EMT Basic Pharmacology

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EMT Basic Pharmacology

• EMT 151
• Summer 2005

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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

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Pharmacology

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

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PharmacologyBasic drug information

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

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Pharmacology

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

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Pharmacology

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

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Pharmacology

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

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Pharmacology

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

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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,

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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?

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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

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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.

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5 rights of medication administration (or is it
6?)

• Right patient
• Right medication
• Right route
• Right dose
• Right date
• Right to refuse

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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

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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

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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

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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

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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

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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

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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

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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

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Ouch!

• 22g

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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!

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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?

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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

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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.

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Aspirin Actions

• Inhibits platelet aggregation
• Mild analgesic and anti-inflammatory agent

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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

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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

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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

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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

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S/S AMI, cont.

• Diaphoresis (profuse sweating)
• Dyspnea (difficulty breathing)
• Nausea/vomiting
• Weakness
• Dizziness
• Palpitations
• Feeling of impending doom
• Denial

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S/S, cont.

• General appearance
• Anxious
• Frightened
• In pain
• Poor color (gray, pale, cyanosis)

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Assessment

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

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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?

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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?

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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?

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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?

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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?

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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?

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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?

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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?