Transcript General Pharmacology

Objectives
• Overview of General
Pharmacology
• Develop a Basic Knowledge of
medications used by BLS
Providers
• Identify situations when each
medication may be indicated
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General
Pharmacology
• For every medication you may
administer, you must thoroughly
understand the following:
•Actions
•Dosage
•Indications
•Route
•Contraindications •Side effects
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General
Pharmacology
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Right
Right
Right
Right
Right
Time
Patient
Drug
Dose
Route
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General
Pharmacology
• Generic name
– Original chemical name
• Trade name
– Brand name given by manufacturer
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General
Pharmacology
Dosage Forms
• Solutions
– Liquid mixture of one or more
substances
• Nebulized Solution
– Pressurized gas passed over a
solution to create an aerosol mist,
which is then inhaled
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Anaphylaxis
Epinephrine for
BLS Providers
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Anaphylaxis
• An exaggerated
immune response to an
allergen
• Sudden, rapid onset
• Systemic involvement
• Severe allergic
reaction
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Common Causes of
Allergic Reactions
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Allergic Reactions
• Very Common
• Range from mild and local to
severe and systemic.
– Mild reactions usually affect only
one area of the body
– Slow onset, and minor symptoms
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Mild Allergic
Reactions
A mild, local
reaction
caused by a
bee sting
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Severe Allergic
Reaction
• A Clear History of Allergen
Exposure AND Signs and
Symptoms including:
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–
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Shock (hypoperfusion)
Respiratory Distress
Wheezing, stridor, cough
Chest / throat tightness
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Severe Allergic
Reaction
• Itching, skin
flushing
• Hives and/or
swelling
–(esp. face,
extremities)
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Severe Allergic
Reaction
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Increased Pulse
Decreased Blood Pressure
Nausea & Vomiting
Altered Mental Status
Allergen exposure with
history of anaphylaxis
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Patient History
• Determine if the patient’s
history includes:
– Anaphylaxis
– Severe allergic reactions
– Recent exposure to a known
or potential allergen
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Focused
Physical Assessment
• Assess ABCs • Assess Respiratory
System
• Breath Sounds
• Assess
• Vital Signs
Cardiovascular
• O2 Saturation
System
•Assess for Signs & Symptoms
of Anaphylaxis
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Epinephrine
• Generic Name
–Epinephrine
• Trade Name
–EpiPen
–EpiPen Jr.
•Also called
– Adrenalin
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Epinephrine
Actions
• Dilates Bronchioles
• Constricts Blood Vessels
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Epinephrine
Indications
• Signs and Symptoms of
Severe Allergic Reaction
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Epinephrine
Contraindications
•
None
BUT MUST FOLLOW
NYS PROTOCOLS!
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Epinephrine
Dosage
• Adult
• One Adult Auto-injector (0.3 mg)
• Infant and Child
(< 9 y/o or < 30 kg / 66 lbs.)
• One Infant/Child Auto-injector
(0.15 mg)
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Epinephrine
Route
• Deep Intramuscular
Injection
• Lateral thigh, midway
between waist and knee
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Epinephrine
Side Effects
– Increased
pulse rate
– Pallor
– Dizziness
– Chest Pain
–Headache
–Nausea
–Vomiting
–Excitability
–Anxiety
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Epi auto-injector
Protocol
• Call ALS
• Administer Oxygen
• Assess Respiratory
Status
• Assess Cardiac Status
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Epi auto-injector
Protocol
If the patient has an epi
auto-injector prescribed:
• assist the patient in
administering the autoinjector
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Epi auto-injector
Protocol
• If the patient’s epi autoinjector is not available or
expired:
• Administer the agency’s
epi auto-injector Per
Protocol
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Epi auto-injector
Protocol
If no epi auto-injector has
been prescribed:
• Begin transport
• Contact medical control
for authorization to
administer the agency’s
epi auto-injector
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Epi auto-injector
Protocol
If unable to contact Medical
Control, and patient is less
than 35 years of age:
• Administer agency supplied
epi auto-injector per
protocol
• Contact Medical Control
ASAP
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What Is
Medical Control?
1. A REMO Physician
2. If no REMO Physician is
available, contact ED
Physician at the
Destination Hospital
3. Document WHO you
talked to
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Epi auto-injector
Protocol
• Medical Control MUST be
contacted to administer a
second auto-injector.
• Be prepared to perform
CPR if patient deteriorates.
• Document history, vitals,
and treatment on PCR.
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Epi auto-injector
Protocol
Summary:
• ALS must be called
• Contact Medical Control
• If Medical Control
unavailable and patient is
<35 years old, administer
epi auto-injector
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Epi auto-injector
Administration
• Remove safety cap from autoinjector
• Hold auto-injector from center
(Do Not place thumb over either
end!)
• Place against patient’s thigh
– Lateral portion, midway between
waist and knee
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Epi auto-injector
Administration
• Push until autoinjector activates
• Hold until
medication
injected (10
seconds).
• Record Time
• Record Response
•Dispose of auto-injector in biohazard
“sharps” container.
