And the. Two types of orders:

Transcription

1 1 PHARMACOLOGY And the EMT-B 2 MEDICAL DIRECTION Must have Dr. s orders to administer any drug to a Pt Local medical director can override any state set protocols Two types of orders: On-line : verbal orders phone, radio, in person Off-line : written orders standing orders 3 ADMINISTRATION Difference between Administer and Assist-Administer Administer Know what you can do Assist administer pills, Metered Dose Inhalers, Epinephrine pens Administer Nebulizers 4 SOME DRUG CATEGORIES Analgesics - pain relief Antiarrhythmics - heart rhythm disorders Antihypertensives - reduce high BP Bronchodilators - relax smooth muscles Antihistamines - block histamine release 5 DRUG CHARACTERISTICS Name: Drug name - chemical name Generic name - simple form of drug name Trade name - Given by the manufacturer Official name - in official text (USP) Class Antiarrhythmic Calcium channel blocker Non_steroidal anti-inflammatory inflammatory drug 6 DRUG CHARCTERISTICS Indications - these are the ONLY reasons you can use the drug. These conditions must be present for use! Contraindications - These are conditions in which use of the drug would be harmful and is not approved. Side effects - Effects the drug often has that are not it s intended effects. 7 DRUG CHARACTERISTICS Form - how the drug is supplied powder pills

2 liquid gas gels suspensions others.. 8 DRUG CHARACTERISTICS Dose - how much we give Adult and Pedi Route of Administration Inhaled, PO, IV, IM, SL, SQ, ET, PR Actions - how the drug does what it does inside the body 9 MEDICATION LABELS 1 Get used to reading them You should read them a minimum of twice each time you administer a drug (preferably 3 times) 2 Albuterol 2.5 mg in 3 ml.9% Saline solution expires: 2/99 Epinephrine 1: mg expires: 9/98 10 CHECK The 5 R s! Pt? medication? dose? time? route of administration? 11 ADMINISTRATION of MEDS Difference between RULES and PROTOCOLS Drug administration follows PROTOCOLS - learn them and follow them 12 PROTOCOL: Obtain order from medical control in class/scenarios you have standing orders for state test you will be given orders (on-line) when in doubt, call medical control must describe what you want and why Repeat the order back, to verify accuracy 13 PROTOCOL: Select the proper drug read the label (out loud in class) and expiration date Explain to the Pt what you re going to do and why. Question the Pt about allergies (again) and prior use of the drug Check the medication for impurities,, floaties floaties,, leaks, discoloration 14 PROTOCOL:

3 Recheck the medication label and date Prepare the drug for administration explain to your Pt what you will do demonstrate on YOURSELF if you need to show the Pt what to do Recheck the label and date a third time Administer the drug DISPOSE OF EQUIPMENT!!!!!!!!!!!!! 15 Protocol Overview 1 Obtain order Repeat the order Select the drug - read label and date Explain to the Pt Question the Pt Check for impurities ReCheck label/date(2) 2 Prepare the Drug/Pt ReCheck the label/date(3) Administer the drug DISPOSE of the equipment 16 Our Box-of of-death 1 Activated Charcoal Syrup of Ipecac Aspirin (ASA) Oral Glucose Epinephrine auto-injector Nitrolycerin 2 Bronchodilators Metered Dose Inhalers Nebulizers 17 Activated Charcoal 18 ASA - Aspirin 19 Oral Glucose 20 Epi Auto-injector 21 Nitro 22 Bronchodilators 23 Activated Charcoal Med. Name: : Activated Charcoal, Super Char, InstaChar, Actidose, LiquiChar Indications: : Pts who have ingested poisons by mouth (within 2 hours) after contacting Poison Control Contraindications: : 1. Altered mental status 2. Swallowed acids or alkalis 3. Unable to swallow Medication form: : 12.5 g premixed in water (suspension)

