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EMT Basic Pharmacology

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May reduce HYPOXIC Drive in COPD. 2-15 lpm via mask or n/c. Glucose ... Dose/route 162-324 mg (2-4) chewable baby aspirin. Quickest route vs swallowing ... – PowerPoint PPT presentation

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Title: EMT Basic Pharmacology


1
EMT Basic Pharmacology
  • EMT 151
  • Summer 2005

2
Basic Pharmacology
  • Medications that the EMT Basic is allowed to
    administer by Oregon statute
  • Epinephrine 11,000
  • Activated charcoal
  • Oxygen
  • Syrup of ipecac
  • Aspirin
  • Glucose

3
Pharmacology
  • Medications that the EMT Basic is allowed to
    assist a patient with administration
  • Nitroglycerin
  • Inhaler/Bronchodilator

4
PharmacologyBasic drug information
  • Chemical- 1, 2, 3-propanetriol trinitrate
  • Generic-nitroglycerin tablets
  • Trade-Nitrostat
  • Official nitroglycerin tablets, U.S.P.

5
Pharmacology
  • Routes of medications
  • PO (by mouth)
  • IV (intravenous)
  • IM (intramuscularly)
  • SQ (subcutaneous)
  • SL (sub-lingual)
  • IO (intraosseous)
  • Inhalation

6
Pharmacology
  • Forms
  • Solution
  • Topical
  • Tablet
  • Capsule
  • Suspension
  • Transdermal
  • Inhalation

7
Pharmacology
  • Indications
  • Contraindications
  • Dose
  • Route
  • Action
  • Side effects

8
Pharmacology
  • Nitroglycerin suspected MI
  • Epinephrine - anaphylaxis
  • Oxygen medical/trauma conditions
  • Activated Charcoal poisoning/OD
  • Inhalers asthma, emphysema
  • Glucose - hypoglycemia

9
Case 1
  • You are dispatched to a report of a 52 y/o male
    c/o sudden onset chest pain while at rest. You
    arrive to find this anxious patient sitting on
    his couch. He is CAO PPTE, skin is pale and
    diaphoretic, B/P 152/94, HR 76, RR 30.
  • PMH AMI in 1995 NIDDM, HTN.
  • Meds NTG, Glucaphage,

10
Case 1, cont.
  • What is your DDX?
  • What is your immediate tx?
  • Which of his medications can you assist him in
    taking?
  • Any other concerns?

11
Patients Medication
  • Physician order
  • Read the Label CAREFULLY
  • Patients Name
  • Name of Drug
  • Medication Strength
  • Number of Pills
  • Route and Directions
  • Record this Information Clearly
  • Write carefully and neatly

12
Allergies To Medications
  • ALWAYS ASK Are you allergic to any medications?
  • Remember this Once you give a medication, it
    may be impossible to get it out of the patient.
    So it better not be one they are allergic to!
    Always ask BEFORE giving a drug.

13
5 rights of medication administration (or is it
6?)
  • Right patient
  • Right medication
  • Right route
  • Right dose
  • Right date
  • Right to refuse

14
Now, reassess the pt.
  • Mentation
  • Airway patency
  • Respiratory rate, quality
  • Pulse rate, quality
  • Skin color, temperature, condition
  • B/P
  • Change in patient complaint s/s
  • Side effects

15
Oxygen
  • Basic need by all cells
  • Inhaled, absorbed through lungs
  • Needs red blood cells to carry to body
  • Careful around flames
  • May reduce HYPOXIC Drive in COPD
  • 2-15 lpm via mask or n/c

16
Glucose
  • Basic need by all cells
  • Good at proper levels (80-110)
  • Too High is bad
  • Too Low is bad
  • Not for those with compromised Gag
  • Not good in the lungs
  • Oral intake (25 grams)
  • Paste or in drink

17
Activated Charcoal
  • Binds chemicals to it
  • Dont use in patients with compromised gag reflex
  • Good in stomach
  • Bad in lungs
  • Yucky Black Stuff
  • Challenge to get kids to drink it
  • 25-100 grams in suspension

18
Nitroglycerine
  • Dilates Veins and coronary arteries
  • Causes hypotension and a headache (migraine like)
  • Dont give if already hypotensive
  • Sublingual spray or tablets
  • Dont shake the bottle (Boom!)
  • Just kidding, but dont shake the bottle

19
Administ. Of NTG, cont.
  • Assess vitals
  • B/P gt90 systolic
  • PMH ulcers, GI bleed, Alcohol abuse
  • Meds Viagra?
  • Have pt. Sit or lie down
  • Sl spray or tablet just one spray
  • Wait 5 min. consider another spray
  • Wait 5 min., consider another spray

20
Epinephrine
  • Constricts arteries
  • Dilates Bronchioles
  • Increases Heart Rate
  • Increases Blood Pressure
  • Use with caution
  • Always useful in True Anaphylaxis
  • Sub-Q 0.3-0.5 ml 11000 dilution

21
So what is true anaphylaxis?
  • An Extreme Allergic Reaction
  • Symptoms of
  • Flushing, swelling of tongue, lips, extremities
  • Wheezing, SOB, Coughing, Hoarseness
  • Headache
  • Nausea, Vomiting, abdominal cramps
  • Sense of Impending Doom, decreased mentation

22
Ouch!
  • 22g

23
Inhalers
  • Albuterol, Proventil, Terbutaline, etc.
  • Open up the airways
  • Inhaled by puffer or nebulizer
  • Similar effects to body as epi.
  • Safer than epi, multiple dosing with less side
    effects
  • Use of conserving devices common
  • Remember this They have to be breathing well
    enough to get the meds into lungs!

