Transcript Paramedic Care: Principles & Practice Volume 1

Paramedic Care:
Principles & Practice
Volume 1
Introduction to Advanced
Prehospital Care
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Chapter 10
Intravenous Access
and Medication Administration
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Chapter 10, Part 1
Principles and Routes of
Medication Administration
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Part 1 Topics
General Principles
Percutaneous Drug Administration
Pulmonary Drug Administration
Enteral Drug Administration
Parenteral Drug Administration
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
General Principles
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
General Principles
The paramedic is responsible for ensuring
that all emergency drugs are in place and
ready for immediate use.
– Know your local drug distribution system.
Document the administration and restocking
of narcotics.
– Federal, state, and local laws mandate this.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
General Principles
Six Rights of Drug Administration:
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–
–
–
–
–
Right person
Right drug
Right dose
Right time
Right route
Right documentation
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
General Principles
You will be responsible for the safe and
appropriate delivery of medications.
– Medical control should be used.
Echo procedure
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Medical Direction
The medical director determines which
medications you will use and the routes by
which you will deliver them.
Knowing all drug administration protocols is
essential.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Standard Precautions
Gloves
Goggles
Mask
Gown
Frequent
handwashing
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Medical Asepsis
Sterilization
– Free of all forms of life
– Heat or chemical sterilization
– Medically clean techniques involve the careful
handling of sterile equipment to prevent
contamination.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Medical Asepsis
Disinfectants and Antiseptics
– Disinfectants are toxic to living tissue.
Use them only on nonliving surfaces or objects.
– Antiseptics are not toxic to living tissue.
Common antiseptics include alcohol and iodine
preparations.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Disposal of Contaminated
Equipment and Sharps
Minimize the tasks performed in a moving
ambulance.
Immediately dispose of used sharps in a
sharps container.
Recap needles only as a last resort.
Every medical organization must have a
biological hazard exposure plan.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Medication Administration
and Documentation
Record all information concerning the
patient and medication including:
– Indication, dosage, and route delivered
– Patient response to the medication
The routes of drug administration fall into
four basic categories:
– Percutaneous, pulmonary, enteral, and
parenteral
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Percutaneous Drug
Administration
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Percutaneous Drug
Administration
Transdermal administration
– The transdermal route promotes slow, steady
absorption.
Nitroglycerin, hormones, and analgesics
– Thin skin, overdose, or penetrating solvents can
increase the absorption rate.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Mucous Membranes
Absorbed through the mucous membranes
at a moderate to rapid rate
Sublingual, buccal, ocular, nasal, and aural
administration
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Sublingual Medication
Sublingual Medication
Administration
– Place the pill or direct
spray between the
underside of the
tongue and the floor of
the oral cavity.
Permits rapid
absorption with
systemic delivery
Nitroglycerin
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Buccal Medication
Administration
Buccal medications
—generally tablets
Administer in
theoral cavity
between the cheek
and gums
Hormonal and
enzyme
preparations
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Ocular Administration
Medications for
alleviating eye pain,
treating infection,
decreasing
intraocular
pressure, or
lubricating the
eyelid
Packaged as drops
or ointments
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Nasal Administration
Nasal medications —
usually drops or
sprays intended for
local effect
Emergency
medications via the
intranasal route
– Fentanyl, midazolam,
naloxone
Rapidly absorbed
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Aural Medication
Administration
Aural medications
primarily treat local
infections and ear
pain.
Manually open the
ear canal and
administer the
appropriate dose.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Pulmonary Drug Administration
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Pulmonary Drug Administration
Medications are administered into the
pulmonary system via inhalation or injection.
Promote bronchodilation for respiratory
emergencies.
Other inhaled drugs are mucolytics,
antibiotics, and topical steroids.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Pulmonary Drug Administration
Small volume
nebulizer
Patient must have
an adequate tidal
volume and
respiratory rate
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Pulmonary Drug Administration
Metered Dose
Inhaler
– Handheld devices
produce a
medicated spray for
inhalation
– Some metered dose
inhalers come
equipped with a
spacer
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Endotracheal Tube
Several medications can be administered
through an endotracheal tube:
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Lidocaine
Epinephrine
Vasopresin
Atropine
Naloxone
Increase conventional IV dosages from two to
two-and-one-half times.
Dilute the medication in normal saline to create
10 mL of solution.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Enteral Drug Administration
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Enteral Drug Administration
The delivery of any
medication that is
absorbed through
the gastrointestinal
tract
– Orally, through a
gastric tube, or
rectally
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Oral Drug Administration
An oral drug is any medication taken by
mouth and swallowed into the GI tract.
