Transcript 2 - EMS Online

Seattle/King County EMT-B Class
Topics
1
Pharmacology: Chapter 10
2
Respiratory Emergencies: Chapter 11
3
Cardiovascular Emergencies: Chapter 12
1
Pharmacology
1
General Pharmacology
• You will be responsible for administering
certain drugs.
• You will be responsible for assisting patients
to self-administer other drugs.
• Not understanding how medications work
places you and the patient in danger.
1
Pharmacology Definitions
Pharmacology
• The science of drugs, including their
ingredients, preparation, uses and
actions on the body
Dose
• Amount of medication given
Action
• Therapeutic effects expected on the
body
1
Pharmacology Definitions, cont'd
Indications
• Therapeutic uses for a particular drug
Contraindications
• Conditions in which a medication
should not be given
Side effects
• Actions of a drug other than the desired
ones
1
Medication Names
Trade name
• Brand name given by manufacturer
Generic name
• Original chemical name
1
Medication Types
Prescription drugs
• Given by pharmacists according to
doctor’s order
Over-the-counter (OTC) drugs
• Available without a prescription
1
Routes of Administration
Intravenous (IV) injection
• Injected directly into the vein
Oral
• Taken by mouth; enters body through
digestive system
Sublingual
• Placed under the tongue; absorbed by
mucous membranes
1
Routes of Administration, cont'd
Intramuscular (IM) injection
• Injection into the muscle
Intraosseous (IO)
• Injection into the bone marrow
Subcutaneous (SC) injection
• Injection into tissue between skin
and muscle
1
Routes of Administration, cont'd
Transcutaneous
• Medications absorbed through the skin
Inhalation
• Medications inhaled into the lungs
Per rectum (PR)
• Administration by rectum
1
Dosage Forms
Tablets
• Materials mixed
with medication
and compressed
under pressure
Capsules
• Gelatin shells filled
with powdered or
liquid medication
1
Dosage Forms, continued
Solutions
• Liquid mixture of one or more
substances
Suspensions
• Mixture of fine particles distributed
throughout a liquid by shaking
1
Dosage Forms, continued
Metered-dose inhaler
(MDI)
• Miniature spray canister,
used to direct medication
through the mouth into
the lungs
Topical medications
• Lotions, creams, and
ointments applied to skin
1
Dosage Forms, continued
Transcutaneous medications
• Designed to be
absorbed through the
skin
Gels
• Semi-liquid
substances
administered orally
Gases for inhalation
• Oxygen
1
Oxygen
• Required by all cells of the body
• Administered as a gas for inhalation
• Ignites easily, requiring caution near
sources of ignition
1
Activated Charcoal
• Suspension used to
absorb ingested poisons
• Often combined with a
laxative
• Administered orally as a
suspension
1
Oral Glucose
• Glucose is used by
cells for energy.
• Patients with low
blood glucose are
hypoglycemic.
• It is administered
orally as a gel.
1
Aspirin
• Reduces pain
• Reduces fever
• Reduces
inflammation
• Cardiac uses
1
Epinephrine
• Increases heart rate and blood pressure
• Eases breathing problems in asthma or
allergic reactions
1
Administering Epinephrine
1. Sterilize skin.
2. Insert needle.
3. Inject medication.
4. Dispose of needle.
We will cover King County's EPI PEN
protocol in more detail at a later time.
1
Metered-Dose Inhaler
• Medication should be
delivered as the
patient is inhaling.
• Device may include
spacer (atomizing
chamber).
1
Nitroglycerin
• Increases blood flow by causing arteries
to dilate
• May decrease blood pressure
• Available in tablet or spray
1
Steps to Administer Medications
• Obtain orders from medical control.
• Verify proper medication and prescription.
• Verify form, dose, and route of the
medication.
• Check expiration date and condition of the
medication.
1
Steps to Administer Medications
• Reassess vital signs, especially heart rate
and blood pressure, at least every 5
minutes or as the patient’s condition
changes.
• Document, document, document
1
Patient Medications
• Clue you in to patient
conditions
• Especially helpful when
patient has altered mental
status
• Include over-the-counter
medications and dietary
supplements
2
Respiratory Emergencies
2
Respiratory System
2
Anatomy and Function of the Lung
2
Adequate Breathing
• Normal rate and depth
• Regular breathing pattern
• Good breath sounds on both sides of the
chest
• Equal rise and fall of chest
• Pink, warm, dry skin
2
Inadequate Breathing
• Pulmonary vessels become obstructed.
