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MEDICATIONS

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Develop a Basic Knowledge of medications used by BLS Providers ... For every medication you may administer, you must thoroughly understand the following: ... – PowerPoint PPT presentation

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Title: 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

4
General Pharmacology
  • Right Time
  • Right Patient
  • Right Drug
  • Right Dose
  • Right Route

5
General Pharmacology
  • Generic name
  • Original chemical name
  • Trade name
  • Brand name given by manufacturer

6
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

7
Anaphylaxis
  • Epinephrine for
  • BLS Providers

8
Anaphylaxis
  • An exaggerated immune response to an allergen
  • Sudden, rapid onset
  • Systemic involvement
  • Severe allergic reaction

9
Common Causes of Allergic Reactions
10
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

11
Mild Allergic Reactions
A mild, local reaction caused by a bee sting
12
Severe Allergic Reaction
  • A Clear History of Allergen Exposure AND Signs
    and Symptoms including
  • Shock (hypoperfusion)
  • Respiratory Distress
  • Wheezing, stridor, cough
  • Chest / throat tightness

13
Severe Allergic Reaction
  • Itching, skin flushing
  • Hives and/or swelling
  • (esp. face, extremities)

14
Severe Allergic Reaction
  • Increased Pulse
  • Decreased Blood Pressure
  • Nausea Vomiting
  • Altered Mental Status
  • Allergen exposure with history of anaphylaxis

15
Patient History
  • Determine if the patients history includes
  • Anaphylaxis
  • Severe allergic reactions
  • Recent exposure to a known or potential allergen

16
Focused Physical Assessment
  • Assess ABCs
  • Breath Sounds
  • Vital Signs
  • O2 Saturation
  • Assess Respiratory System
  • Assess Cardiovascular System
  • Assess for Signs Symptoms of Anaphylaxis

17
Epinephrine
  • Generic Name
  • Epinephrine
  • Trade Name
  • EpiPen
  • EpiPen Jr.
  • Also called
  • Adrenalin

18
EpinephrineActions
  • Dilates Bronchioles
  • Constricts Blood Vessels

19
EpinephrineIndications
  • Signs and Symptoms of Severe Allergic Reaction

20
EpinephrineContraindications
  • None

BUT MUST FOLLOW NYS PROTOCOLS!
21
EpinephrineDosage
  • Adult
  • One Adult Auto-injector (0.3 mg)
  • Infant and Child
  • (
  • One Infant/Child Auto-injector (0.15 mg)

22
EpinephrineRoute
  • Deep Intramuscular Injection
  • Lateral thigh, midway between waist and knee

23
Epinephrine Side Effects
  • Increased pulse rate
  • Pallor
  • Dizziness
  • Chest Pain
  • Headache
  • Nausea
  • Vomiting
  • Excitability
  • Anxiety

24
Epi auto-injectorProtocol
  • Call ALS
  • Administer Oxygen
  • Assess Respiratory Status
  • Assess Cardiac Status

25
Epi auto-injectorProtocol
  • If the patient has an epi auto-injector
    prescribed
  • assist the patient in administering the
    auto-injector

26
Epi auto-injectorProtocol
  • If the patients epi auto-injector is not
    available or expired
  • Administer the agencys epi auto-injector Per
    Protocol

27
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

28
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

29
What IsMedical Control?
  • A REMO Physician
  • If no REMO Physician is available, contact ED
    Physician at the Destination Hospital
  • Document WHO you talked to

30
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.

31
Epi auto-injectorProtocol
  • Summary
  • ALS must be called
  • Contact Medical Control
  • If Medical Control unavailable and patient is years old, administer epi auto-injector

32
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

33
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.

34
Reassessment Strategy
  • Monitor A-B-Cs
  • Reassess Vitals
  • Oxygen!
  • Watch for changes in Patient Condition

35
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

37
Asthma
  • A common but serious disease
  • Affects more than 10 million Americans.
  • Kills 4000 to 5000 Americans annually.

