EMS Medications
Normal Saline Administration
Dose: Depends on the condition you are treating...TKO is 30 mL/hour (TKO = to keep open...the slowest rate necessary to keep the vein open) Route: IV/IO How supplied: Bags: 250 mL; 500 mL; 1000 mL Pregnancy Grade: N/A
Lactated Ringer's Administration
Dose: Depends on the conditions being treated (TKO = 30 mL/hour) Route: IV/IO How supplied: Bags (250 mL; 500 mL; 1000 mL)
Albuterol Sulfate Administration
Dosage: 1) MDI (metered dose inhaler) = 90 mcg spray 2) Nebulizer = 2.5 mg diluted in 2.5 mL of normal saline, administered over 5-15 min. 3) Pediatric = .15 mg/kg diluted in 2.5 mL normal saline Route: Inhalation How supplied: 1) Nebulizer bullet = 2.5 mg in 3 mL of saline bullet 2) Solution = 5 mg/mL concentrate solution
Activated Charcoal Administration
Dose = 1 g/kg, up to 50 g Route = oral How supplied = suspended liquid slurry, 25 g or 50 g tubes
Oxygen Administration
Dose: Nasal Cannula = 2-6 LPM titrated to effect NRB mask = 12-15 LPM titrated to effect
Atropine Sulfate Administration
Dose: 1) Symptomatic Bradycardia...Adults = 0.5 mg - 1 mg, rapid bolus...repeat every 5 minutes up to 0.04 mg/kg....Pediatrics = 0.02 mg/kg (minimum dose of 0.1 mg)...repeat every 5 minutes up to maximum dose 2) Organophosphate poisoning = 2 mg rapid IV push or IM, every 15 min. to treat symptoms...some literature suggests 2-5 mg rapid IV push Route = IM (auto-injector); IV/IO How supplied = 1) preloaded autoinjector with 2 mg atropine (Mark I kit) 2) preloaded syringe (1 mg)
Epinephrine 1:1000 Administration
Dose: Adult = 0.3 mg - 0.5 mg, every 15 min. as needed Pediatric = 0.01 mg/kg Route: subcutaneous of intramuscular injection How supplied: 1) 1 mg/mL ampule (1 mL) 2) 1 mg/mL vial (30 mL) 3) 0.3 mg prefilled auto injector 4) 0.15 mg prefilled autoinjector
Dextrose Administration
Dose: Adult = 25 g slow IV push; may be repeated in 10-15 minutes if the glucose level remains below 70 Pediatric = 0.5 g/kg of D-25 Neonates = 10 g/100 mL Route: Slow IV push through an 18 guage or larger needle How supplied: prefilled syringe with 25 g in 50 mL
Nitroglycerin Administration
Dose: Adults = 0.4 mg (tablets) or 1 spray, every 15 minutes...max dosage of 1.2 mg Pediatric = not indicated Route = Tablet (placed under the tongue and allowed to dissolve); Spray How supplied = Sublingual spray or tablet
Glucagon Administration
Dose: 1 mg Route: IM injection/IV/IO How supplied: supplied as a kit with powder and solvent that must be combined
Glucose Administration
Dose: 15 g Route: Oral (rub on inside of cheeks and gums and let it sit to allow for buccal absorption) How supplied: 1) Tube (15 g or 45 g) 2) Tablets
Acetylsalicylic Acid Administration
Dose: 325 mg...4 81 mg tablets Route: Oral (chewed, not swallowed)
Epinephrine 1:10,000 Administration
Dose: Adult = 1 mg, ever 3-5 min...Pediatric = 0.1 mg/kg, every 3-5 min. Route: IV/IO bolus How supplied: 1) preloaded syringe (10 mL) 2) can dilute epi 1:1000 (1 mL of 1:1000 with 9 mL of saline)
Acetaminophen Administration
Dose: Adult = 325-650 mg, every 5-6 hours...Pediatric (6-11 yrs. old) = 150-300 mg, every 6-8 hours Route: Oral How supplied: Tablets; suspension
Morphine Sulfate Administration
Dose: Adults = 2-15 mg (2-4 mg increments)...Pediatrics = 0.1 mg/kg (max of 15 mg) Route: IM injection, IV/IO bolus, SQ injection How supplied: Preloaded syringes of varying concentrations
Nitrous Oxide Administration
Dose: Self-administered 50/50 mix of O2 and NOX...until the patient passes out Route: Inhalation How supplied: 50/50 O2 and NOX mixture
Dextrose 5% Administration
Dose: Usually at TKO (30 mL/hour) Route: IV/IO How supplied: Bags
Fentanyl Citrate Administration
Dose: Adults = 25-200 mcg (25-50 mcg per dose), titrated to effect...Pediatrics = 0.5-2 mcg/kg, titrated to effect Route: IV/IO bolus, IM injection, nasal spray How supplied: 0.05 mg/mL = 50 mcg/mL
Normal Saline Description
(0.9% NaCl solution) Class: Isotonic crystalloid solution Mechanism: Isotonic solution that is used to temporarily expand blood volume by replacing water and electrolytes Indications: *3HDK*...*H*ypovolemia; *H*eat exhaustion; *H*eat stroke; and *D*iabetic *K*etoacidosis Contraindications: *HF*...should not be given to patients with *H*eart *F*ailure bc fluid overload could occur Precautions: patients receiving large volumes of NS should be carefully monitored for fluid overload...in patients who have lost significant amounts of electrolytes it may be more appropriate to use LR Side effects: administration of large amounts of NS may result in hemodilution and electrolyte imbalance Interactions:...
