MEDICATIONS

1
MEDICATIONS

• The Role of the
• BLS Provider

2
Objectives

• Overview of General Pharmacology
• Develop a Basic Knowledge of medications used by
  BLS Providers
• Identify situations when each medication may be
  indicated

3
General Pharmacology

• For every medication you may administer, you must
  thoroughly understand the following

• Actions
• Indications
• Contraindications

• Dosage
• Route
• Side effects

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General Pharmacology

• Right Time
• Right Patient
• Right Drug
• Right Dose
• Right Route

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General Pharmacology

• Generic name
• Original chemical name
• Trade name
• Brand name given by manufacturer

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General Pharmacology

• Dosage Forms
• Solutions
• Liquid mixture of one or more substances
• Nebulized Solution
• Pressurized gas passed over a solution to create
  an aerosol mist, which is then inhaled

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Anaphylaxis

• Epinephrine for
• BLS Providers

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Anaphylaxis

• An exaggerated immune response to an allergen
• Sudden, rapid onset
• Systemic involvement
• Severe allergic reaction

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Common Causes of Allergic Reactions
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Allergic Reactions

• Very Common
• Range from mild and local to severe and
  systemic.
• Mild reactions usually affect only one area of
  the body
• Slow onset, and minor symptoms

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Mild Allergic Reactions
A mild, local reaction caused by a bee sting
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Severe Allergic Reaction

• A Clear History of Allergen Exposure AND Signs
  and Symptoms including
• Shock (hypoperfusion)
• Respiratory Distress
• Wheezing, stridor, cough
• Chest / throat tightness

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Severe Allergic Reaction

• Itching, skin flushing
• Hives and/or swelling
• (esp. face, extremities)

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Severe Allergic Reaction

• Increased Pulse
• Decreased Blood Pressure
• Nausea Vomiting
• Altered Mental Status
• Allergen exposure with history of anaphylaxis

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Patient History

• Determine if the patients history includes
• Anaphylaxis
• Severe allergic reactions
• Recent exposure to a known or potential allergen

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Focused Physical Assessment

• Assess ABCs
• Breath Sounds
• Vital Signs
• O2 Saturation

• Assess Respiratory System
• Assess Cardiovascular System

• Assess for Signs Symptoms of Anaphylaxis

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Epinephrine

• Generic Name
• Epinephrine
• Trade Name
• EpiPen
• EpiPen Jr.
• Also called
• Adrenalin

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EpinephrineActions

• Dilates Bronchioles
• Constricts Blood Vessels

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EpinephrineIndications

• Signs and Symptoms of Severe Allergic Reaction

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EpinephrineContraindications

• None

BUT MUST FOLLOW NYS PROTOCOLS!
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EpinephrineDosage

• Adult
• One Adult Auto-injector (0.3 mg)
• Infant and Child
• (
• One Infant/Child Auto-injector (0.15 mg)

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EpinephrineRoute

• Deep Intramuscular Injection
• Lateral thigh, midway between waist and knee

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Epinephrine Side Effects

• Increased pulse rate
• Pallor
• Dizziness
• Chest Pain

• Headache
• Nausea
• Vomiting
• Excitability
• Anxiety

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Epi auto-injectorProtocol

• Call ALS
• Administer Oxygen
• Assess Respiratory Status
• Assess Cardiac Status

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Epi auto-injectorProtocol

• If the patient has an epi auto-injector
  prescribed
• assist the patient in administering the
  auto-injector

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Epi auto-injectorProtocol

• If the patients epi auto-injector is not
  available or expired
• Administer the agencys epi auto-injector Per
  Protocol

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Epi auto-injectorProtocol

• If no epi auto-injector has been prescribed
• Begin transport
• Contact medical control for authorization to
  administer the agencys epi auto-injector

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Epi auto-injectorProtocol

• If unable to contact Medical Control, and patient
  is less than 35 years of age
• Administer agency supplied epi auto-injector per
  protocol
• Contact Medical Control ASAP

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What IsMedical Control?

• A REMO Physician
• If no REMO Physician is available, contact ED
  Physician at the Destination Hospital
• Document WHO you talked to

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Epi auto-injectorProtocol

• Medical Control MUST be contacted to administer a
  second auto-injector.
• Be prepared to perform CPR if patient
  deteriorates.
• Document history, vitals, and treatment on PCR.

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Epi auto-injectorProtocol

• Summary
• ALS must be called
• Contact Medical Control
• If Medical Control unavailable and patient is years old, administer epi auto-injector

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Epi auto-injector Administration

• Remove safety cap from auto-injector
• Hold auto-injector from center
• (Do Not place thumb over either end!)
• Place against patients thigh
• Lateral portion, midway between waist and knee

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Epi auto-injector Administration

• Push until auto-injector activates
• Hold until medication injected (10 seconds).
• Record Time
• Record Response

• Dispose of auto-injector in biohazard sharps
  container.

