Ch18 EMT

PHARM

Each drug has at least three names…+ example

Chemical name, generic name, brand(trade) name

Ex:

Chemical name: B-(3, 4 dihydroxyphenyl)-a-methylaminoethanol

Generic name: Epinephrine

Brand (trade) name: Epi-pen

The four things you need to know when giving a medication (+definitions/examples)

1) Indications — helps the patient; indicates you should give it

2) contraindications — when you shouldn’t use it (ex: don’t use albuterol if you don’t hear wheezing or there’s no bronchoconstriction. Just because you can doesn’t mean you should)

3) Side effects: common ones include nausea, headaches, dizziness, tachycardia

4) Untoward effects / adverse effects: allergic reactions, fainting, may cause death; more severe and life threatening to ABCs (vomiting is also included since its a risk to aspiration)

Medication Safety / Clinical Judgement

Administering or assisting with/medication is a serious responsibility, so it’s important to know the medication and use good judgment in administering it. i

Medication authorization is given via…

off-line medical direction (standing orders) or on-line medical direction (speak directly to physician)

The Six Rights

TRAMP-ED!

Right Time

Right Route

Right Amount

Right Medication

Right Patient

(Expired)

Right Documentation (include vitals pre and post)

Routes of administration

-Oral (PO)

-Sublingual (SL)

-Inhaled

-Intramuscular (IM)

-Intranasal (IN) — done via a Mucosal atomization device (MAD)

-Subcutaneous (SubQ)

-Intraosseous (IO)

-Endotracheal (ET)

-Intravenous (IV)

Oral (PO)

Easiest, longest to have effect, must be alert + able to swallow

Sublingual (SL)

Under the tongue; not for chewing. Absorb fast (3-5mins) but IV is faster

Inhaled

Patent airway, must be breathing

Intranasal (IN) — Mucosal Atomization Device (MAD)

MAD helps to deliver meds via this route; absorbs fast. Only need access to nare; don’t need any patient participation

Subcutaneous (SubQ)

Under the skin; EMTs don’t give meds this way

Intraosseous (IO)

Drill into middle of bone and give through bone

Endotracheal (ET)

Liquid and bag it into a tube in throat; not preferred or commonly used

Intravenous (IV)

Into the vein

Pharmacodynamics (PD)

Study of the effects of medications on the body

Pharmacokinetics (PK)

Study of absorption and elimination in the body

Patient-specific factors change how a med is absorbed, works, and is eliminated (medications are usually metabolized in the liver and excreted via the kidneys; peds have higher metabolism and may need a higher dose because of this)

Documentation

-Document assessments and reassessments

-Clearly document medications administered

What medications can EMTs administer

Aspirin, oral glucose, activated charcoal, oxygen, narcan, epipen, albuterol

What medications can EMTs assist with? (MUST HAVE PRESCRIPTION)

Inhaler, nitroglycerin, epipen

Aspirin: Dose

81mg baby chewable aspirin, not adult –3 or 4 of them (324mg) or 1 325mg adult

Chewing is faster; absorbed faster. Adult is swallowed

Aspirin: Route

Chewed/PO

Aspirin: MoA

Prevents further aggregation of platelets (does not ‘bust’ clots)

Aspirin: indications

Cardiac nature chest pain / discomfort (1 drug that we know has tangible benefit to MI patients)

Aspirin: contraindications

Asthma (can induce an attack; however, incidence is low), recent trauma, GI bleeding (causes further bleeding), use in children (may cause Reye’s syndrome; acetaminophen used in children)

Side effects of aspirin

GI upset, N/V, heart burn

Do you need medical command for aspirin

Not required

PA protocol: complete dose or regive whole dose (aspirin)

Regive whole dose (324mg); some states have local protocols where you complete the dose if the patient is already taking aspirin

Oral Glucose Dose

15g (1 single dose tube or 1/3 triple dose tube)

Oral Glucose Route

Buccal (cheek); Park in between gums in mouth; try not to swallow

Oral Glucose MoA

Increases blood sugar level

Oral Glucose Indications

AMS with a history of DM, with suspected hypoglycemia (may need to microdose until you get amount if AMS)

Oral Glucose Contraindications

Unable to follow simple commands, unable to protect airway (put in recovery position to protect airway)

Oral Glucose side-effects

Possible hyperglycemia

Is medical command required for oral glucose

No

Notes about Oral Glucose:

Be sure to protect the airway, It may be possible to give to pt w/severe AMS, low LOC, remember hypoglycemia is a STROKE MIMIC!

ALSO TREAT WHEN BELOW 60mg/dL IN PA!!

Oxygen dose

Given in LPM: NC 4-6LPM, NRB 15LPM

Oxygen route

Inhalation

Oxygen MoA

Provides increased % of O2 in inhaled air (Doesn’t change CO2 / anemia. So it doesn’t necessarily increase SpO2)

Oxygen Indications

Any patient in respiratory distress or suspected shock

Oxygen contraindications

None for ER use

Do you need med command for oxygen

No

Oxygen side effects

Long-term, non-humidified use can cause dehydration and nose bleeds (doesn’t go through nose so its not humidified in the nasal passages)

Activated Charcoal (ActiChar) dose

Adult 25-30g (1-2 bottles)

Pedi 12.5-25g (1.5-1 bottle)

ActiChar is no longer…

A required medicine on an ambulance

Route of ActiChar

Oral (PO)

MoA of ActiChar

Binds to ingested particulate (binds to what’s in stomach to prevent further absorption)

Indications of ActiChar

Ingestion of poison/toxin w/ medical command order***

Contraindications of ActiChar

Unable to protect airway, swallow, or follow simple commands. Ingestion of caustic substance. Exposure to toxin/poison via means other than ingestion

Side effects of ActiChar

Vomiting, black/tar stool, a few days post administration (not designed to make you vomit; prevents further absorption)

Is medical command required for ActiChar?