Acetylsalicylic Acid Description
(Aspirin) Class: Platelet aggregation inhibitor; NSAID; analgesic Mechanism: Blocks part of the chemical reaction responsible for activating platelets...platelet aggregation inhibitor, NSAID, analgesic Indications: Acute coronary syndrome and stroke??? Contraindications: *HC/SALKS A PBUA* hypersensitivity; not given to children or adolescents Precautions: use with caution in patients with Seasonal allergies, Asthma, Liver disease, Kidney disease, Stroke, Alcohol abuse (PBUAA, pregnant, bleeding disorders, ulcers, anticoagulant usage, allergic) Side effects: GI upset, bleeding, nausea, vomiting, and wheezing Interactions: none with a single dose
Diphenhydramine Description
(Benadryl) Class: antihistamine Mechanism: blocks histamine release Indications: anaphylaxis, allergic reaction (hives, swelling, red itching) Contraindications: hypersensitivity Precautions: use caution in asthmatic patients or patients who are taking other antihistamines or medications containing antihistamines, such as Tylenol PM....may cause hyperactivity in children
Diphenhydramine Administration
(Benadryl) Dose: Adult = 50 mg...Pediatric = 1 mg/kg, up to 25 mg Route: IV/IO bolus; IM injection; oral (swallowed or chewed, depending on the form) How supplied: 50 mg/mL vial (1 mL)
Naloxone Administration
(Narcan) Dose: 1-2 mg slow IV push titrated to effect...may be repeated at 5 mniute intervals Route: Slow IV push/Intranasal How supplied: 1) Pre-filled syringe (2 mg/2 mL) 2) Vial (4 mg/10 mL) 3) Ampule
Naloxone route, onset, peak, duration, pregnancy grade
(Narcan) Route: IM/IV/IO/IN Onset: 2-10 min (IM)...<2 min (IV/IO) Peak: 2-10 min. (IM)...<2 min (IV/IO) Duration:... Pregnancy Grade: C
Naloxone Description
(Narcan) Class: Narcotic agonist Mechanism: has a higher affinity for narcotic receptor sites and displaces the narcotic (via competitive inhibition) Indications: used for patients with respiratory depression associated with narcotic overdose Contrindications: hypersensitivity Precautions: may cause narcotic withdrawal symptoms Side effects: None Interactions: may cause withdrawal symptoms in patients addicted to narcotics
Promethazine Description
(Phenergan) Class: antihistamine, antiemetic, sedative-hypnotic Mechanism: blocks effects, but not release of histamine and exerts strong alpha-adrenergic effect...it also inhibits chemoreceptor trigger zone in medulla and alters dopamine effects by indirectly reducing reticular stimulation of CNS Indications: Nausea; vomiting Contraindications: *HHAC* *H*ypersensitivity, *H*ypotension (systolic BP < 100 mmHg or absent peripheral pulses) *A*sthma, *C*OPD Precautions: CNS depression caused by narcotics, barbiturates, general anesthesia, tranquilizers, or alcohol Side effects: ... Interactions: ..
