Test 4 (16, 17, 18, 19)

six medications EMT’s can administer or assist with

aspirin, oral glucose, O2, prescribed bronchodilator inhalers, nitroglycerine, and epinephrine auto injectors

asprin

a medicine used to reduce the clotting ability of blood to prevent and treat clots associated with myocardial infraction

oral glucose

form of glucose given by mouth to treat an awake patient, who is able to swallow, with an altered mental status and history of diabetes

oxygen

a gas commonly found in the atmosphere

activated charcoal

powder prepared from charred wood, usually premixed with water to form a slurry for use in the field. It is used to treat or overdose when a substance is swallowed and It is in the patient’s digestive track

inhaler

a spray device with a mouthpiece that contains an aerosol form of a medication that a patient can spray into his airway

nitroglycerin

a drug that helps to dilate the coronary vessels, that supply the heart muscles with blood

epinephrine

a dug that helps constrict the blood vessels and relax passages of the airway. It may be used to counter a severe allergic reaction

the fact that albuterol acts primarily on the B-specific receptors means there

will be limited cardiac side effects (such as rapid heart rate)

atomizer

a device to the end o a syringe that atomizes medication (turns it into a very fine mist)

naloxone

an antidote for narcotic overdoses

teach drug actually has at least three names:

the chemical name, the generic name, and one or more trade names

indications

specific sign or circumstances under which it is appropriate to administer a drug to a patient

contraindications

specific signs or circumstances under which it is not appropriate and may be harmful to administer a drug to a patient

side effect

any action of a drug other than the desired action

as an EMT, you are authorized to administer medications by your

medical director

offline medical direction

you will not actually speak to a physician to ask permission. off line medical direction uses “standing orders” that is orders written down in for form of protocols

online medical direction

you will need to speak directly to a physician (or his designee) to obtain verbal permission to administer a medication

the five rights

right patient, right medication, right time to administer the medication, right dose of medication, right route of administration

oral administration

swallowing

sublingual

dissolved under the tongue

inhaled

breathed into the lungs, usually as tiny aerosol particles (such as from an inhaler) or a gas (such as oxygen)

intranasl

sprayed into the nostrils

intravenous

injected into the veins

intramuscular

injected into a muscle

subcutaneous

injected under the skin

intraosseous

injected into the bone marrow cavity

endotracheal

sprayed directly into a tube inserted into the trachea

geriatric patients will have difficulty

eliminating medications and there fore feel the effects of medications longer

after administering any medications, you must

reassess your patient

when reassessing your patient

look got any changes-improvements, deteriorations, or unintended effects that the medications might have caused

inspiration

active process in which the intercoastal (rib) muscles and the diaphragm contract, expanding the size of the chest cavity and causing air to flow into the lungs

expiration

a passive process in which the intercostal (rib) muscles and the diaphragm relax, causing the chest cavity to decrease in size and forcing air from the lungs

adult adequate breathing

12-20/minute

child adequate breathing

15-30/minute

infant adequate breathing

25-50/minute

inadequate breathing is

breathing that is not sufficient to support life

agonal respiration (also called dying respirations) are

sporadic, irregular breaths that are usually seen just before respiratory arrest

types of agonal respiration

shallow and gasping with only a few breaths per minute

in pediatric patients

the tracea is smaller, softer and more flexible in infants and children which may lead to obstructions from swelling or trauma more easily than in adults. the cricoid cartilage is less developed and less rigid

in pediatric patients, be aware that some signs of inadequate breathing are unique to or more-dominate in infants and small children

therefore, be on the lookout for signs such as; nasal flaring, grunting, seesaw breathing, retractions (pulling in of the muscles) between the ribs (intercostal), above the clavicles (supraclavcyular) and above the sternum (suprasternal)

adequate breathing signs

rate and depth of breathing are adequate, no abnormal breath sounds, air moves freely in and out of the chest, skin color is normal

