EMT

Appropriate O2 Delivery Flow Rates

  • Nasal Cannula = 2-6 Liters per minute

  • Simple Mask (NO reservoir bag) = 6-10 Liters per minute

  • NRM (HAS a reservoir bag) = 10-15 Liters per minute

  • CPAP = Depending on the settings provided. Max, 25 liters per minute.

  • BVM = 15 Liters per minute. Squeeze bag for 1-6 seconds for adults / Squeeze bag for 3 seconds for children

  • Nebulizer 6-8 Liters per minute. 

Differentiate Respiratory Failure and Respiratory Distress

  • Respiratory distress: It is when someone is having difficulty breathing.   

Symptoms include: rapid breathing, increased effort to breathe, and changes in skin color. The airway can remain open without support.

Treatments include: oxygen therapy, medications that address the underlying cause, ensuring that the patient has access to air, and monitoring vital signs.

  • Respiratory failure: This is a more severe form of distress. O2 Sat goes down. 

Symptoms include: Slow or no breathing, abnormal lung sounds, and cyanosis. Check to make sure the airway is not obstructed.

Treatments include: Ventilation support, CPAP, IV meds to support BP and cardiac function, aggressive fluid management, post-monitoring, and ICU(Intensive care unit).

Causes include: Overdoses, pneumonia, and Chronic Obstructive Pulmonary Disease (COPD).

Medications

Aspirin

Indications:

  • Symptoms secondary to suspected acute coronary syndrome

Contraindications:

  • Patients who have experienced signs of severe allergic reaction or anaphylaxis with the use of aspirin

  • Patients with active gastrointestinal bleeding

  • Pediatric patients 

Mechanism of Action

  • Aspirin (Acetylsalicylic Acid) inhibits platelet aggregation and blood clotting and is indicated for treatment of acute
    coronary syndrome in which platelet aggregation is a major component of the pathophysiology. It is also an
    analgesic and antipyretic


Doses

  • Adult: 2 to 4 chewable tablets (162 to 324 mg) to a total dose 324 mg PO

Zofran 

Indications:

  • Nausea or vomiting stemming from any medical or traumatic complaint

  • Prophylaxis treatment for opioids (Pain management, CPSP, Spinal Motion Restriction)

  • Prophylaxis treatment for any patient with a high risk of motion sickness

Contraindications:

  • Patients with a known history of hypersensitivity to the drug 


Mechanism of Action

  • Serotonin 5-HT3 receptor antagonist.

  • Prevents nausea and vomiting by blocking serotonin.

Doses 

  • Adult: 4 mg ODT/IM/PO/IV/IO/IN• Repeat as needed every 10 minutes to a MAX 2 doses

  • Pediatric: >40 kg: 4 mg ODT/IM/PO/IV/IO/IN• Repeat as needed every 10 minutes to a MAX 2 doses

  • Pediatric: <40 kg: 0.1 mg/kg  IV/IM/PO/IO/IN• Repeat as needed every 10 minutes to a MAX of 2 doses


Acetaminophen 

Indications:

  • Mild to moderate pain

  • Fever

Contraindications: 

  • Hypersensitivity to drug

  • Hepatic Impairment/Failure

  • Suicide Attempt

Mechanism of Action 

- Acts centrally through the activation of the descending serotonergic pathways. Increases that pain threshold by inhibiting the prostaglandin synthesis through the COX pathways. Does not have significant anti-inflammatory or antiplatelet effects. Antipyretic effect by inhibiting the prostaglandin synthesis in the CNS and blocking the actions of endogenous pyrogens at the hypothalamic centers.

Doses

  • Adult: PO 500-1000 mg; as needed every 6 hours

       IV/IO <50 KG 500mg over 15 minutes; as needed every 6 hours

      IV/IO >50 KG 1000mg over 15 minutes; as needed every 6 hours

  • Pediatric: PO 15 mg/kg; as needed every 6 hours

             IV/IO 15 mg/kg to a max dose of 750 mg; as needed every 6 hours


Narcan

Indications 

  • Reversal of suspected opioid or clonidine induced CNS respiratory depression.