Promethazine Administration
(Phenergan) Dose: IV = 12.5-25 mg, titrated to effect, diluted with 5-10 mL of Normal Saline...IM = 25 mg Route: IV/IO/IM injection How supplied: 25 mg/1 mL ampule (1 mL)
Promethazine route, onset, peak, duration, pregnancy grade
(Phenergan) Route: IV/IO/IM injection Onset: 20 min. (IM)...3-5 min. (IV/IO) Peak: Unknown for both Duration: 4-12 hours for both Pregnancy Grade: C
Acetaminophen Description
(Tylenol) Class: non-narcotic analgesic; antipyretic Mechanism: not known Indications: fever; pain...but mostly fever! Contraindications: *H/PM on L*...hypersensitivity Precautions: *P*ediatric solutions come in varying concentrations...*M on* = Medications (OTC and narcotics) acetaminophen is found in many other *M*edications, such as OTC flu medications or narcotics...obtain a full medication history to prevent acetaminophen toxicity; use with caution in patients with *L*iver problems Side effects: ... Interactions: alcohol; NSAIDs; Dilantin; warfarin
Lidocaine
(Xylocaine) Class: Antidysrhythmic Mechanism: suppresses automaticity in the His/Purkinje system...elevates the threshold for ventricular dysrhythmias and lowers the threshold for defibrillation and cardioversion Indications: ventricular fibrillation and pulseless v-tach (shockable rhythms) Contraindications: *HSvdBSB/HLiKiRSCHF* patients with known *H*ypersensitivity, *S*upra*v*entricular *d*yshrhythmias, high-grade heart *b*locks, or *S*inus *B*radycardia Precautions: marked *H*ypoxia; *Li*ver disease; *Ki*dney disease; *R*espiratory depression; *S*hock; *CHF* (congestive heart failure)...IV drip should be used cautiously in the first 2 minutes following return of spontaneous circulation Side effects: drowsiness, dizziness, confusion, bradycardia, conduction disorders, blurred vision, nausea, vomiting Interactions:...
Lidocaine Administration
(Xylocaine) Dose: VF/VT cardiac arrest: 1.0 to 1.5 mg/kg via IV...repeat every 3-5 min. up to a maximum dose of 3 mg/kg...following ROSC (return of spontaneous circulation), begin infusion at 2-4 mg/min (depending on doses administered prior to ROSC)...that seems like a lot to me? why does that work? Route: IV/IO bolus; IV/IO drip How supplied: 1) Preloaded syringe (100 mg/5 mL) 2) 250 mL IV bag or 500 mL IV bag
Ondansetron Description
(Zofran) Class: Antiemetic Mechanism: selective serotonin receptor agonist...this receptor is present on the vagus nerve terminals and in the chemoreceptor trigger zone for vomiting located in the CNS Indications: Nausea, vomiting Contraindications: hypersensitiviity Precautions: ... Side effects: hypotension, tachycardiia, constipation, CNS depression Interactions: ...
Ondansetron Administration
(Zofran) Dose: Adult = 4-8 mg slow IV bolus over 2-5 min. every 4-6 hours...Pediatrics: 0.1 mg/kg (maximum 4 mg) slow IV bolus every 4-6 hours...not recommended for children under 2 years old Route: IV/IO bolus; IM injection How supplied: 1) 2 mg/mL vial (20 mL) 2) 2 mg/mL preload syringe (2 mL)
Ondansetron route, onset, peak, duration, pregnancy grade
(Zofran) Route: IV/IO/IM Onset: rapid for both routes Peak: 40 min. (IM)...14-30 min. (IV/IO) Duration: Unknown (IM)...4-8 hrs. (IV/IO) Pregnancy Grade: B
Symptomatic Bradycardia in a Pediatric patient
-if the patient's heart rate is less than 60/min, begin chest compressions -administer Epinephrine FIRST! (0.01 mg/kg of Epi 1:10,000...can be readministered every 3-5 minutes) -administer Atropine (minimum dose of 0.1 mg with a max dose of 0.02 mg/kg body weight)...for pediatrics, you usually give them a 0.5 mg bolus and for adolescents you usually give them a 1 mg bolus...dose can repeated every 5 min. up to the max dose
Why are most of the oral drugs that we administer supposed to dissolve in the mouth rather than be swallowed?