38
Asthma
  • Reversible smooth muscle spasm of the airway
    (bronchospasm) associated with hypersensitivity
    to various stimuli

39
Bronchospasm Triggers
  • Allergy
  • Aspiration
  • Exertion
  • Infection
  • Stress
  • Temperature change
  • Seasonal changes

40
Asthma
  • Signs and Symptoms
  • Dyspnea
  • Wheezing
  • Tachypnea
  • Tachycardia
  • Cyanosis
  • Cough

41
Asthma
  • Signs and Symptoms (cont.)
  • Accessory muscle use
  • Inability to speak in complete sentences
  • Anxiety (hypoxia)
  • Prolonged expiratory phase
  • Tripod positioning

42
Patient History
  • O
  • P
  • Q
  • R
  • S
  • T
  • S
  • A
  • M
  • P
  • L
  • E

43
Patient History
  • Confirm Asthma History
  • All That Wheezes Is Not Asthma
  • Hospital visits for asthma in past year?
  • Any previous intubations due to asthma?

44
Physical Exam
  • Position found
  • Pursed lip breathing
  • Vital signs
  • Ability to speak in complete sentences
  • Accessory muscle use

45
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)

46
Albuterol
  • Generic Name
  • Albuterol
  • Trade Names
  • Proventil
  • Ventolin

47
AlbuterolActions
  • Bronchodilation
  • Duration of effect is up to five hours.

48
AlbuterolIndications
  • History of Asthma
  • Respiratory Distress

49
AlbuterolContraindications
  • Known hypersensitivity to albuterol
  • Respiratory Failure

50
AlbuterolDosage
Single-dose solution of 2.5 mg in 3 ml of normal
saline for use in small volume nebulizer
51
AlbuterolRoute
Nebulized Medication
  • By Mouthpiece

By Mask
52
AlbuterolSide Effects
  • Nervousness
  • Tremors
  • Headache
  • Tachycardia
  • Palpitations
  • Muscle cramps
  • Weakness
  • Dizziness
  • Drowsiness
  • Flushing
  • Chest discomfort

53
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

54
AlbuterolProtocol
  • If patient is in respiratory failure, assist
    ventilations with BVM
  • Determine if patient has self-administered any
    nebulized albuterol

55
AlbuterolProtocol
  • If patient is in respiratory failure, assist
    ventilations with BVM
  • Determine if patient has self-administered any
    nebulized albuterol

56
AlbuterolProtocol
  • If agency is approved to carry albuterol, and
  • Patient age is 1 to 65 Years old
  • and
  • Has previously been diagnosed with asthma

57
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!

58
AlbuterolProtocol
  • If respiratory distress continues and ALS is not
    yet available
  • Contact Medical Control for further orders

59
Nebulized Albuterol
aerosol tubing
tee
nebulizing chamber
mouthpiece
medication
oxygen supply tubing
60
Nebulized Albuterol
Pour Unit Dose into Nebulizing Chamber
61
Nebulized Albuterol
Assemble nebulizer, hook to oxygen regulator, and
run between 6 and 10 L/min
62
Nebulized Albuterol
Encourage the patient to breath deeply.
63
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.
64
Nebulized Albuterol
  • Place the mask on the patient normally.
  • Both children and some elderly may require a
    pediatric non-rebreather mask for the treatment

65
Nebulized Albuterol
Try to avoid inhaling the excess aerosol mist
while assessing the patient.
66
Reassessment Strategy
  • Monitor A-B-Cs
  • Position of Comfort
  • Reassess Vitals
  • Oxygen by NRB
  • Watch for changes in Patient Condition

67
Documentation
  • Vital signs before and after meds are given.
  • Current and Past medical histories
  • Any changes in patient condition

68
Words of Wisdom
  • DONT FORGET
  • A-B-CS
  • Good BLS
  • Call ALS
  • Frequent Reassessment
  • Detailed Documentation
  • Medical Control

69
Questions?
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