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Reassessment
Strategy
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Monitor A-B-Cs
Reassess Vitals
Oxygen!
Watch for changes in
Patient Condition
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Reassessment
Strategy
If the patient deteriorates...
• Oxygenate
• Contact Medical Control for
order for second dose
• Prepare for resuscitation
• Oxygenate
• Treat for shock
Oxygenate
Did we mention Oxygenate?
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Asthma
Albuterol for
BLS Providers
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Asthma
• A common but serious disease
– Affects more than 10 million
Americans.
– Kills 4000 to 5000 Americans
annually.
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Asthma
• Reversible smooth muscle
spasm of the airway
(bronchospasm) associated
with hypersensitivity to
various stimuli
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Bronchospasm
Triggers
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Allergy
Aspiration
Exertion
Infection
Stress
Temperature change
Seasonal changes
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Asthma
• Signs and Symptoms
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Dyspnea
Wheezing
Tachypnea
Tachycardia
Cyanosis
Cough
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Asthma
• Signs and Symptoms
(cont.)
– Accessory muscle use
– Inability to speak in
complete sentences
– Anxiety (hypoxia)
– Prolonged expiratory phase
– Tripod positioning
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Patient History
•O
•P
•Q
•R
•S
•T
•S
•A
•M
•P
•L
•E
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Patient History
• Confirm Asthma History
• “All That Wheezes Is Not
Asthma”
• Hospital visits for asthma
in past year?
• Any previous intubations
due to asthma?
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Physical Exam
• Position found
• Pursed lip breathing
• Vital signs
• Ability to speak in
complete sentences
• Accessory muscle use
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Physical Exam
•Lung Sounds
• Wheezing may or may not be
present
• Wheezes may be audible with or
without a stethoscope
• Decreased breath sounds (poor
air movement)
•Patient’s self-assessment
(0-10 scale)
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Albuterol
• Generic Name
•Albuterol
• Trade Names
•Proventil
•Ventolin
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Albuterol
Actions
• Bronchodilation
• Duration of effect is up to
five hours.
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Albuterol
Indications
• History of Asthma
• Respiratory Distress
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Albuterol
Contraindications
• Known hypersensitivity to
albuterol
• Respiratory Failure
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Albuterol
Dosage
Single-dose solution of 2.5 mg
in 3 ml of normal saline for use
in small volume nebulizer
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Albuterol
Route
Nebulized Medication
By Mouthpiece
By Mask
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Albuterol
Side Effects
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Nervousness
Tremors
Headache
Tachycardia
Palpitations
•Muscle cramps
•Weakness
•Dizziness
•Drowsiness
•Flushing
•Chest discomfort
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Asthma
Severe Respiratory Distress
• Call for ALS
• Do Not delay transport to
administer medication!
• Do Not wait for ALS
 Confirm No Signs of
Imminent Respiratory
Failure
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Albuterol
Protocol
• If patient is in respiratory
failure, assist ventilations
with BVM
• Determine if patient has
self-administered any
nebulized albuterol
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Albuterol
Protocol
• If patient is in respiratory
failure, assist ventilations
with BVM
• Determine if patient has
self-administered any
nebulized albuterol
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Albuterol
Protocol
If agency is approved to carry
albuterol, and:
• Patient age is 1 to 65 Years old
and
• Has previously been diagnosed
with asthma
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Albuterol
Protocol
• Administer 2.5mg albuterol in
3cc normal saline (one unit
dose) by nebulizer
• If respiratory distress
continues, administer second
dose albuterol
• Maximum of two doses
may be given!
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Albuterol
Protocol
If respiratory distress
continues and ALS is not yet
available:
• Contact Medical Control for
further orders
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Nebulized Albuterol
aerosol tubing
“tee”
mouthpiece
nebulizing
chamber
medication
oxygen supply tubing
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Nebulized Albuterol
Pour Unit Dose into Nebulizing Chamber
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Nebulized Albuterol
Assemble nebulizer, hook to oxygen
regulator, and run between 6 and 10 L/min
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Nebulized Albuterol
Encourage the patient
to breath deeply.
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Nebulized Albuterol
If the patient is
too tired to hold
the mouthpiece,
remove the
facepiece from a
non-rebreather
mask, and
connect it firmly
to the top of the
nebulizing
chamber.
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Nebulized Albuterol
• Place the mask on the patient normally.
• Both children and some elderly may
require a pediatric non-rebreather mask
for the treatment
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Nebulized Albuterol
Try to avoid
inhaling the
excess
aerosol
mist while
assessing
the patient.
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Reassessment
Strategy
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Monitor A-B-Cs
Position of Comfort
Reassess Vitals
Oxygen by NRB
Watch for changes in
Patient Condition
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Documentation
• Vital signs before and after
meds are given.
• Current and Past medical
histories
• Any changes in patient
condition
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Words of Wisdom
DON’T FORGET:
• A-B-C’S
• Good BLS
• Call ALS
• Frequent Reassessment
• Detailed Documentation
• Medical Control
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