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Reassessment Strategy

• Monitor A-B-Cs
• Reassess Vitals
• Oxygen!
• Watch for changes in Patient Condition

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ReassessmentStrategy

• If the patient deteriorates...
• Oxygenate
• Contact Medical Control for order for second dose
• Prepare for resuscitation
• Oxygenate
• Treat for shock

Oxygenate
Did we mention Oxygenate?
36
Asthma

• Albuterol for
• BLS Providers

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Asthma

• A common but serious disease
• Affects more than 10 million Americans.
• Kills 4000 to 5000 Americans annually.

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Asthma

• Reversible smooth muscle spasm of the airway
  (bronchospasm) associated with hypersensitivity
  to various stimuli

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Bronchospasm Triggers

• Allergy
• Aspiration
• Exertion
• Infection
• Stress
• Temperature change
• Seasonal changes

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Asthma

• Signs and Symptoms
• Dyspnea
• Wheezing
• Tachypnea
• Tachycardia
• Cyanosis
• Cough

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Asthma

• Signs and Symptoms (cont.)
• Accessory muscle use
• Inability to speak in complete sentences
• Anxiety (hypoxia)
• Prolonged expiratory phase
• Tripod positioning

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Patient History

• O
• P
• Q
• R
• S
• T

• S
• A
• M
• P
• L
• E

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Patient History

• Confirm Asthma History
• All That Wheezes Is Not Asthma
• Hospital visits for asthma in past year?
• Any previous intubations due to asthma?

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Physical Exam

• Position found
• Pursed lip breathing
• Vital signs
• Ability to speak in complete sentences
• Accessory muscle use

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Physical Exam

• Lung Sounds
• Wheezing may or may not be present
• Wheezes may be audible with or without a
  stethoscope
• Decreased breath sounds (poor air movement)
• Patients self-assessment
• (0-10 scale)

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Albuterol

• Generic Name
• Albuterol
• Trade Names
• Proventil
• Ventolin

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AlbuterolActions

• Bronchodilation
• Duration of effect is up to five hours.

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AlbuterolIndications

• History of Asthma
• Respiratory Distress

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AlbuterolContraindications

• Known hypersensitivity to albuterol
• Respiratory Failure

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AlbuterolDosage
Single-dose solution of 2.5 mg in 3 ml of normal
saline for use in small volume nebulizer
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AlbuterolRoute
Nebulized Medication

• By Mouthpiece

By Mask
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AlbuterolSide Effects

• Nervousness
• Tremors
• Headache
• Tachycardia
• Palpitations

• Muscle cramps
• Weakness
• Dizziness
• Drowsiness
• Flushing
• Chest discomfort

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Asthma Severe Respiratory Distress

• Call for ALS
• Do Not delay transport to administer medication!
• Do Not wait for ALS
• Confirm No Signs of Imminent Respiratory Failure

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AlbuterolProtocol

• If patient is in respiratory failure, assist
  ventilations with BVM
• Determine if patient has self-administered any
  nebulized albuterol

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AlbuterolProtocol

• If patient is in respiratory failure, assist
  ventilations with BVM
• Determine if patient has self-administered any
  nebulized albuterol

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AlbuterolProtocol

• If agency is approved to carry albuterol, and
• Patient age is 1 to 65 Years old
• and
• Has previously been diagnosed with asthma

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AlbuterolProtocol

• Administer 2.5mg albuterol in 3cc normal saline
  (one unit dose) by nebulizer
• If respiratory distress continues, administer
  second dose albuterol
• Maximum of two doses may be given!

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AlbuterolProtocol

• If respiratory distress continues and ALS is not
  yet available
• Contact Medical Control for further orders

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Nebulized Albuterol
aerosol tubing
tee
nebulizing chamber
mouthpiece
medication
oxygen supply tubing
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Nebulized Albuterol
Pour Unit Dose into Nebulizing Chamber
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Nebulized Albuterol
Assemble nebulizer, hook to oxygen regulator, and
run between 6 and 10 L/min
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Nebulized Albuterol
Encourage the patient to breath deeply.
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Nebulized Albuterol
If the patient is too tired to hold the
mouthpiece, remove the facepiece from a
non-rebreather mask, and connect it firmly to the
top of the nebulizing chamber.
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Nebulized Albuterol

• Place the mask on the patient normally.
• Both children and some elderly may require a
  pediatric non-rebreather mask for the treatment

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Nebulized Albuterol
Try to avoid inhaling the excess aerosol mist
while assessing the patient.
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Reassessment Strategy

• Monitor A-B-Cs
• Position of Comfort
• Reassess Vitals
• Oxygen by NRB
• Watch for changes in Patient Condition

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Documentation

• Vital signs before and after meds are given.
• Current and Past medical histories
• Any changes in patient condition

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Words of Wisdom

• DONT FORGET
• A-B-CS
• Good BLS
• Call ALS
• Frequent Reassessment
• Detailed Documentation
• Medical Control

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Questions?