adequate breathing EMT intervention

oxygen by a nonrebreather mask or nasal cannula

inadequate breathing signs

patient has some breathing but not enough to live, rate and or depth outside of normal limits, shallow ventilations, diminished or absent breath sounds, noises such as crowing, stridor, snoring, gurgling, or gasping, cyanosis skin, decreased minute volume

inadequate breathing EMT interventions

assisted ventilation with a BVM, pocket face mask, or FROPVD

respiratory arrest signs

no chest rise, no evidence of air being moved from the mouth or nose, no breath sounds

respiratory arrest EMT interventions

assisted ventilations at 10-12 minute for an adult and 20/ minute for an infant or child

for any patient, adult, child, or infant, if the chest does not rise and fall with each artificial ventilation or the pulse does not return to normal

increase the force of ventilations

wheezes

high pitched sounds that will seem almost musical in nature. created by air moving through narrowed passages in the lungs. Can be heard during expiration

crackles (also known as rales)

fine crackling or bubbling sounds heard on inspiration. caused by fluid in the alveoli or by the opening of closed alveoli

rhonchi

lower pitched sounds that resemble snoring or rattling. Caused by secretions in larger airways as might be seen with pneumonia or bronchitis or when materials are aspirated into the lungs

stridor

high pitched sound that is heard on inspiration Upper airway sound that indicates partial obstruction of the trachea or larynx. usually audible without a stethoscope

continuous positive airway pressure (CPAP)

form of noninvasive positive pressure ventilation consisting of a mask and a means of blowing oxygen or air into the mask to prevent airway collapse or to help alleviate difficulty breathing

if a patient is experiencing breathing difficulty but is breathing adequately, place him in a position of comfort. Most patients with breathing difficulty feel they can breathe better sitting up

however, this is not possible if the patient has inadequate breathing since the patient would need to be supine to receive assisted ventilations

CPAP may not be contraindicate, the EMT nevertheless needs to exercise caution for

claustrophobia or inability to tolerate the mask and seal; inability to use CPAP, secretion so copious that they need to be suctioned, and a history of pulmonary fibrosis

what causes the overwhelming majority cases of COPD

cigarette smoking

the airflow is mainly restricted in one direction for

asthma

is there known way to prevent asthma?

no

when the patient inhales, the expanding lungs exert an outward pull, increasing the diameter of the airway and allowing air to flow into the lungs. during exhalation, however, the opposite offers and the stale air becomes trapped in the lungs

this requires the patient to exhale the air forcefully, producing the characteristic wheezing associated with asthma

patients with CHF may experience difficulty breathing because of

fluid that accumulates in the lungs, preventing them from breathing adequately

what is pneumonia

an infection of one or both lungs caused by bacteria, viruses, or fungi

what is spontaneous pneumothorax

when a lung collapses without injury or any other obvious cause

what is pulmonary embolism

when a patient has a surgeon onset of sharp pleuritic chest pain: shortness of breath; anxiety; a cough (sometimes with bloody sputum), sweaty skin that is either pale or cyanotic; tachycardia; and tachypnea

what is epiglottis

typical male in his forties who may have had a recent cold. Symptoms include sore throat and painful or difficulty swallowing. the patient is typically in the tripod position to increase the glottic opening as much as possible. other signs may include sick appearance, muffled voice, fever, and drooling because of the pain and difficult swallowing

if you encounter a patient with cystic fibrosis

the patient or parent will be able to tell you about how the disease affects the child. although most patients with this disease are children, many of these patients are now surviving through adulthood

because the signs and symptoms of a respiratory infection resemble those of so many other diseases,

the EMT should administer oxygen and care for the patient as with ant other patient with respiratory distress

for a prescribed inhaler

you need to get permission from medical direction to help the patient use the inhaler

the inhaler is prescribed for patients with respiratory problems that causes bronchoconstriction or other types of lung obstruction

the inhalers contain a drug that dilates, or enlarges, the air passages, making breathing easier

after the patient inhales, make sure he holds his breath

as long as possible so the medication can be absorbed. this may be difficult with a patient who is anxious, but unless the medication is held in the lungs, it will have minimum or no value