  • Coma with impaired reflexes or respiratory depression


Contraindications 

  • Known Hypersensitivity.


Mechanism of Action 

  • Competitive opiate receptor antagonist. 

Doses

  • Adult: 

    • First Dose: 0.5 mg to 1 mg bolus (IV/IO/IM/IN)

    • 2nd Dose: 1 mg to 2 mg bolus (IV/IO/IM/IN)

    • 3rd Dose: 2 mg to 4 mg bolus (IV/IO/IM/IN)

    • If symptoms redevelop repeat the last effective dose

    • If symptoms do not improve after 4 mg consider other causes

  • Pediatric:

    •  ≥20 kg:.0.5 mg bolus (IV/IO/IM/IN); titrate to the desired effect up to 2 mg total

    • <20 kg: 0.01 mg/kg bolus (IV/IO/IM/IN); titrate to the desired effect up to 2 mg total

    • Neonate: Not allowed


Ibuprofen 

Indications 

  • Mild to moderate pain. 

  • Frostbite or frozen extremity.

Contraindications 

  • Hypersensitivity

  • GI Disease or bleeding

  • ACS

  • Pregnancy

  • Patient on blood thinners not including ASA

  • Children < 6 months old

Mechanism of Action 

  • Ibuprofen is a propionic acid nonsteroidal anti-inflammatory drug. The anti-inflammatory mechanism is due to decreased prostaglandin synthesis. The analgesic activity is effective in cases where inflammation has caused sensitivity of pain receptors. 

Doses 

  • Adult: 600 mg PO; PRN every 6 hours

  • Pediatric:≥ 6 month old: 10 mg/kg PO mg PRN every 6 hours to a max dose of 600mg 


Nitroglycerin

Indications:

  • Chest pain is suspected of cardiac origin.

Contraindications:

  • Hypotension (Systolic BP <100)

  • Recent use of phosphodiesterase(erectile dysfunction medications) inhibitors within 24/48hr

Mechanism of Action:

  • Short-acting peripheral vasodilator decreasing cardiac preload and afterload 

Forms:

Dosages

  • Adult: 0.4mg sublingual repeat it as needed for every 5 min up to 3 doses max

  • Pediatric: NOT APPROVED

  • Given orally or between the gum and cheek.



Activated Charcoal

Indications:

        -ingested toxins less than 1 hr before administration 

Contraindications:

  • Inability to swallow or protect the airway

  • Ingested caustic substances, hydrocarbon

Mechanism of Action:

  • Binds to ingested toxin to prevent absorption 

Forms:

Dosages for all ages is 1g/ 1kg of the patient's weight. PO if sorbitol-free activated charcoal

               Route:

Oral, Nasogastric tubes, or Orogastric Tubes

Albuterol

Indications:

  • Bronchospasm, asthma attack, wheezing, or difficulty breathing.

Contraindications:

  • Severe Tachycardia (relative contradiction)

  • Allergy to medication 

Mechanism of Action:

  • Albuterol is a selected B-2 adrenergic receptor agonist. It is a bronchodilator and positive chronotropic, meaning it affects the heart rate  

Forms:

  • Dosage adult and pediatric>2 albuterol sulfate solution 0.083%(2.5mg in 3ml) by nebulizer repeat as needed every 10 min

  • Pediatric < 2 mix 1.5ml(half of unit dose bottle of 3 ml premix solution) with 2 ml of saline and repeat as needed every 10 min

               Route:

  • Oral (breathed in through the mouth)







Oral Glucose

Indications:

  • Known or suspected hypoglycemia and able to swallow and has a patent airway

Contraindications:

  • Inability to swallow or protect the airway

  • Unable to take oral medications 

Mechanism of Action:

  • Glucose is the body's basic fuel and is required for cellular metabolism 

  • After absorption from the GI tract, glucose is distributed in the tissue and provides a prompt increase in circulating blood sugar 

Forms:

  • Dosage For all ages 1 to 2 tubes or 15g buccal(cheeks), repeat as needed every 10 min

                Route

  • Orally(OS) 

Oxygen

Indications:

  • Low Spo2<90%

Contraindications:

  • Hyperoxia>90%

Mechanism of Action:

Forms:


Epinephrine

Indications:

  • Anaphylaxis 

Contraindications:

  • Known hypersensitivity 

Mechanism of Action:

  • Catecholamine with alpha and beta effect. Dilates the bronchioles and constricts blood vessels 

Forms:

  • Dosage

Adult 0.5mg IM (1:1000) repeat as needed every 5 min

Pediatric 0.01 mg/kg IM(1:1000) to a single max dose of 0.5mg and repeat as needed for 5 min

Route :

  • (IM) intramuscular.