2 reasons: 1) it allows for much more rapid integration into the bloodstream bc it is absorbed in the mucous membrane of the mouth directly into the bloodstream rather than having to be dissolved in the stomach 2) when drugs are swallowed and are absorbed by the body in the digestive system (small intestine) the drugs experience what is called first pass metabolism...that is bc the drugs first pass through the hepatic portal vein which carries the absorbed drug through the liver first where much of it is metabolized before it can reach the rest of the body and produce the effects it should...by allowing a drug to be absorbed directly into the bloodstream in the mouth, the drug can bypass the liver and thus can be administered in smaller doses and can have a faster effect
Activated Charcoal Description
Class: Absorbent Mechanism: finely powdered charcoal activated with oxygen that provides a large surface area to bind certain toxins, carrying them through the GI tract Indications: oral ingestion of toxins Contraindications: ALICM and Petroleum Products (alkalis, acids, iron, cyanide, lithium, altered mental status that prevents swallowing) Precautions: will inactivate other oral medications Side effects: black, tarry stools, and constipations Interactions: None
Atropine Sulfate Description
Class: Anticholinergic; parasympatholytic Mechanism: blocks the effects of acetylcholine (the principal neurotransmitter for the parasympathetic nervous system) Indications: Symptomatic bradycardia; organophosphate poisoning Contraindications: None in the emergency setting Precautions: Use with caution in ACS...will not be effective in treating bradycardia in transplanted hearts
Albuterol Sulfate Description
Class: Beta2 selective sympathomimetic; bronchodilator Mechanism: acts on beta2 sympathetic receptors in bronchiolar muscle to cause bronchodilation Indications: wheezing caused by asthma, COPD, and some other conditions Contraindications: *(HST)* hypersensitivity and symptomatic tachycardia Precautions: albuterol has minimal beta1-adrenergic effects, but may increase heart rate and myocardial oxygen demand...use with caution in patients with heart disease Side effects: anxiety, palpitations, chest discomfort, headache, perspiration Other interactions: do NOT adminsiter other beta agonists with albuterol
Dextrose Description
Class: Carbohydrate Mechanism: directly increases glucose concentration in the blood Indications: Hypoglycemia Contraindications: *HIH* Hyperglycemia and Intracranial Hemorrhage (stroke) Precautions: Check blood glucose level before administering D50; D50 is hypertonic and will cause tissue necrosis if infiltration occurs (make sure you have a good stick!) Side effects: irritation of the IV site Interactions: No significant interactions
Glucose Description
Class: Carbohydrate Mechanism: simple carbohydrate that can be absorbed through the buccal membrane or the GI tract Indications: Hypoglycemic patient who is conscious and able to protect their own airway Contraindications: inability to maintain patent airway Precautions: carefully monitor the patient for aspiration Side effects: nausea and vomiting Interactions: None
Oxygen Description
Class: Gas Indications: Dyspnea, hypoxia, SpO2 <95% Contraindications: None Precautions: Use with caution in neonates or patients with COPD Side effects: Hyperoxemia Interactions: None
Glucagon Description
Class: Hormone Mechanism: hormone synthesized and secreted into the bloodstream by the alpha cells of the pancreas...it inhibits glycogenesis and it stimulates glycogenolysis and gluconeogenesis Indications: inability to establish IV access in patients with hypoglycemia Contraindications: hypersensitivity Precautions: will not be effective if glycogen stores are depleted Side effects: Side effects are rare, but may include hypotension, dizziness, headache, nausea, and vomiting Interactions: None
Dextrose 5% Description
Class: Hypotonic carbohydrate-containing solution Mechanism: sterile water containing 5% dextrose...this is a hypotonic concentration that will not remain in the vascular space, reducing the danger of fluid overload on the heart Indications: D5W is used for prophylactic IV access or to dilute concentrated drugs for IV infusion Contraindications: D5W should not be used for patients who require IV fluid replacement or in patients who are hyperglycemic...do NOT use in patients with TBI (traumatic brain injury) or stroke Precautions: D5W may be more irritating to the tissues than NS, so the IV site should be closely monitored for irritation, swelling, or redness Side effects: Rare Interactions: D5W should not be used for blood product infusion
