EMT Drugs and Conditions

What does albuterol target?

Bronchodilator, so it relaxes and opens the air passage, making it easier breathing easier for the lungs

How does Albuterol work?

Beta-2 adrenergic receptor of sympathomimetic immune system. Smooth muscle relaxant in the bronchial tree

Indicators of Albuterol?

Treatment of bronchospasm; reversible airway obstruction; COPD, Asthma, etc.

Contraindicators of Albuterol?

Tachycardia and dysrhythmia, especially digitalis (medicines for heart diseases like heart failure and arrythmia)

How is Albuterol delivered?

Meter-dose Inhaler or Nebulizer (misting)

Dosage for Albuterol?

Mature (2+ years old): 2.5mg

Pediatric (6 month - 2 year): 1.25mg in 3mL normal saline

What does Aspirin do?

It inhibits platelet formation and is an anti-inflammatory agent

Transient vasodilator in acute coronary syndrome

How does Aspirin work?

Prostaglandin inhibition (makes platelets less sticky). Blocks Thromboxane A2 via COX 1 pathway

Vasodilation of coronary arteries via the COX 2 pathway

Indicators of Aspirin?

Chest pain suggestive of acute MI

Contraindicators of Aspirin?

Hypersensitivity, GI Bleeding, any indicators of cerebrovascular accidents (blood flow disrupted to the brain)

Patients allergic to NSAIDS (non-steroidal antiinflammatory drugs)

Dosage of Aspirin?

Mature: 162mg or 324mg (depending on severity)

Pediatric: Don’t give

What is Diphenhydramine

AKA Benadryl

Blocks cellular histamine receptors
Decreases

Indications of Diphenhydramine

Symptomatic relief of allergies, allergic reaction, anaphylaxis, acute dystonic reaction (phenothiazines)

Contraindications of Diphenhydramine

Asthma, glaucoma, pregnancy, hypertension

No infants

Adverse Reactions to Diphenhydramine

Sedation, hypotension, seizures, visual disturbance, vomiting, palpations, dysrhythmias, dry mouth + throat

Paradoxical CNS excitation in children

Dosage of Diphenhydramine

Adult: 25-50mg by liquid or oral tablet

Pediatric: 1mg/kg for patients 2 years and older (total of 25mg)

Special considerations of Diphenhydramine

Not used in infants or in pregnancy

If used in anaphylaxis, will be in conjunction with epinephrine/steroids

How does epinephrine work?

Direct-acting Alpha and Beta agonist, targets vascular bronchioles, cutaneous, renal, and visceral arteriolar vasoconstriction

Beta 1: Positive inotropic (increases strength of heart), chronotropic (increases heart rate), dromotropic (increased speed of electrical impulse)

Beta 2: Bronchial smooth muscle relaxation and dilation of skeletal vasculature Blocks histamine release

Indications of epinephrine

Severe bronchospasm, asthma, bronchiolitis (Medical control)

Anaphylaxis and acute allergic reactions (Standing order)

Contraindications of epinephrine

Hypertension, hypothermia, pulmonary edema, coronary insufficiency, hypovolemic shock

Adverse reactions of epinephrine

Hypertension, dysrhythmias, pulmonary edema, anxiety, psychomotor agitation, nausea, angina, headache, restlessness

Dosage of epinephrine

Adult: 0.3mg of injection into muscle (usually lateral thigh). A second dose may be administered in 5-10 mins if first dose is insufficient

Pediatric (over 6 months and under 25kg): 0.15mg. Contact medical control if a second dose is needed after 5-10 minutes

What is glucagon

Hyperglycemic agent + pancreatic hormone

Increases blood glucose by stimulating glycolysis. Insulin antagonist. Unknown mechanism of stabilizing cardiac rhythm in beta-blocker overdose. Relaxes smooth muscle of GI tract

Indications of glucagon

Altered level of consciousness when hypoglycemia is suspected

May be used as an inotropic agent in beta-blocker overdose

Contraindications of glucagon

Hyperglycemia, hypersensitivity

Adverse reactions of glucagon

Nausea, vomiting, tachycardia, hypertension

Dosage of glucagon

Administered when there is no IV/IO available for Dextrose administration

Adult: 1mg intramuscular/intranasally.