  • (IV) Intravenous

  • (IO) intraosseous 


Atrovent

Indications:

  • Adjunct bronchodilator for asthma, chronic bronchitis, allergy/ anaphylaxis, and emphysema which is not adequately controlled by a beta-adrenergic agent  such as albuterol 

Contraindications:

  • Patients with a  history of hypersensitivity to the drug 

  • Can only be used in conjunction with albuterol 

Mechanism of Action:

  • An anticholinergic agent that inhibits the  interaction of Acetylcholine at parasympathetic receptor sites on the bronchial smooth muscle, which prevents the constriction of smooth muscle  (Absorbs the fluid and mucus on the lungs)

Forms:

  • Dosage 

Adults 0.5 mg given with albuterol nebulizer repeat as needed every 15 min

Pediatric 0.25 mg given with albuterol nebulizer repeat as needed every 15 min

Route 

Orally with 2 inhalations 4 times a day 




When To Use

SAMPLE

SAMPLE history is an acronym for remembering what questions are important to ask during your assessment of a patient. 

Signs/Symptoms: What seems to be bothering you? 

Allergies: Are you allergic to anything? 

Medications: Do you currently take any medications? 

Past medical hx: Do you have any current medical conditions?

Last Oral: When was the last time you ate or drank something? What was it? 

Events Leading Up: What were you doing when the symptoms started? 


OPQRST

A guide for asking questions regarding a patient's symptoms, specifically pain, during acute illness. It is a great acronym to find out subjective history about a person's chest or abdominal pain.

Onset: Did the pain start gradually or all of a sudden?

Provocation: Does anything make the pain feel worse or better? 

Quality: Can you describe the pain? 

Radiation: Where is the pain? Does it radiate anywhere else in your body? 

Severity: How would you rate the pain on a scale 1-10? 

Time: How long ago did the pain start? 







Signs/Symptoms/Treatments


Angina(chest  pain) Pectoris 

Stable and unstable?-stable goes away 

Unstable- does not improve 


S: shortness of breath, nausea or vomiting, sweating, pale skin

S: feeling of impending doom, feeling faint, fatigue, chest pain, rapid or irregular heartbeat

T: Nitroglycerin, Aspirin, lifestyle changes, procedures 


Myocardial Infarction(heart attack) 

S: shortness of breath, sweating profusely, vomiting, cold hands or feet

S: Chest pain, nausea, dizziness, or lightheadedness, fatigue, rapid or irregular heartbeat, weakness or numbness in the arms and legs, diaphoretic(sweating for you knumbskulls that don’t know what that means)

T: Aspirin, oxygen, nitroglycerin, 


Urinary tract infection

S:   fever or feeling hot and shivery, pressure in the lower abdomen or back, feeling the need to urinate even after emptying the bladder ( More common in females and children, females ureter is shorter)

S: pain or burning when urinating, frequent urination especially at nights, cloudy or bloody urine, foul smelling urine,

T: Antibiotics


Testicular torsion

S: swelling and redness of the scrotum, vomiting, testicle is higher than normal or at unusual angle, difficulty walking, discoloration of the scrotum, 

S: sudden or severe pain in the scrotum, nausea, pain in the lower abdomen and thigh, difficulty walking, fever, urinating more than usual, tenderness 

T: Rapid transport and put him in a position of comfort.


