drug Administration

Oral route- Many drugs can be administered orally as liquids, capsules, tablets, or chewable
tablets. Because the oral route is the most convenient and usually the safest and least
expensive, it is the one most often used. When a drug is taken orally, food and other drugs in
the digestive tract may affect how much of and how fast the drug is absorbed. Thus, some
drugs should be taken on an empty stomach, others should be taken with food, others should
not be taken with certain other drugs, and still others cannot be taken orally at all.
Injection routes- Administration by injection (parenteral administration) includes the following
routes:
Subcutaneous (under the skin)-administered at 45 degree angle. Subcutaneous means under
the skin. In this type of injection, a short needle is used to inject a drug into the tissue layer
between the skin and the muscle.
Intramuscular (in a muscle)- administered at 90 degree angle. It delivers a substance deep into
a muscle, where they are quickly absorbed by the blood vessels. Common injection sites
includes the deltoid, thigh and buttocks.
Intravenous (in a vein)- administered at 25 degree angle. This means medication sent directly
into your vein using a needle or tube. “Intravenous” means “into the vein”.
Intradermal (in a dermis)- administered at 10-15 degree angle. Medication is delivered directly
into the dermis, the layer just below the epidermis of the skin. This route is usually used when
localised reaction is required, for example with some vaccinations, allergy testing, or tests to
determine previous exposure to some infections.
Sublingual and buccal routes- A few drugs are placed under the tongue (taken sublingually) or
between the gums and teeth (buccally) so that they can dissolve and be absorbed directly into
the small blood vessels that lie beneath the tongue.

Rectal route-Many drugs that are administered orally can also be administered rectally as a
suppository. In this form, a drug is mixed with a waxy substance that dissolves or liquefies after
it is inserted into the rectum. Because the rectum’s wall is thin and its blood supply rich, the drug
is readily absorbed. A suppository is prescribed for people who cannot take a drug orally
because they have nausea, cannot swallow, or have restrictions on eating, as is required before
and after many surgical operations.
Vaginal routes- Some drugs may be administered vaginally to women as a solution, tablet,
cream, gel, suppository, or ring. The drug is slowly absorbed through the vaginal wall. This route
is often used to give estrogen to women during menopause to relieve vaginal symptoms such
as dryness, soreness, and redness.
Ocular Route- Drugs used to treat eye disorders (such as glaucoma, conjunctivitis, and injuries)
can be mixed with inactive substances to make a liquid, gel, or ointment so that they can be
applied to the eye. Liquid eye drops are relatively easy to use but may run off the eye too
quickly to be absorbed well.
Otic Route- Drugs used to treat ear inflammation and infection can be applied directly to the
affected ears. Ear drops containing solutions or suspensions are typically applied only to the
outer ear canal.
Nasal Route- If a drug is to be breathed in and absorbed through the thin mucous membrane
that lines the nasal passages, it must be transformed into tiny droplets in air (atomized). Once
absorbed, the drug enters the bloodstream. Drugs administered by this route generally work
quickly.
Inhalation and Nebulization route- Drugs given by nebulization must be aerosolized into small
particles to reach the lungs.
Cutaneous Route- Drugs applied to the skin are usually used for their local effects and thus are
most commonly used to treat superficial skin disorders.
Transdermal Route- Some drugs are delivered body wide through a patch on the skin.
Calculating Tablet Dosages
In calculating tablet dosages, the following formula is useful:

DESIRED DOSAGE ÷ STOCK STRENGTH = NUMBER OF TABLETS

The desired dosage is the ordered dosage of the physician while the stock strength is the
amount of drug present in each tablet. Stock strength is also known as stock dose.
Example:
The physician orders 1,000 mg of calcium carbonate for the patient. The drug is available in
250 mg tablets. How many tablets should be given to the patient?

Desired dosage ÷ stock strength = number of tablets

1,000 mg ÷ 250 mg = 4 tablets

Calculating Mixtures and Solutions

The following formula is useful in calculating mixtures and solutions:

DESIRED DOSAGE ÷ STOCK STRENGTH X STOCK VOLUME = AMOUNT OF SOLUTION
TO BE

GIVEN
The desired dosage is the ordered dosage of the physician. The stock strength is the amount of
drug present in the preparation while the stock volume is the amount of the solution where the
drug is diluted.
Example:
The physician orders 275 mg of Cefixime for the patient. The drug is available in 500 mg vial.
You plan to dilute it in 5 mL of sterile water. How much should you give to your patient?

[Desired dosage ÷ stock strength] x stock volume = amount of solution to be given

[275 mg ÷ 500 mg] x 5 mL = amount of solution to be given

0.55 mg x 5 mL = 2.75 ml

Calculate IV Rate – mL per hour and minute

It is easy to calculate the running rate of IV fluids in terms of mL per hour or mL per minute:

TOTAL IV VOLUME ÷ TIME (HOUR OR MINUTE) = ML PER HOUR OR MINUTE

The total IV volume is the amount of fluid to be infused while the time is the number of running
hours or minutes.
Examples:
Start venoclysis with D5LR 1 L to be infused for 8 hours. How many mL of the IV fluid should
you infuse per hour?

Total IV volume ÷ time (hour or minute) = mL per hour

1 L ÷ 8 hours = mL per hour

[1 L x 1,000] ÷ 8 hours = mL per hour

1,000 mL ÷ 8 hours = 125 mL per hour

Calculate IV Rate – drops per minute

Calculating for drops per minute is simple with the following formula:

[TOTAL IV VOLUME ÷ TIME (MINUTE)] X DROP FACTOR = DROPS PER MINUTE

The total IV volume is the amount of IV fluid to be infused while time is the duration of how long
the IV fluid should be infused in terms of minutes.

The drop factor is the “drops per milliliter” delivered to the patient and it depends on the
macrodrip used for the infusion. The common drop factors used in different hospitals are 10, 15
and 20.
Examples:
The physician orders to start venoclysis with PNSS1 L solution. The IV fluid will be infused for
12 hours and the drop factor of the macrodrip used is 20. It should be regulated to how many
drops per minute?

[Total IV volume ÷ time (minute) ] x drop factor = drops per minute

[1 L ÷ 12 hours] x 20 = drops per minute

[{1 L x 1,000} ÷ {12 hours x 60} ] x 20 = drops per minute

[1,000 mL ÷ 720 minutes] x 20 = drops per minute

1.36 x 20 = 27 to 28 drops per minute

Calculate IV Rate – Remaining Time of Infusion

Calculating for the remaining time of infusion for a certain IV fluid is possible with the following
formula:

[VOLUME REMAINING (IN ML) ÷ DROPS PER MINUTE] X DROP FACTOR = MINUTES
REMAINING

The volume remaining is the amount of IV fluid remaining for the infusion while the drops per
minute is the regulation of the IV infusion. The drop factor can be determined in the macrodrip
used in the hospital.
Example:
You see that your patient has D5 0.9 NaCl IV infusion at 500 mL level. It is regulated to run for
20 drops per minute using a macrodrip set with drop factor 20. How many minutes are
remaining before you are due to change the IV fluid?

[Volume remaining (in mL) ÷ drops per minute] x drop factor = minutes remaining

[500 mL ÷ 20] x 20 = minutes remaining

25 x 20 = 500 minutes or 8 hours