• Alveoli are damaged.
• Air passages are obstructed.
• Blood flow to the lungs is obstructed.
• Pleural space is filled.
2
Signs of Inadequate Breathing
• Slower than 12
breaths/min or faster
than 20 breaths/min
• Unequal chest
expansion
• Decreased breath
sounds
• Muscle retractions
• Pale or cyanotic
skin
• Cool, damp
(clammy) skin
• Shallow or
irregular
respirations
• Pursed lips
• Nasal flaring
2
Dyspnea
• Shortness of breath or difficulty breathing
• Patient may not be alert enough to
complain of shortness of breath.
2
Upper or Lower Airway Infection
• Infectious diseases may affect all parts of
the airway.
• The problem is some form of obstruction
to the air flow or the exchange of gases.
2
Acute Pulmonary Edema
• Fluid build-up in the lungs
• Signs and symptoms
– Dyspnea
– Frothy pink sputum
• History of chronic congestive heart failure
• Recurrence high
2
COPD
• Chronic Obstructive Pulmonary Disease is
the result of direct lung and airway
damage from repeated infections or
inhalation of toxic agents.
• Bronchitis and emphysema are two
common types of COPD.
• Abnormal breath sounds may be present.
• Rhonchi and wheezes
2
Asthma
• Common, serious disease
• Acute spasm of the bronchioles.
• Wheezing may be audible without a
stethoscope.
2
Spontaneous Pneumothorax
•
•
•
•
Accumulation of air in the pleural space
Caused by trauma or some medical conditions
Dyspnea and sharp chest pain on one side
Absent or decreased breath sounds on one
side
2
Anaphylactic Reactions
• An allergen can trigger an asthma attack.
• Asthma and anaphylactic (allergic)
reactions can be similar.
• Hay fever is a seasonal response to
allergens.
2
Pleural Effusion
• Caused by irritation,
infection, cancer, or
trauma (bruised lung)
• Collection of fluid
outside lung
• Causes dyspnea
• Eased if patient is
sitting up
2
Obstruction of the Airway
• Be prepared to treat quickly.
• Obstruction may result from the position of
head, the tongue, aspiration of vomit, or a
foreign body.
• Opening the airway with the head tilt-chin
lift maneuver may solve the problem.
2
Pulmonary Embolism
• A blood clot that breaks
off and circulates through
the venous system
• Signs and symptoms:
– Dyspnea
– Acute pleuritic pain
– Hemoptysis
– Cyanosis
– Tachypnea
– Hypoxia
2
Hyperventilation
• Over-breathing resulting in a decrease in
the level of carbon dioxide
• Signs and symptoms:
– Anxiety
– Numbness
– A sense of dyspnea despite rapid
breathing
– Dizziness
– Tingling in hands and feet
2
Scene Size-up
1. Scene Size-up
• Is the patient coughing?
• If yes, wear a HEPA mask
and be ready to put one
on them as well.
2
Initial Assessment
1. Scene Size-up
2. Initial
Assessment
• Decide SICK/NOT SICK.
• Perform initial assessment.
• Place the patient on
oxygen.
• If patient is in respiratory
distress, ventilate.
• Check pulse.
2
Focused History/Physical Exam
1. Scene Size-up
2. Initial
Assessment
3. Focused History/
Physical Exam
• O2 saturation
• Full set of vital signs
• Bilateral breath sounds
2
Detailed Physical Exam
1. Scene Size-up
• Performed only once life
threats are addressed.
2. Initial
• May not be able to do if
Assessment
busy treating airway or
breathing problems.
3. Focused History/
Physical Exam
4. Detailed Physical
Exam
2
Ongoing Assessment
1. Scene Size-up
• Carefully watch patients
for shortness of breath.
2. Initial
• Reassess vital signs.
Assessment
• Ask patient if treatment
has made a difference.
3. Focused History/
Physical Exam
• Check for accessory
muscle use.
