Drug Order Details

Identify the person placing the order and then enter the quantity to be ordered.  Enter a whole number to identify how many of each item is being ordered and leave the line blank if none of the particular item is being ordered. 

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* 1. Bethel Fire Department

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* 2. Name of person completing order

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* 3. Contact number for person completing order

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* 4. albuterol 2.5mg/3mL (0.083%) neb solution 5 x 3mL bullets

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* 5. amiodarone 150mg/3mL injection solution 3 mL vial

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* 6. atropine sulfate 1mg/10mL injection solution 10 mL syringe

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* 7. charcoal, activated 50gm in sorbitol 240 mL bottle

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* 8. dextrose 25% injection solution 10 mL syringe

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* 9. dextrose 50% injection solution 50 mL syringe

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* 10. diphenhydramine 50mg/mL injection solution 1 mL vial

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* 11. epinephrine 1:1,000 injection solution 30 mL vial

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* 12. epinephrine 1:10,000 injection solution 10 mL syringe

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* 13. epinephrine 0.15mg (Epipen Jr) 2 syringe Kit

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* 14. epinephrine 0.3mg (Epipen) 2 syringe Kit

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* 15. glucagon 1mg injection kit

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* 16. glucose oral gel (Glutose 15) 3x15 gm tube/package

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* 17. lidocaine 2% 100mg/5mL injection solution 5 mL syringe

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* 18. lidocaine 2% 20mg/mL injection solution 20 mL vial

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* 19. lidocaine 2gm/D5W 500 mL intravenous solution premix bag

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* 20. magnesium sulfate 5g/10mL 10mL vial

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* 21. naloxone 1mg/mL luer-lock syringe (Narcan) 2 mL syringe

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* 22. nitroglycerin 0.4mg sublingual spray 1 bottle

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* 23. sodium bicarbonate 8.4% injectable solution 50mEq/50 mL syringe

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* 24. sodium chloride 0.9% injection solution 10 mL flush syringe

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* 25. sodium chloride 0.9% Intravenous solution 1,000 mL

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* 26. sodium chloride 0.9% Irrigation solution 1,000 mL

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