Chapter 14

Oxygen:

• Indications - hypoxia, dyspnea (difficulty breathing/SOB)

  • Medical patients < 94%

  • Trauma patients <95%

  • COPD patient <88-92%

  • Pregnant patient

• Contraindications - fire, petroleum products; no dyspnea/SOB, SpO2 good; newborn requiring BVM (room air only)

• Action - enables aerobic metabolism

• Dose:

  • NC: 1-6 lpm

  • SVN: 6-10 lpm

  • NRB: 8-15 lpm

  • BVM: 15 lpm

  • CPAP: whatever the manufacturer says

• Route - inhalation

• Side effects - a small amount of euphoria, dry mouth

Aspirin:

• Indications - cardiac ischemia (blood flow to heart muscle is reduced, causing chest pain)

• Contraindications - active bleed, unable to control airway or chew/swallow

• Action - anti-platelet (not an anti-coagulant)

• Dose - 160-325 mg

• Route - PO (chewed)

• Side effects - gastric irritation, taste

Oral glucose:

• Indications - AMS, BGL < 70 mg/dL, AND able to swallow

• Contraindications - Unresponsive, BGL > 70 mg/dL, or unable to swallow

• Action - increases BGL (blood glucose level)

• Dose - one tube

• Route - PO

• Side effects - bad taste, high BGL

Glucagon:

• Indications - AMS, BGL < 70 mg/dL, AND unable to swallow

• Contraindications - none, assuming it’s indicated

• Action - increases BGL by releasing glycogen stores in liver; takes 13-16 minutes to work

• Dose - 1 mg per nostril, with max volume 0.5 mL per spray; 2 mg total

  • Follow up with oral glucose PRN

• Route - IN spray

• Side effects - nasal drainage

Albuterol:

• Indications - asthma with wheezing (bronchoconstriction)

• Contraindications - known sensitivity, not responsive enough to use SVN or MDI

• Action - beta 2 causes bronchodilation

• Dose:

  • SVN: 2.5 mg in 3 cc/mL of NS (saline) with O2 at 6-10 lpm

  • MDI: one puff (after shaking for 30 sec)

• Route - inhalation through SVN or MDI (metered dose inhaler)

• Side effects - anxious/jittery, increased HR

Epinephrine:

• Indications - anaphylaxis

• Contraindications - none, assuming it’s indicated

• Action:

  • Alpha 1 causes vasoconstriction

  • Alpha 2 is a check on that vasoconstriction

  • Beta 1 causes increased HR and stroke volume

  • Beta 2 causes bronchodilation

• Dose:

  • 0.2 mg through an adult auto-injector; takes 1 min to work, lasts 15-20 min

  • 0.15 mg through a pedi auto-injector

• Route - IM auto-injector

• Side effects - increased HR, N/V, anxious/jittery

Naloxone Hydrochloride (Narcan):

• Indications - known/suspected opioid OD AND respiratory depression requiring BVM

• Contraindications - none, assuming it’s indicated

• Action - competitive opioid antagonist binds to opioid receptor sites

• Dose - 1 mg per nostril with max volume 0.5 mL per spray; 2 mg total

  • Repeat q 5 min PRN

• Route - IN spray

• Side effects - possibility of acute opioid withdrawal resulting in agitation, vomiting

Nitroglycerin (NTG):

• Indications - pain/discomfort due to cardiac ischemia

• Contraindications:

  • SBP < 90 mmHg or SBP drops 30 mmHg below baseline

  • ED (erectile dysfunction) medication was used in past 48 hrs

  • Unable to control airway (if med is in pill form)

• Action - vasodilation, causing decreased preload/afterload, leading to decreased workload

• Dose - 0.4 mg pill/spray

  • Repeat q 5 min with continued CP (chest pain) and no contraindications

  • Max 3 doses

• Route - SL pill/spray

• Side effects - decreased BP, HA (headache), stinging under tongue

How to administer medication:

• Obtain an order (offline or online)

  • Echo the order back if online order

• Select proper medication

  • Check expiration twice

  • Check for contamination and discoloration

  • So, checked three times total

• Get informed consent

  • Explain procedure

  • Ask allergies

• Prepare equipment and keep it clean

• Administer medication according to dose/route

• Document

  • Medication

  • Dose

  • Route

  • Time

• Reassess the patient

  • Positive side effects and negative

Can too much oxygen be harmful?

Yes; perfusion injuries, oxygen toxicity, newborns, etc

Five rights of medication administration:

• Right patient

• Right medication

• Right dose

• Right route

• Right date/time