24
So, when do I administer an Inhaler?
  • Obvious respiratory distress
  • S/s
  • Audible wheezing
  • Wheezing on auscultation
  • Previously used inhaler?
  • What if it doesnt work?

25
Aspirin Special circumstances
  • Pathophysiology of acute myocardial infarction
  • Occurs when blood supply to the myocardium (heart
    muscle) is interrupted long enough that the
    muscle dies
  • Coronary artery disease (CAD), Angina pectoris,
    AMI

26
Pharmacology
  • Administration
  • AHA ACLS guidelines indicate that aspirin should
    be given immediately for the general treatment of
    chest pain suggestive of ischemia.
  • The action of ASA when given in AMI has shown to
    decrease mortality.

27
Aspirin Actions
  • Inhibits platelet aggregation
  • Mild analgesic and anti-inflammatory agent

28
Aspirin
  • Contraindications
  • Known allergy or ASA induced asthma
  • Hx of active bleeding disorder
  • Current ulcer or GI bleed
  • Taking ASA within last 24 hours
  • Check local protocol
  • Receiving anticoagulation therapy
  • Possibility of aortic dissection

29
Aspirin
  • Side effects
  • GI distress (cramping, heartburn, mild nausea)
  • May exacerbate bleeding disorders
  • GI bleeding signs and symptoms
  • Low grade toxicity may cause ringing in the
    ears, headache, dizziness, flushing, tachycardia

30
Aspirin
  • Precautions use with caution in patients with
    renal failure or vitamin K deficiency
  • Dose/route 162-324 mg (2-4) chewable baby
    aspirin
  • Quickest route vs swallowing

31
So, when do I give Aspirin?
  • Signs and symptoms AMI
  • Pain/pressure - Angina vs. AMI
  • Silent AMI
  • Indicated in unstable angina and AMI
  • Chest pain not relieved by NTG or lasting more
    than 15 minutes

32
S/S AMI, cont.
  • Diaphoresis (profuse sweating)
  • Dyspnea (difficulty breathing)
  • Nausea/vomiting
  • Weakness
  • Dizziness
  • Palpitations
  • Feeling of impending doom
  • Denial

33
S/S, cont.
  • General appearance
  • Anxious
  • Frightened
  • In pain
  • Poor color (gray, pale, cyanosis)

34
Assessment
  • Vital signs
  • Respirations
  • Level of consciousness
  • Pulse
  • Blood pressure
  • Pulse oximetry

35
Tx
  • General approach to the patient
  • ABCs
  • Oxygen therapy
  • Vital signs
  • Prepare for immediate transport
  • Nitroglycerin
  • Aspirin
  • Prepare for the worst!
  • Extra hands for CPR maybe?

36
Scenario 1
  • 45 yo male, sitting in truck on side of road.
    Truck parked the wrong way on a small side
    street. Man is confused and tired looking. He
    repeatedly refuses any care. His speech is
    slurred and you notice nothing else remarkable
    about his appearance. When asked about where he
    is headed, he asks directions to Turner, over and
    over again. He cannot get his cigarette lighter
    to work and is frustrated.
  • What do you do?

37
Scenario 2
  • You arrive at a home with an elderly woman who
    called you because she is having chest pain and
    is short of breath. She has no medication in the
    house and is otherwise very healthy. This has
    been going on for 30 minutes and is getting more
    uncomfortable.
  • What drugs may be useful for her?

38
Scenario 3
  • Elderly man complaining of SOB. He has a history
    of COPD. All he wants is some oxygen and he will
    be fine. You give him some oxygen and he gets
    better. He assures you that if you leave the tank
    of oxygen, he will see his doctor tomorrow.
  • Do you see anything wrong with this?

39
Scenario 4
  • Your neighbor has eaten some lima beans by
    mistake. She is allergic to them and is now
    having hives all over her. She is very
    uncomfortable and itches badly. She asks you to
    help her with her epinephrine shot.
  • Are you comfortable with helping her with the
    shot?

40
Scenario 5
  • A child at a T-ball game becomes Short of Breath
    after running the bases during a home run hit. He
    is wheezing terribly and laboring to breath. He
    has a proventil puffer and wishes help to use it.
    Mother is anxious and hands you the puffer.
  • What is the next course of action?

41
Scenario 6
  • Little LeRoy has done it again. This time he has
    eaten all of Grandpas percocet tablets. Mom
    caught him doing it just minutes ago and called
    you. Mom has Poison Control on the phone as you
    arrive.
  • What is Poison Control going to want to know
    about the child? What do you suppose they will
    suggest doing?

42
Scenario 7
  • Mr. Jones is feeling great. He is returning from
    a jog and has become SOB and has Chest Pain at
    8/10 scale. He doesnt understand this, he had a
    pre-marriage physical exam last month and at 84
    years of age, he is fit as a fiddle.
  • What might you ask Mr. Jones before giving him
    any medication?
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