Lactated Ringer's Description
Class: Isotonic Crystalloid solution Mechanism: sterile water containing many electrolytes to replace both fluid and electrolytes (Na, K, Ca, Cl, Lactate) Indications: Significant burns and hypovolemia Contraindications: *HFRFHK*..Do not use in patients with *H*eart *F*ailure, *R*enal *F*ailure, or suspected *H*yperkalemia Precautions: monitor closely for signs of circulatory overload Side effects: Rare Interactions: Do not use with blood product infusion
Nitroglycerin Description
Class: Nitrate Mechanism: metabolized to Nitric oxide which is a vasodilator for some arteries and veins, such as the coronary artery Indications: chest pain associated with acute myocardial infarction (AMI)...sweating, pain, anxiety...it is also indicated for patients with a known history of CHF and you can hear rales/crackles when listening to lung sounds Contrindications: *3HIV* *H*ypotension (systolic BP below 100 mmHg...or if systolic BP drops >30mmHg below the patient's baseline); *H*ypovolemic; *H*ypersensitivity; *I*ncreased Intracranial pressure; *V*iagra or other erectile dysfunction drugs in the past 24 hours Precautions: NTG breaks down rapidly in sunlight or humidity; can cause a sudden decrease in BP, so it is best to start an IV BEFORE giving nitrates so that you can increase the BP again if necessary Side effects: dizziness, headache, hypotension Interactions: effects may be accentuated with alcohol or beta blocker use
Fentanyl Citrate Description
Class: Opioid analgesic Mechanism: synthetic opioid that rapidly crosses the blood-brain barrier and acts directly on the opiate receptors in the brain Indications: Pain Contraindications: *HH MARC/PE* *H*ead injury; *H*ypotension; *M*yasthenia gravis; *A*llergic to opiates; *R*espiratory depression; *C*ardiac dysrhythmia Precautions: *P*regnant patients and *E*lderly patients Side effects: respiratory depression, hypotension, bradycardia, nausea, vomiting, itching
Epinephrine 1:1000 Description
Class: Sympathomimetic Mechanism: Binds to alpha1, beta1, and beta2 receptors causing vasoconstriction, increased heart rate, and dilation of bronchiolar smooth muscle Indications: Anaphylaxis Contraindications: ... Precautions: *ABCS-IV* A = Epi is inactivated by alkaline solution...B = high blood pressure is a precaution...C = significant cardiovascular disease is a precaution...S = sunlight inactivates Epi...IV = do NOT administer via IV/IO Side effects: Palpitations, tachycardia, anxietym headache, dizzyness, nausea, vomiting, chest pain, myocardial infarction Interactions: effects are intensified by some antidepressants
Epinephrine 1:10,000 Description
Class: Sympathomimetic Mechanism: acts on both the alpha and beta adrenergic receptors and imitates the actions of the sympathetic nervous system Indications: Cardiac arrest Contraindications: None Side effects: headache, nausea, weakness, dysrhythmias, hypertension, chest pain, tachycardia Interactions: ...
Nitrous Oxide Description
Class: analgesic; anesthetic Mechanism: CNS depressant Indications: severe pain from trauma Contraindications: *ABCD PIT* *A*bdominal pain; suspected *B*owl obstruction; *C*OPD; *D*ecreased responsiveness; suspected *P*neumothorax; *I*nability to follow instructions; *T*raumatic brain injury Precautions: use in well-ventilated area to prevent sedation of EMS providers Side Effects: dizziness, decreased mental status, hallucinations, nausea, and vomiting Interactions: do not use with other sedatives, alcohol, or narcotics
Morphine Sulfate Description
Class: opiate analgesic Mechanism: acts on the opiate receptors in the braiin...primary effect is analgesia but also causes vasodilation, sedation, and euphoria Indications: Pain Contraindications: *Morphine IS 4H* increased *I*ntracranial pressure; *S*evere respiratory depression; *H*ypotension; *H*ypovolemia; *H*ypersensitivity to opiates; *H*ead injury Precautions: ... Side effects: respiratory depression, hypotension, sedation, tachycardia, bradycardia, palpitation, flushing, burning sensations, itching, euphoria, bronchospasm, dry mouth Interactions:...
