Pharmacology For The EMT - INHS Health Training

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6/4/2013Pharmacology for theEMTPresented byWade Scoles RRT, NREMTDrug StoragePharmacodynamics Everybody reacts to drugs differently Potency can be altered by:– Factors altering drug responses – Temperature– Light– Moisture– Expiration dateAgeBody massSexPathologic stateGenetic factorsPsychological factorsOther drugsRoutes of medicationsForms of Medications– Solution– Topical– Tablet– Capsule– Suspension– Transdermal– Inhalation PO (by mouth)IV (intravenous)IM (intramuscular)SQ (subcutaneous)SL (sub-lingual)IO (intraosseous)Inhalation1

6/4/2013Essential Medication Information Indications Contraindications Dose Administration Actions Side EffectsEssential Medication Information Indications Contraindications Dose Administration Actions Side EffectsThe indications for a medication include the mostcommon uses of the drug in treating a specific conditionContraindications are situations in which the drugshould not be administered because of the potentialharm that could be caused to the patient.Essential Medication InformationEssential Medication Information Indications Contraindications Dose Administration Actions Side Effects Indications Contraindications Dose Administration Actions Side EffectsThe dose simply indicates how much of the drugshould be given to the patientAdministration refers to the route and form in whichthe drug is given.Essential Medication InformationEssential Medication Information Indications Contraindications Dose Administration Actions Side Effects Indications Contraindications Dose Administration Actions Side EffectsThe actions are the therapeutic effects the drugwill have.Side effects are actions that are not desired andoccur in addition to the desired therapeutic effects.Some side effects are unpredictable2

6/4/2013Know Your Local ProtocolsSix Rights of Drug Administration Follow local protocols for guidelineson approved medication usage Check for allergies & sensitivitiesbefore administering any medicationConfirm with yourpartner if possible Right personRight drugRight doseRight timeRight routeRight documentationEMT MedicationsEMT MedicationsOxygen – Medical/Trauma conditionsNitroglycerin – Suspected MIAspirin – Suspected MIEpinephrine & Auto-Injector –Anaphylaxis Bronchodilator Inhalers – Asthma,Emphysema Oral Glucose – Hypoglycemia Activated Charcoal – Poisoning/ODOxygenOxygen Indications– Hypoxia, respiratory distress, chest pain Contraindications– None in EMS Dose– 1-15 LPM Administration– Blow-by, NC, NRB mask, Bag-valve Actions– Absorbed into blood from lungs andcarried by hemoglobin to cells Side Effects– Dry nose & secretions if not humidified– Oxygen toxicity can cause inflammatoryprocess and retinopathy (in newborns)– Respiratory depression in some COPDpatients3

6/4/2013NitroglycerinOxygen Indications How much to give?– Let oximetry be your guide– SpO2 goal 94-96% What about COPD patients?– Chronically high CO2 “burns out” thatstimulus to breathe so they rely onhypoxic drive– Chest pain, MI, CHF Contraindications– Known hypersensitivity, hypotension(SBP 90), recent Viagra or Cialis use Dose– 400 mcg (0.4mg) SL tablet or spray Administration– SublingualNitroglycerinAdministration of NTG Assess vitals– B/P 90 systolic– Meds, allergies– Have patient sit or liedown with HOB up– SL spray or tabletunder tongue– Reassess– Repeat up to 3 timesprn Actions– Dilates blood vessels including coronaryarteries and reduces cardiac workload Side Effects– Hypotension, headacheAspirinAspirin (ASA) Aspirin given in AMI has beenshown to decrease mortality. Indications– Chest pain, MI Contraindications– Known allergy or ASA-induced asthma– Hx of active bleeding disorder– Current ulcer or GI bleed– Receiving anticoagulation therapy4

6/4/2013AspirinAspirin Dose– 325 mg (check local protocol) Side Effects– GI upset, Bleeding with chronic use Administration– Oral (have patient chew it) Actions– Inhibits platelet aggregation– Mild analgesic and anti-inflammatoryagentEpipen or epinephrine Indication What if patient takes daily aspirin?– Follow local protocolEpipen or epinephrine Administration– Anaphylaxis– IM injection Contraindications– None in true severe anaphylaxis– Caution in patients with heart disease Dose– Epipen 0.3mg IM– Epipen Jr 0.15mg IM Actions– Vasoconstriction– Bronchodilation– Increases HR & BP Side Effects– Tachycardia, hypertensionInhalers Albuterol, Proventil, Ventolin,Combivent most commonAlbuterol Inhaler Indications– Respiratory distress/wheezing due toasthma/COPD Contraindication– Known hypersensitivity (rare) Dose– 2 puffs or as prescribed5