4. Detailed Physical
Exam
5. Ongoing
Assessment
2
COPD Patients
• COPD patients cannot handle pulmonary
infections well
• Usually age 50 or older
• History of recurring lung problems
• Long-term smokers
• Tightness in chest/constant fatigue
2
Signs and Symptoms
•
•
•
•
•
•
•
Difficulty breathing
Altered mental status
Anxiety or restlessness
Increased or decreased respirations
Increased heart rate
Irregular breathing
Cyanosis
2
Honestly, Don…
I've never
smoked a day in
my life…
• Pale conjunctivae
Signs and Symptoms, cont'd
• Abnormal breath
sounds
• Difficulty speaking
• Use of accessory
muscles
• Coughing
• Tripod position
• Barrel chest
2
Medications in MDI
Trade names
• Proventil
• Ventolin
• Alupent
• Metaprel
• Brethine
Generic names
• Albuterol
• Metaproterenol
• Terbutaline
2
Prescribed Inhalers
Actions
• Relax the muscles surrounding
the bronchioles
• Enlarge the airways leading to
easier passage of air
Side effects
• Increased pulse rate
• Nervousness
• Muscle tremors
2
Prior to Administration
• Read label carefully.
• Verify it has been prescribed by a
physician for this patient.
• Consult medical control.
• Make sure the medication is indicated.
• Check for contraindications.
2
Contraindications for MDI
• Patient unable to help coordinate inhalation.
• Inhaler not prescribed for patient.
• No permission from medical control.
• Maximum dose prescribed has been taken.
2
Reassessment
• Carefully watch for shortness of breath.
• 5 minutes after administration:
– Obtain vital signs again.
– Perform focused reassessment.
• Transport and continue to assess breathing.
2
Upper or Lower Airway Infection
• Administer oxygen.
• Do not attempt to suction the airway or
insert an oropharyngeal airway in a
patient with suspected epiglottitis.
• Transport patient in position of comfort.
2
Acute Pulmonary Edema
• Administer 100% oxygen.
• Suction secretions.
• Transport in appropriate position (as
opposed to position of comfort).
• For example, a 70-year-old male with a
BP of 78/palp who claims he would feel
better sitting up. Good or bad?
2
COPD
• Assist with prescribed inhaler if patient
has one.
• Transport promptly in position of
comfort.
2
Spontaneous Pneumothorax
• Administer oxygen.
• Transport in position of comfort.
• Monitor closely.
2
Asthma
•
•
•
•
•
Obtain history.
Assess vital signs.
Assist with inhaler if patient has one.
Administer oxygen.
Transport promptly.
2
Pleural Effusion
• Definitive treatment is performed in a
hospital.
• Administer oxygen and support
measures.
• Transport promptly.
2
Obstruction of the Airway
• Clear airway.
• Administer oxygen.
• Transport promptly.
2
Pulmonary Embolism
• Administer oxygen.
• Place patient in comfortable position,
usually sitting.
• Assist breathing as necessary.
• Keep airway clear.
• Transport promptly.
2
Hyperventilation
• Complete initial assessment and history
of the event.
• Assume underlying problems.
• DO NOT have patient breathe into a
paper bag.
• Give oxygen.
• Reassure patient and transport.
3
Cardiovascular Emergencies
3
Cardiovascular Emergencies
• Cardiovascular disease (CVD) claimed
931,108 lives in the US during 2001.
– 2,551 per day
– Almost two people per minute!
• CVD accounts for 38.5% of all deaths.
– One of every 2.6 deaths
3
Blood Flow Through the Heart
3
Electrical System of the Heart
3
Coronary Arteries
3
Blood Flow
3
Atherosclerosis
• Materials build up
inside blood vessels.
• This decreases or
obstructs blood flow.
• Risk factors place a
person at risk.
3
Coronary Artery Disease (CAD)
• Coronary artery disease involves
decreased blood flow to the heart and
the potential for ischemia.
• Chest pain results from ischemia.
• If blood flow is not restored, the tissue
dies.
3
Angina Pectoris
• Pain in chest that occurs when the heart
does not receive enough oxygen
• Typically crushing or squeezing pain
• Rarely lasts longer than 15 minutes
• Can be difficult to differentiate from heart
attack
3
Heart Attack
• Acute myocardial
infarction (AMI)
• Pain signals death of
cells.
• Opening the coronary
artery within the first
hour can prevent
damage.
• Immediate transport is
essential.
