Transcript EMT Basic Pharmacology

EMT Basic Pharmacology
EMT 151
Spring 2006
Basic Pharmacology
• Medications that the EMT Basic
is allowed to administer by
Oregon statute:
• Epinephrine 1:1,000
• Activated charcoal
• Oxygen
• Aspirin
• Glucose
Pharmacology
• Medications that the EMT Basic
is allowed to assist a patient
with administration:
• Nitroglycerin
• Inhaler/Bronchodilator
Pharmacology
Basic drug information
• Chemical- 1, 2, 3propanetriol trinitrate
• Generic-nitroglycerin tablets
• Trade-Nitrostat
• Official – nitroglycerin
tablets, U.S.P.
Pharmacology
• Routes of medications:
• PO (by mouth)
• IV (intravenous)
• IM (intramuscularly)
• SQ (subcutaneous)
• SL (sub-lingual)
• IO (intraosseous)
• Inhalation
Pharmacology
• Forms
• Solution
• Topical
• Tablet
• Capsule
• Suspension
• Transdermal
• Inhalation
Pharmacology
• Indications
• Contraindications
• Dose
• Route
• Action
• Side effects
Pharmacology
• Nitroglycerin – suspected MI
• Epinephrine - anaphylaxis
• Oxygen – medical/trauma
conditions
• Activated Charcoal –
poisoning/OD
• Inhalers – asthma, emphysema
• Glucose - hypoglycemia
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,
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?
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
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.
5 “rights” of medication
administration (or is it
6?)
•
•
•
•
•
Right
Right
Right
Right
Right
patient
medication
route
dose
date
• Right to refuse
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
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
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
Activated Charcoal
• Binds chemicals to it
• Don’t 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
Nitroglycerine
• Dilates Veins and coronary
arteries
• Causes hypotension and a
headache (migraine like)
• Don’t give if already
hypotensive
• Sublingual spray or tablets
• Don’t shake the bottle (Boom!)
• Just kidding, but don’t shake
the bottle
Administ. Of NTG, cont.
• Assess vitals
• B/P >90 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
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 1:1000 dilution
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
Ouch!
• 22g
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!”
So, when do I administer
an Inhaler?
• Obvious respiratory distress
• S/s
•
•
•
•
Audible wheezing
Wheezing on auscultation
Previously used inhaler?
What if it doesn’t work?
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
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.
Aspirin – Actions
• Inhibits platelet aggregation
• Mild analgesic and antiinflammatory agent
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
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
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
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
S/S AMI, cont.
•
•
•
•
•
•
•
•
Diaphoresis (profuse sweating)
Dyspnea (difficulty breathing)
Nausea/vomiting
Weakness
Dizziness
Palpitations
Feeling of impending doom
Denial
S/S, cont.
• General appearance
• Anxious
• Frightened
• In pain
• Poor color (gray, pale,
cyanosis)
Assessment
• Vital signs
• Respirations
• Level of consciousness
• Pulse
• Blood pressure
• Pulse oximetry
Tx
• General approach to the patient
• ABC’s
• Oxygen therapy
• Vital signs
• Prepare for immediate transport
• Nitroglycerin
• Aspirin
• Prepare for the worst!
• Extra hands for CPR maybe?
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?
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?
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?
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?
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?
Scenario 6
• Little LeRoy has done it again. This
time he has eaten all of Grandpa’s
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?
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 doesn’t 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?