what medications should not be used to reverse an acute attack

beclomethasone, flovent, adviar

prescribed inhaler medication name

generic: albuterol, metaproterenol; trade: Proventil, Ventolin, alupent, metaprel

prescribed inhaler dosage

number of inhalations based on medical directions order or physician’s order

prescribed inhaler side effects

increased pulse rate, tremors, nervousness

indications for prescribed inhaler

patient is exhibits signs and symptoms of respiratory emergency, patient has physical-prescribed handheld inhaler, medical direction gives you specific authorization to use

contraindications for prescribed inhaler

PT is unable to use the device, inhaler is not prescribed for the PT, no permission has been given by MD, the PT has already taken the max prescribed she prior to EMT’s arrival

actions of a prescribed inhaler

beta-agonist bronchodilator dilates bronchioles, reducing airway resistance

what is a nebulizer

produces a continuous flow of aerosolized medication that can be taken in during multiple breaths over several minutes, giving the patients a greater exposure to the medication

cardiopulmonary resuscitation

actions taken to receive a person by keeping the person’s heart and lungs working

acute coronary syndrome

a blanket term used to represent any symptoms related to lack of O2 (ischemia) in the heart muscle

dyspnea

shortness if breathing , labored or difficult breathing

bradycardia

when the heart rate is slow, usually less than 60 BPM

tachycardia

when the heart rate is fast, more than 100 BPMN

what should you do if the patient has any of the following: no history of cardiac problem, history of cardiac problem but does not have nitroglycerin, systolic BP below 90 to 100

transport immediately

what should you give the patient if all of these conditions are met: patient complains of chest pain, patient has a history of cardiac problems, patient’s physician has prescribed nitroglycerin, patient has the nitroglycerin with him, systolic BP meets your protocol criteria, patient has not yet taken viagra or a similar drug for erectile dysfunction within 48 to 72 hours, medical direction has authorized administration of the medication

nitroglycerin

after giving one dose of the NTG, gib a repeat dose in five minutes if

PT experiences no relief or only partial relief, systolic BP remains greater than 90 to 100 systolic, MD authorizes another dose of the medication

nitroglycerin medication name

generic: nitroglycerin, trade: nitrostat, nitrolingual

nitroglycerin indications

PT has complained of chest pain, PT has a history of cardiac problems, PT’s physician has prescribed nitroglycerin, systolic BP is greater than 90 systolic, medical direction authorizes administration of the medication

nitroglycerin contraindications

PT has hypotension or systolic BP below 90, PT has head injury, PT is an infant or child, PT has already taken the maximum prescribed dose, PT has recently taken viagra, Cialis, levity, or another drug for erectile dysfinction

nitroglycerin dosage

one dose, max dose is three (.o4 mg)

nitroglycerine actions

relaxes blood vessels, decreases workload of heart

nitroglycerin side effects

hypotension (lowers bp), headache, pulse rate change

aspirin indications

PT complains of chest pain, PT is not allergic to aspirin, PT has no history of asthma, PT is not already taking any medications to prevent clotting, PT has no other contraindications to aspirin, PT is able to swallow without endangering the airway, MD authorizes administration of the medication

aspirin contraindications

PT is unable to swallow without endangering the airway, PT is allergic or sensitive to aspirin, PT has a history of asthma, PT has gastrointestinal ulcer or recent bleeding, PT has known bleeding disorder, MD orders

aspirin dosage

162 to 324mg (two to four 81 mg tables of chewable baby aspirin)

aspirin action

prevents blood from clotting as quickly, leading to increased survival after myocardial infraction, when administered to cardiac patients, aspirin is not being used to relieve pain

aspirin side effects

nausea, vomiting, heartburn, if PT is allergic, bronchospasm and wheezing, bleeding

do not give ASA to a patient who

is allergic to it

aneurysm

with dilation, or ballooning, of a weakened section of the wall of an artery

dysthymias include

bradycardia, tachycardia, rhythms that mat be present when there is no pulse. these rhythms include ventricular fibrillation, ventricular tachycardia, pulseless electrical activity, and asystole

dysrhythmia

a disturbance in heart rate and rhythm