3
Signs and Symptoms
• Sudden onset of weakness, nausea, sweating
without obvious cause
• Chest pain/discomfort
– Often crushing or squeezing
– Does not change with each breath
• Pain in lower jaw, arms, back, abdomen, or
neck
• Sudden arrhythmia with syncope
• Shortness of breath or dyspnea
• Pulmonary edema
• Sudden death
3
Pain of Heart Attack
• May or may not be caused by exertion
• Does not resolve in a few minutes
• Can last from 30 minutes to several hours
• May not be relieved by rest or nitroglycerin
3
Sudden Death
• 40% of AMI patients do not reach the
hospital.
• Heart may be twitching.
Ventricular fibrillation
3
Arrythmias
Bradycardia (heart rate
less than 60)
Ventricular tachycardia
3
Cardiogenic Shock
• Heart lacks power to force blood
through the circulatory system.
• Onset may be immediate or not
apparent for 24 hours after AMI.
3
Congestive Heart Failure
• CHF occurs when ventricles are
damaged.
• Heart tries to compensate.
• Increased heart rate
• Enlarged left ventricle
• Fluid backs up into lungs or body as
heart fails to pump.
3
Scene Size-up
1. Scene Size-up
• General impression
• Is the patient responsive?
3
Initial Assessment
1. Scene Size-up
2. Initial
Assessment
• Decide SICK/NOT SICK.
• Chief complaint on
responsive patients
– A chief complaint of
chest discomfort,
shortness of breath, or
dizziness must be taken
seriously.
• ABCs
• Get oxygen started
3
Focused History/Physical Exam
1. Scene Size-up
• SAMPLE
• OPQRST
2. Initial
• Medications are
Assessment
important!
3. Focused History/ • Medications often
Physical Exam
prescribed for CHF:
– Furosemide
– Digoxin
– Amiodarone
3
Focused History/Physical Exam
1. Scene Size-up
• Cardiac and respiratory
systems.
2. Initial
• Look for skin changes.
Assessment
• Check lung sounds.
3. Focused History/ • Baseline vital signs:
Physical Exam
– BOTH systolic and
diastolic BP readings
3
Detailed Physical Exam
1. Scene Size-up
• Perform if time allows.
• Do not gather information
2. Initial
unless:
Assessment
– Patient’s condition is
stable
3. Focused History/
Physical Exam
– Everything else is done
4. Detailed Physical
Exam
3
Ongoing Assessment
1. Scene Size-up
• Repeat initial assessment.
• Reassess vital signs every
2. Initial
5 minutes.
Assessment
• Monitor closely.
3. Focused History/ • If cardiac arrest occurs,
Physical Exam
begin defibrillation or CPR
immediately.
4. Detailed Physical
• Record interventions,
Exam
instructions from medical
control, patient’s
5. Ongoing
response.
Assessment
3
Communication
• Relay history, vital signs, changes,
medications, and treatments.
3
Aspirin
• Administer according to local protocol.
• Prevents clots from becoming bigger
• Normal dosage is from 162 to 324 mg.
3
Nitroglycerin
Forms
• Pill, spray, skin
patch
Effects
• Relaxes blood
vessel walls
• Dilates coronary
arteries
• Reduces workload
of heart
3
Nitroglycerin Contraindications
• Systolic blood pressure of less than 100
mm Hg
• Head injury
• Maximum dose taken in past hour
• Cialis, Lavetra, and Viagra (Erectile
Dysfunction [ED] drugs)
3
Assisting With Nitroglycerin
• Obtain order from medical direction.
• Take patient’s blood pressure.
3
Assisting With Nitroglycerin
• Check that you have right medication,
patient, and delivery route.
• Check expiration date.
• Find out last dose taken and effects.
• Be prepared to lay the patient down.
3
Assisting With Nitroglycerin
• Administer tablet or spray under tongue.
• Have patient keep mouth closed until
tablet dissolves or is absorbed.
3
Assisting With Nitroglycerin
•
•
•
•
Recheck blood pressure.
Record each activity and time of application.
Reevaluate and note response.
May repeat dose in 3 to 5 minutes.
3
Heart Surgeries and Pacemakers
• Coronary artery bypass graft (CABG)
• Angioplasty
• Cardiac pacemaker
3
Implantable Cardiac Defibrillators
• Maintains a
regular heart
rhythm and rate
• Monitors heart
rhythm and
deliver shocks as
needed.
Do not place AED patches
over pacemaker.
Questions
• What questions do you have?
To review this presentation, go to:
http://www.emsonline.net/emtb