Kidney stones

S: vomiting, hematuria

S: nausea, hematuria, fever, cloudy urine, difficulty passing urine, painful urination, pain in the flank, pain in your sides, radiating pain, chills, repeated infections, urine odor

T: rapid transport, or call ALS


Peptic ulcers

S: vomiting, bleeding, black or tarry stool

S: upper abdominal pain, nausea, bleeding, bloating, indigestion, rapid pulse, black or tarry stool,

T: Rapid Transport, or ALS


Gallstones

S: vomiting, jaundice

S: pain in the upper right abdomen, nausea, fever, chills, 

T: depends on if its causing symptoms or not


Cystitis

S: blood in urine, frequent urination

S: midline lower abdominal pain, pressure and pain around the bladder, can become inflamed, causes urinary retention, tenderness,

T: Heat Therapy, antibiotics, acetaminophen, and ibuprofen 


Spontaneous pneumothorax

S: shortness of breath, cough, cyanosis 

S: sudden onset of sharp chest pain, rapid heartbeat, 

T: Rapid transport, oxygen, call ALS 


Pulmonary embolism

S: Sudden S.O.B. Coughing/Coughing up blood. Sweating. Rapid breathing.

S: Irregular heartbeat. Palpitations, chest pain, and feeling of anxiety.

T: Anticoagulant medications(blood thinners). Surgery.


Asthma

S: Chest tightness, difficulty talking, blue lips

S: Wheezing, shortness of breath, Coughing 

T: Oxygen, inhalers


COPD

S: Shortness of breath, coughing, wheezing, weight loss, swelling, 

S: Chest tightness, fatigue, weight loss, frequent chest infections 

T: Oxygen, inhalers, call ALS 


CHF

S: swollen ankles, skin is pale or cyanotic, and sweaty

S: agitated, chest pain may not be present, distended neck veins, high BP, rapid heart rate, rapid respirations, usually using accessory breathing muscles of the neck and ribs present hard work breathing, may produce crackles, easier to breath when sitting up, laying down is harder because more blood is returned to the right ventricle and lungs causing further congestion.

T: Oxygen by (CPAP), oxygen by mask or cannula to maintain saturation between 95% and 99%, allow patient to remain sitting upright, reassure patients, gather specific medication the patients has and take to hospital, Nitroglycerin, prompt transport to ED is essential


Pneumonia

S: Cough, shortness of breath, wheezing 

S: Fever, chest pain, fatigue, headache, muscle pain, nausea, loss of appetite 

T: Depends on the underlying cause and severity of the infection 


Bronchitis

S: cough, shortness of breath, wheezing, runny nose, coughing up mucus

S: chest pain, fever, chills, sore throat, headache, aches/pain

T: Oxygen, humidifier, copd/asthma treatment


Right-sided heart failure

S: Fluid retention (swelling, veins popping, weight gain), cough 

S: Difficulty breathing, fatigue, nausea, loss of appetite, abdominal pain

T: Rapid transport, call ALS 


Left-sided heart failure

S: Constant Coughing. S.o.B. Edema in ankles, legs or abdomen.

S: Weight gain. Coughing up pink or foamy mucus. Cyanosis on the lips(?). Sleepiness.

T: Rapid Transport. 


End-stage renal disease

S: swelling in feet, hands, ankles, and arms

S: weight loss, fatigue, changes in urination, bone pain, nausea

T: Rapid Transport xx


Patients on Dialysis

Hemodialysis

  • The process is when the patient's blood is filtered and cleansed of the toxins and then returned to the body. The treatment eliminates waste, normalizes the blood chemistry, and reduces excess fluid. 

  • If the patient missed dialysis treatment, weakness and pulmonary edema can be the first in series of conditions that can progressively more serious if normal balance is not returned to the patients 


Peritoneal Dialysis

  • Fluid circulates within the peritoneal cavity, urea and other toxins diffuse across the peritoneum into the dialysis fluid, which then drained from the peritoneum allowing the peritoneum to essentially function as a kidney 

  • Large amounts of specifically formulated dialysis fluid are infused into (and back out of) a large catheter in the abdominal cavity

  • Carries risk of peritonitis, this can occur due to bacteria contaminating the dialysis site

This may present with abdominal pain, hypotension, fever, nausea, diarrhea, and cloudy dialysis fluid.