Ibuprofen Description
Ibuprofen (Advil) Class: analgesic, antipyretic, anti-inflammatory Mechanism: NSAID that is thought to inhibit COX-1 Indications: pain, fever Contraindications: *H*ypersensitivity to NSAIDs, *P*regnancy Precautions: pediatric concentrations may vary...closely check the concentration Side effects: Gastric irritation Interactions: Do not give with aspirin or other NSAIDs
Ibuprofen Administration
Ibuprofen (Advil) Dose: Adult = 200-500 mg every 6-8 hours; Pediatric = 5 to 10 mg/kg, every 6-8 hours...(Utah County EMS: Adults = 800 mg; Pediatrics = 10 mg/kg) Route = Oral How supplied = Adults: tablets are 200 mg each...pediatric doses vary!
Diphenhydramine route, onset, peak, duration, pregnancy grade
Rooute: IM; IV/IO; Oral Onset: 20-30 min (IM)...rapid (IV/IO)...15-60 min. (Oral) Peak: 1-4 hrs (IM)..unknown (IV//IO)...1-4 hrs (PO) Duration: 4-8 hours for all routes Pregnancy grade: B
Glucagon route, onset, peak, duration, pregnancy grade
Route = IM injection/IV/IO Onset = 4-10 min. (IM)...Immediate (IV/IO) Peak = Unknown (IM)...30 min. (IV/IO) Duration = 12-32 min. (IM)...60-90 min. (IV/IO) Pregnancy Grade = B
Epinephrine 1:1000 route, onset, peak, duration, pregnancy grade
Route = IM, SubQ Onset = 1-5 min. Peak = 5-30 min Duration = 20-30 min Pregnancy Grade = C ...on the drug card it says it can be administered via IV/IO??? How??
Atropine Sulfate route, onset, peak, duration, pregnancy grade
Route = IM/IV/IO Onset = Immediate Peak = 2-4 min. Duration = 4-6 hours Pregnancy Grade =...
Fentanyl Citrate route, onset, peak, duration, pregnancy grade
Route = IM/IV/IO/IN Onset = 7-8 min. (IM)...1-2 min. (IV/IO) Peak = 20-30 min. (IM)...3-5 min. (IV/IO) Duration = 1-2 hours (IM)...30-60 min. (IV/IO) Pregnancy Grade = C
Dextrose route, onset, peak, duration, and pregnancy grade
Route = IV/IO Onset = 2-3 minutes Peak = Unknown Duration = .... Pregnancy grade = C
Epinephrine 1:10,000 route, onset, peak, duration, pregnancy grade
Route = IV/IO Onset = < 2 min. Peak = < 2 min. Duration = 5-10 min.
Lidocaine route, onset, peak, duration, pregnancy grade
Route = IV/IO bolus; IV/IO drip Onset = < 3 min. Peak = 5-7 min Duration: ... Pregnancy Grade = B
Ibuprofen route, peak, onset, duration, pregnancy grade
Route = Oral Onset = 30 min Peak = 1-2 hours Duration = 4-6 hours Pregnancy Grade = B; third trimester = D
Albuterol Sulfate route, onset, peak, duration, pregnancy grade
Route = PO Onset = 15-30 min. Peak = 2-3 hours Duration = 6-12 hours Pregnancy grade = C
Acetaminophen route, onset, peak, duration, pregnancy grade
Route = PO Onset = 30-60 min Peak = 10-60 min. Duration = 3-8 hours Pregnancy Grade = B
Acetylsalicylic Acid route, onset, peak, duration, pregnancy grade
Route = PO (chewable) Onset = rapid Peak = unknown Duration = 1-4 hours Pregnancy Grade = C; but for a full dose during the third trimester it is D
Nitroglycerin route, onset, peak, duration, pregnancy grade
Route = Sublingual tablet/Translingual spray Onset = 1-3 min. (SL)...2-4 min (TL spray) Peak = Unknown for both Duration = 30-60 min. for both Pregnancy Grade = C
Morphine Sulfate route, onset, peak, duration, pregnancy grade
Route: IM/IV/IO/SQ Onset: 10 - 30 min (IM)...rapid (IV/IO)...20 min. (SQ) Peak: 30-60 min. (IM)...20 min. (IV/IO)...50-90 min. (SQ) Duration: 4-5 hours for all rroutes Pregnancy grade: C
Nitrous Oxide route, onset, peak, duration, pregnancy grade
Route: Inhalation Onset: Immediate Peak: 30 seconds Duration:... Pregnancy Grade: Not determined
Glucose route, peak, onset, duration, pregnancy grade
Route: PO Onset: ... Peak:... Duration:... Pregnancy grade:...