Be sure the patient has an adequate level of
consciousness to prevent aspiration.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Oral Drug Forms
Capsules
Tablets
Pills
Enteric coated/
time-release
capsules and
tablets
Elixirs
Emulsions
Lozenges
Suspensions
Syrups
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Equipment for
Oral Administration
Soufflé cup
Medicine cup
Medicine dropper
Teaspoon
Oral syringe
Nipple
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Gastric Tube Administration
Gastric tubes
provide access
directly to the GI
system.
Used in instances
of drug overdose,
trauma, and upper
gastrointestinal
bleeding.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Rectal Administration
The rectum’s extreme vascularity promotes
rapid drug absorption.
Medications administered rectally do not
travel through the liver and are not subject
to hepatic alteration.
EMS may administer rectally diazepam
(Valium), lorazepam (Ativan), or midazolam
(Versed) for protracted seizures or aspirin
for cardiac or neurologic emergencies.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Rectal Administration
Suppositories and
Enemas
– Catheter placement
on needleless
syringe
– Syringe attached to
endotracheal tube
– Prepackaged
enema container
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Parenteral Drug Administration
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Parenteral Drug Administration
Drug administration outside of the
gastrointestinal tract.
The parenteral route involves the use of
needles as medications are injected into the
circulatory system or tissues.
Parenteral drug delivery affords the most
rapid drug delivery and absorption.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Syringes and Needles
A syringe is a plastic
tube with which liquid
medications can be
drawn up, stored, and
injected.
The hypodermic
needle is a hollow
metal tube used with
the syringe to
administer
medications.
– Gauge describes its
diameter
photos © Scott Metcalfe
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Medication Packaging
Glass ampules
Single and multidose vials
Nonconstituted syringes
Prefilled syringes
Intravenous medication fluids
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Medication Packaging
Information on
Drug Labels:
– Name of
medication
– Expiration date
– Total dose and
concentration
Always use them to
confirm the correct
medication.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Medication Packaging
Ampule
– Breakable glass
vessel containing
liquid medication
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Medication Packaging
Single and
Multidose Vials
– The medication
inside the vial is
packaged in a
vacuum.
– This permits
multiple access
with a syringe and
hypodermic needle.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Medication Packaging
Nonconstituted Drug
Vial
– Extends the viability
and storage time of
drugs
– Must mix it, or
reconstitute it
– May have to place
multiple medications
into one syringe for a
single delivery
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Medication Packaging
In the Mix-O-Vial
system, the vials
are joined at the
neck. Confirm the
labels.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Medication Packaging
Prefilled or Preloaded Syringes
– Tamperproof containers with the medication
already in the syringe
– Consists of two parts:
A syringe
A glass tube prefilled with liquid medication
– Pushing the glass container into the syringe
barrel expels the medication.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Medication Packaging
Intravenous Medication Solutions
– Medications packaged in an IV bag and
administered as an IV infusion
– May be premixed or you may have to mix them
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Parenteral Routes
Parenterally administered drugs can be
absorbed locally or systemically.
Parenteral delivery bypasses the digestive
tract.
Routes:
–
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–
–
Intradermal injection
Subcutaneous injection
Intramuscular injection
Intravenous access
Intraosseous infusion
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Parenteral Routes
Intradermal Injection
– Injections deposit medication into the dermal
layer of the skin.
– The amount of medication placed in the dermal
layer is quite small.
Less than 1cc
– Useful for allergy testing and tuberculin skin
testing.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Parenteral Routes
Intradermal Injection
– Prepare equipment
– 25- to 27-gauge
needle, up to 1 inch
long
– Insert needle at 1015° angle with bevel
up
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Parenteral Routes
Subcutaneous
Injection
– Promotes slow,
sustained
absorption, which
prolongs a drug’s
effect on the body
– No more than 1.0
mL of medication
– Sites
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Parenteral Routes
Subcutaneous
Injection (cont.)
– Prepare equipment
– 24- to 26-gauge
hypodermic needle,
to 1 inch long
– 45° angle with the
bevel up
© Scott Metcalfe
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Parenteral Routes
Intramuscular Injection
– Permits systemic delivery at a moderate absorption
rate
– Several sites are used for intramuscular injections
Deltoid
2.0 mL
Dorsal gluteal
5.0 mL of medication or more
Vastus lateralis
5 mL of medication
Rectus femoris
Up to 5 mL
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Intramuscular Injection Sites
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Parenteral Routes
Intramuscular
Injection (cont.)
– Prepare equipment
– 21- to 23-gauge
hypodermic needle,
to 1 inch long
– 90° angle with the
bevel up
© Scott Metcalfe
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Intramuscular Injection
90º
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Part 1 Summary
General Principles
Percutaneous Drug Administration
Pulmonary Drug Administration
Enteral Drug Administration
Parenteral Drug Administration
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