Must contact PRIOR TO ADMINISTRATION

ActiChar notes

If vomiting occurs, repeat the dose once. Vomiting is not the desired effect, but a very frequent complication. (Often unable to meet dosing guidelines bc most ambulances only carry 1)

“if it burns on way down, it will burn on way up.”

Bronchodilator inhaler/albuterol treatment dose

Inhaler: 1 Rx dose (usually 2 puffs)

Albuterol treatment: 2.5mg (through handheld nebulizer)

Bronch./albut. route

inhalation 

Bronch./albut. MoA

Causes bronchodilation, allowing air to more easily pass thru airway structures. Beta 2 agonist (B2 exists on lungs)

Bronch./albut. Indications

Respiratory distress with signs of bronchoconstriction, wheezing

Usually used in asthmatics, COPD, bronchoconstriction pts (only suspect when wheezing or silent lung sounds. sometimes giving albuterol to silent lung sounds can make them become wheezing lung sounds which is an improved condition)

Bronch./albut. contraindications

Broncho-constriction not the suspected cause of respiratory distress

Bronch./albut. side effects

Increased HR (may not want to give to heart pts), anxiety, shaking, nervousness

Bronch./albut. med command

Must call after first adminstration for any subsequent adminstrations

Bronch./albut. notes

You do not need a full set of vitals or assessment; the albuterol treatment that is given in a nebulizer is an administered medication

Nitroglycerin (Nitro) dose

0.4mg (equal to 1 spray or tablet)

Nitro route

SL

Nitro MoA

Dilates coronary arteries, reducing workload of heart, thereby reducing O2 demand (limits ischemia and damage done by MI)

Nitro indications

Pts having chest pain as suspected to cardiac issues

DOES NOT CHANGE OUTCOMES!!! Only helps with pain

Nitro contraindications

Non cardiac CP, ED drug use in last 24-48 hours (or pulmonary hypertension drugs), systolic BP less than 100, recent dosing

Nitro side effects

light headedness, fainting, drop in BP, anxiety, increased HR

Nitro Med Command

Must call after 1st adminstration for any more

Nitro Notes

Must ask all patients about ED drugs, not just males (females can take ED drugs for pulmonary hypertension), must be careful handling drug bc it can be absorbed into skin and cause headaches, N/V, etc…

Naloxone (Narcan) Dose

2mg

2g/nare

Narcan Route

Intranasal

Narcan MoA

Reverses the effects of narcotics, including depressed level of consciousness and respiratory depression

Narcan Indications

Suspected narcotic overdose; coma of an unknown cause

Narcan contraindications

Pt breathing adequately and able to maintain own airway

Narcan Side effects

May preciptate withdrawl in pts dependent on narcotics

Narcan med command

Not required

Narcan Notes

-Only used to attain adequate respiratory effect

-Helpful but still manage ventilation. Use a BVM if needed until pt can breathe on own.

Epinephrine Auto-Injectors Dose

0.3mg for adults, 0.15mg for pedi

Epinephrine Auto-Injectors route

IM

Epinephrine Auto-Injectors MoA

Sympathetic activation, bronchodilation, vasoconstriction

Epinephrine Auto-Injectors indications

Severe allergic rxn w/ signs of AMS or respiratory compromise

Epinephrine Auto-Injectors contraindications

Mild allergic rxn

None in true emergency setting

Epinephrine Auto-Injectors side effects

increase HR, anxiety, shaking, nervousness, headache, numbness in extremities 

Epinephrine Auto-Injectors Med Command

Must call after first administration for additional ones

Epinephrine Auto-Injectors Notes

You do not need a full set of vital signs or assessment

Medication Education

• Do pts know how to take meds (Show me how you take this…)

• 85+ meds interact poorly w/ grapefruit

• antibiotics and birth control

• NSAIDs can reduce effectiveness of antihypertensives

Common med: Metformin

antihyperglycemic — reduces hyperglycemia

Common med: HCTZ

Water Pill, decreases blood pressure

Common med: Lisinopril / amlodipine

BP meds

Common med: omeprazol

GERD

Common med: Simvastatin

High cholesterol

Ways fluids and medications may be adminstered into the vein

Saline lock, Drip set

Saline Lock

-Catheter placed into vein

-Cap (Lock) placed over end of catheter

-Lock contains port for administering meds

Drip Set

-Clear plastic tubing connecting fluid bag to needle or catheter

-3 parts: drip chamber, flow regulator, drug/needle port

-Extension set makes it easier to carry/disrobe pt w/o pulling out IV 

What to do before setting up IV fluid

-Inspect IV bag to be sure it contains the solution that was ordered

-Ensure it is clear, did not leak, is not expired

What to do while setting up IV fluid

-Remove protective coverings from the port of the fluid bag and the spiked end of the tubing

-Insert spiked end of tubing into fluid bag

-Close flow regulator

-Fill the drip chamber

-Open the flow regulator

-Set appropriate rate

Maintaining an IV

-Troubleshoot flow problems: constricting bands left in place by mistake, flow regulator left closed, clamp closed on tubing, tubing kinked, tubing caught under pt or equipment.

-Monitor IV sites for infiltration