Pediatric: If patient less than 20kg (44lbs), glucagon 0.5mg IM/IN

If patient greater than 20kg, glucagon 1mg IM/IN

For both adult and pediatric: Check glucose every 15 minutes. May give repeated treatment if glucose remains less than 70 mg/dl

What is oral glucose

Provides quickly absorbed glucose to increase blood glucose levels

Indications of oral glucose

Conscious patients w/ suspected hypoglycemia

Contraindications of oral glucose

Decreased levels of consciousness, nausea, vomiting

Adverse reactions of oral glucose

Nausea, vomiting

Dosage of oral glucose

Use if glucose is known to be less than 70mg/dl and patient is conscious + can speak, swallow, and listen to commands

Adult: 1 tube of oral glucose (17-25g) depending on brand

Pediatric: Less than 20kg, ½ tube

More than 20kg, 1 tub

What is Nalaxone

Narcan. Competitive inhibitor at narcotic receptor sites

Reverse respiratory depression secondary to depressant drugs. Inhibits effects of morphine

Indications of Nalaxone

Respiratory depression secondary to opiate overdose

Complete or partial reversal of CNS and respiratory depression induced by opioids

Narcotic agonists like morphine, heroin, hydromorphone (Dilaudid), methadone, Meperidine (Demerol), Paregoric, Fentanyl (Sublimase), Oxycodone (Percodan), codeine, propoxyphene (Darvon)

Narcotic antagonists like Butorphanol (Stadol), Pentazocine (Talwin), Nalbuphine (Nubain)

Contraindications of Naloxone

Use with caution on patients who rely on Narcotics, especially with neonates who have narcotic-addicted mothers

Adverse reactions of Naloxone

Withdrawal symptoms in the addicted patient. Tachycardia, hypertension, dysrhythmia, nausea, vomiting, diaphoresis

Dosage of Naloxone

IF TRAINED AND AUTHORIZED

0.4mg-8mg via Nasal Atomizer (IN), or injector (IM). Give second dose if no response after 2-3 minutes. Dosage must not exceed 16mg IM/IN. Use in conjunction w/ oxygen and BVM device

What is nitroglycerin

Smooth muscle relaxant acting on vascular, bronchial, uterine, and intestinal smooth muscle.

Dilation of arterioles and veins in the periphery reduces preload and afterload, decreases workload of the heart so less myocardial oxygen demand

Indications of nitroglycerin

Acute angina pectoris, Ischemic chest pain, CHF, pulmonary edema

Contraindications of nitroglycerin

Hypotension, hypovolemia, intercranial bleeding, head injury

Adverse reactions of nitroglycerin

Headache, hypotension, syncope, reflex tachycardia, flushing

Nausea, vomiting, diaphoresis, muscle twitching

Dosage of nitroglycerin

1 tab/spray (0.4mg), may give every 5 minutes up to 3 doses (including doses self-given by patient before you came).

SBP must be greater than 120mmHg (MA) or 100mmHg (National)
Don’t give to kids

What is oxygen used for

Reverse hypoxemia

Indications of giving oxygen

Confirmed or expected hypoxemia, ischemic chest pain, respiratory insufficiency, prophylactically during air transport, confirmed of suspected carbon monoxide poisoning

Generally if there is anything that causes decreased tissue oxygenation or decreased levels of consciousness

Contraindications of oxygen

Certain patients with COPD, emphysema who will not tolerate oxygen concentrations over 35%

Hyperventilation

Adverse reactions of oxygen

Decreased levels of consciousness and respiratory depression in patients with chronic CO2 retention.

Dosage of given oxygen

Adults: 100% for Cardiac arrest or Carbon monoxide patients

Hypoxemia: 10-15L/min via non-rebreather

COPD: 0-2L/min via nasal cannula or 28-35% venturi mask. Be prepared to provide ventilatory support if higher concentrations of oxygen are needed

What is the recommended delivery level of a nasal cannula?

1-6 liters per minute. Patient should be receiving 22-44 percent ox sat

What is the recommended delivery level of a Non-rebreather mask

10-15 liters per minute. The patient should be receiving 80-90 percent ox sat

What is the recommended delivery level of a Partial rebreather mask?

9-10 liters per minute, patient should be receiving 40-60 percent ox sat

What is the recommended delivery level of a Venturi mask

Varied depending on device, up to 15 liters per minute. Patient should be receiving 24-60 percent oxygen

What is the recommended delivery level of a Tracheostomy mask

8-10 liters per minute. Set up to deliver varying oxygen levels to patients; desired percent of oxygen may be recommended by the home care agency

What is the recommended delivery level of a Bag-Valve Mask

15-25 liters per minute. Patient is receiving 100 percent ox sat