6/4/2013Oral Glucose GelAlbuterol Inhaler Indications Administration– Inhalation (use spacer if available)– Hypoglycemia (measured blood glucose 60 g/dl) Check local protocol Contraindications Actions– Bronchodilation (smooth muscle dilator) Side Effects– Tremors, tachycardia– Unconscious and unable to protect airway Dose 25 grams is common Follow local protocols and know what formyou carry (15-45 grams)Activated CharcoalOral Glucose Gel Administration– Oral (patient must be able to swallowand protect airway) Action– Absorbed by GI tract and providesglucose to cells For treatment of some drugoverdoses and poisonings Only use if directed bymedical control Side Effects– Too much can cause hyperglycemiaActivated CharcoalActivated Charcoal Administration Indications– Poisoning when directed bymedical control Contraindication– Unable to protect airway Dose– 25-50 grams (check protocol)– Orally, tastes bad (can mix withcola, chocolate syrup) Action– Absorbs certain drugs & poisonsbut is itself, non-absorbable Side effects– Nausea, vomiting, constipation6

6/4/2013Reassess Mental statusAirway patencyVital SignsSubjective improvement in signs &symptoms Side effectsDocument AllergiesIndicationDosageAdministration routeExpiration datePatient’s response after reassessingCase 1 Husband of a 68-year-old female calls911 because she is confused withfatigue, nausea & shortness of breath Initial assessment– Airway patent, RR 20– HR 96, BP 158/90, SpO2 92%– BS: Fine inspiratory crackles in bothbasesCase 1 SAMPLE history– S: Fatigue, nausea, dyspnea, chestheaviness– A: None– M: Nitrostat prn, oral insulin– P: Diabetes and coronary artery disease– L: 8 hours ago (didn’t eat much)– E: Doing light houseworkCase 1Case 1 OPQRST– O: Came on gradually while trying to dohousework– P: Symptoms a little better after lying down– Q: Heaviness– R: None– S: Can’t rate on a scale– T: Several hours ago Management– Oxygen NC for SpO2 94-96%– Aspirin (takes 81mg/day) Give additional up to 325 mg– Nitroglycerin (verify Rx and exp date) 1 tablet sublingual– Check blood sugar– 12-lead ECG if able7

6/4/2013Case 1Case 1 Management Reassess– Oxygen NC for SpO2 94-96%– Aspirin (takes 81mg/day) Give additional up to 325 mg– Nitroglycerin (verify Rx and exp date) 1 tablet sublingual– HR 92, BP 144/84, R16, SpO2 97% on 2LNC– Feels a bit better, chest heaviness remains– More Nitroglycerin?– Blood sugar (110)– Check blood sugar (55) Oral glucose gel per protocolCase 2Case 2 Impression 4-year-old girl, history of Asthma Moderate Respiratory Distress Pulse 134, BP 110/64, R30, SaO294% room air BS: Expiratory Wheezes– Acute Asthma attack Management– Oxygen - Be prepared to assist ventilations– Bronchodilators: Patient has two inhalers(Proventil and Advair)-which one isappropriate to give? Use spacer if availableCase 2 Reassessment after 2 puffs– Pulse 130, BP 112/68, R24, SaO2 98%on NRB mask– BS: Expiratory Wheezes continueQuestions? Can you give 2 more puffs?– Check with medical control8

6/4/2013Question 2Question 1You’re caring for a 75-year-old patient with aprobable stroke. He is not short of breathand SpO2 is 97%. Oxygen:a) Should be given but no more than 4 LPMb) Should never be given to stroke patientsc) Should be given by NRB mask to all strokepatientsd) Should only be given if needed to keepSpO2 94-96%You’re caring for a 68-year-old man with chestpain. His HR is 88, BP 86/50, RR16, SpO293% on room air. What medications areindicated (pt. has no allergies)?a)b)c)d)Question 4Question 3What is the dose of epinephrine in theEpiPen Jr?a)b)c)d)0.15mg0.25mg0.35mg0.5mgA patient with a shellfish allergy is having asevere anaphylactic reaction. He states he is“allergic to epinephrine” because it makes himshaky. You should:a)b)c)d)Question 5You’re a basic EMT caring for anunresponsive diabetic. Your glucometer reads“LOW”. You should:a) Call ALS because you can’t give oral glucoseto an unresponsive patientb) Give oral glucose gel anyway-he needs itc) Apply the glucose gel topically-it will absorbd) Give the glucose gel rectallyOxygen, aspirin and SL nitroOxygen and aspirin onlyNitro onlyNone are indicatedNot give the epi to avoid the allergic reactionGive a half dose of epiGive the epi IV instead of IMExplain the shakiness is a side effect, not anallergy, and strongly recommend giving the epiQuestions?Contact: Carolyn ax: 509-232-83449

6/4/2013Special thanks toSheila CrowStitchin’ Dreams EmbroideryUpdates PleaseIf the name and address of your agency contacthas changed, please let us know. This is wherewe mail your certificates.wcsocrow@yahoo.comEmail updated name, address and email to:For providing our Secret Question prizeJackie Williams – williajd@inhs.orgEMS Live @ Nite willreturn in September.Have a greatsummer!10

You’re a basic EMT caring for an unresponsive diabetic. Your glucometer reads “LOW”. You should: a) Call ALS because you can’t give oral glucose to an unresponsive patient b) Give oral glucose gel anyway-he needs it c) Apply the glucose gel topically-it will absorb d) Give the glucose gel rectally Questions? Contact: Carolyn Stovall 509 .

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