Assessment and Medication Administration in Medical Stations

Assessment Overview

  • Assessments are a crucial part of medical stations.
  • The aim is to identify the problem and administer the appropriate treatment, primarily medications.
  • Failing to administer medication in a medical station results in failure of that station.
  • More than one medication may be required depending on the situation (e.g., aspirin and nitroglycerin for chest pain).
  • Assessments should involve physical interaction with the patient (e.g., palpating a pulse).
  • 80% of the station is assessment, and remainder focuses on medication administration.

Assessment Procedure

  • Scene size-up followed by initial assessment.
  • Vitals, SAMPLE (Signs and Symptoms, Allergies, Medications, Past medical history, Last oral intake, Events leading up to the incident), and OPQRST (Onset, Provocation, Quality, Radiation, Severity, Time) is performed to identify the issue and determine medication needs.
  • Medication is administered after assessment.
  • Patient is prepared for transport.
  • For chest pain, SAMPLE and OPQRST do not need to be completed before administering medication.
  • Medications that may be given right away are Narcan and Epinephrine, although Narcan may not be needed for respiratory depression because BVM can be used to support their breathing.

Patient Assessment: Example

  • Confirm scene safety and use PPE.
  • Nature of illness is determined.
  • ALS is requested for chest pain.
  • General Impression: Observe patient's state and position.
  • Determine level of consciousness (AVPU).
  • Assess ABCs (Airway, Breathing, Circulation).
    • If the patient is talking to you, the airway can be considered open.
  • Check pulse.
  • Taking vitals is important.

Oxygen Administration

  • Avoid overthinking oxygen administration.
  • Follow the reading and symptoms before administering oxygen to the patient.
  • For example, a patient can have chest pain and not necessarily require oxygen if their breathing is unlabored, and their pulse oximetry reading is at 96%.

SAMPLE and OPQRST

SAMPLE
  • Signs and Symptoms: What are the main issues?
  • Allergies: Any known allergies?
  • Medications: What medications are they currently taking?
  • Past Medical History: Any relevant medical history?
  • Last Oral Intake: When did they last eat or drink?
  • Events leading up to the incident:
OPQRST
  • Onset: How did the symptoms start?
  • Provocation: What makes the pain better or worse?
  • Quality: How would you describe the pain?
  • Radiation: Does the pain radiate anywhere?
  • Severity: On a scale of 1 to 10, how severe is the pain?
  • Time: When did the symptoms start?

Medication Administration: Nitroglycerin

  • Check vitals, specifically blood pressure, before administering nitroglycerin.
  • If systolic blood pressure is less than 100 mmHg, do not administer.
  • Administer nitroglycerin sublingually.
  • Reassess blood pressure and pain level after five minutes.
  • Transport the patient but also ask if they want to go.
  • Recheck vitals every 15 minutes if patient is stable.
  • Radio report to the hospital with patient information and treatments performed.

Key Medications: Aspirin

  • Aspirin should generally be administered first for chest pain.
  • Aspirin is a life-saving drug in these scenarios.
  • It is not technically a blood thinner, but it helps blood flow around clots.
  • In Maryland, aspirin is the first drug given for chest pain.
  • Dosage:
    • Four 81mg baby aspirins (total 324mg).
  • No need to worry about vital signs before giving aspirin; simply ask about allergies and prior doses.

Oxygen Administration Considerations

  • Avoid over-administration of oxygen.
  • Assess patient's breathing and pulse oximetry before administering oxygen.
  • If breathing is normal and pulse ox is 96%, oxygen may not be immediately necessary.

Physical Examination

  • Even in medical stations, a physical exam is essential.
  • Gross blood sweep should be performed (even if patient is sitting).
  • Palpate the chest to check for pain response.
    • If palpation elicits pain, it may indicate a muscular problem rather than a cardiac issue.
  • Auscultate breath sounds and check legs for swelling (edema), which can indicate heart failure.

Medication Review

  • It is important to know your medications.
  • Utilize resources like Google to identify medications and their uses.
  • Common medications include Lisinopril (for blood pressure) and Atorvastatin (for cholesterol).

Obtaining Patient History

  • Avoid jumping around during SAMPLE/OPQRST to minimize the risk of forgetting things.
  • Onset and provocation are important aspects of OPQRST.

Medication Administration: The Rights

  • Right Patient
  • Right Medication
  • Right Dose
  • Right Route
  • Right Time
  • Right Documentation

Administering Nitroglycerin:

  • Right Route: Sublingual.
  • Right Patient: Experiencing chest pain, over 13, and prescribed nitroglycerin.
  • Right Medication: Verify it is nitroglycerin.
  • Right Time: Experiencing chest pain, has prescription, and hasn't already taken it.
  • Contraindications: Blood pressure above 90/100, pulse above 60 and below 150.
  • Ask about use of sexual enhancement drugs (Cialis, Levitra, Viagra) or pulmonary hypertension drugs (Adcirca, Rovetio) within the last 48 hours.
  • Right dose: One tablet or spray.
  • Right Date: Check the expiration date.
  • Document the administration.
  • Explain procedure to patient.
  • Administer with gloves to avoid absorption through skin.
  • Document time of administration and monitor for side effects (headache, hypotension, dizziness, tachycardia).
  • Additional doses can be administered every five minutes up to a total of three doses, if needed.
  • Transport patient and reassess en route.

Notes

  • Student must verbalize drug names and cannot simply say sexual enhancement drugs.
  • Generic name of Viagra is Sildenafil so ask to see if they are taking this medication if unsure.
  • A drop of more than 20 points can cause a second dose to not be administered.
  • Student must verbalize the names of drugs and cannot simply say the names. (Viagra, Cialis, Levitra, Adcirca, or Rovetio)