4 Dosage: : 1 g/kg of body weight; usual adult dose is 25 to 50 g, infants and children is 12.5 to 25 g 24 Activated Charcoal Administration: : Consult Medical Direction; shake container,; encourage Pt to drink d through a straw; record time and response; if Pt vomits, notify Medical Control for repeat dose Actions: : Binds with poisons in the stomach and prevents their absorption n into the body Side Effects: : Blackening of the stools, possible vomiting Reassessment: : Check for abdominal pain or distress upon administration. Watch h for vomiting; position the Pt and prepare to suction. 25 Epinephrine Auto-Injector Medication Name: : Epinephrine, Adrenaline, EpiPen, EpiPen Jr Indications: : 1. S/S of anaphylaxis Contraindications: : None, when used in the life-threatening anaphylaxis Medication Form: : Liquid drug within an auto-injector Dosage: : Adult 0.3mg, Child/Infant 0.15mg single and double doses in auto-injectors 26 Epinephrine Auto-Injector Administration: : push uncapped tip of injector firmly against lateral aspect of the thigh until medication is delivered. Actions: : Mimics response of sympathetic nervous system: constricts blood d vessels to improve BP, relaxes smooth muscles to improve breathing, stimulates heartbeat, reverses swelling and hives Side effects: : Increased heart rate, pale skin, dizziness, chest pain, headache, he, nausea and vomiting, excitability, anxiousness Reassessment: : Albuterol Medication Name: : Albuterol, Proventil, Ventolin, Indications: : 1. Exhibits S/S of dyspnea with bronchoconstriction / wheezing Contraindications: : 1. Pt is not responsive enough to use. Precautions: Chest pain, HR > 150 Medication Form: MDI: Aerosolized powder in a metered dose inhaler Neb: liquid medication in nebulizer 28 Albuterol Dosage: MDI: Each depression is precise dose Neb: 2.5 mg/ml (1 unit dose) Administration: : 1. Shake MDI for 30 sec. 2. Administer while Pt inhales, encourage them to hold their breath / breathe deeply. Actions: : Beta agonist, relaxes bronchiole smooth muscles, dilates the lower l airway Side Effects: : tachycardia, tremors, shakiness, nervousness, dry mouth Reassessment:. 29 Nitroglycerin Medication Name: : Nitroglycerin, Nitrostat, Nitrobid, Nitrolingual spray Indications: 1. Pt exhibits S/S of chest pain. Contraindications: : 1. Baseline BP below 100mm Hg systolic. 2. Suspected head injury. 3. Pt is child or infant. 4. Three doses have already been taken. 5. Recent use of Viagra, Levitra, Cialis Medication Form: : Tablet or sublingual spray Dosage: : 1 tablet or spray SL; repeat q min as needed. Maximum of 3 doses. BP to remain > 100mm Hg 30 Nitroglycerin Administration: : 1. Assure Bp is greater than 100 systolic. 2. Assure Pt is alert; check expiration date; ask Pt when he took last dose. 3.place or spray medication under the tongue; keep k mouth closed. 4. Reassess BP in 2 minutes. Actions: : relaxes blood vessels, decreases workload of heart Side Effects: : Vessel dilation may cause headache, drop in BP, pulse rate changes Reassessment:.

5 31 Oral Glucose Medication Name: : Oral Glucose, Glutose, Insta glucose Indications: : 1. Altered mental status with, 2. History of diabetes controlled led by medication and 3. Ability to swallow. Contraindications: : Unconscious or unable to swallow Dosage: : Typical dose is one tube (15 g) Administration: : Oral (buccal( buccal) ) squeeze portion between cheek and gum Action: : Increases blood and brain sugar levels Side Effects: : Airway obstruction? Reassessment: Aspirin (ASA) Medication Name: Aspergum, Bayer Indications: : 1. Suspected Acute Myocardial Infarction / chest pain. Contraindication: : 1. ASA allergy or GI ulcer 2. Use caution with anemia or surgical trauma Medication Form: : Tablet (compresses powder) Dosage: : 325 mg PO chew and swallow Administration: : Confirm Pt has S/S of AMI. Assist Pt with placing tablet(s) in mouth. Instruct Pt to chew and swallow the medication. Reassess Pt. 33 Aspirin (ASA) Action: : 1. Inhibits clotting factors in blood stream; reduces clotting in vessels 2. Some pain relief Side Effects: : N/V, dizziness, rash, bruising, rapid pulse, pulmonary edema Reassess EMT-B B Medications a long awaited step... Prior to 1997, you had to go to school for at east a year (EMT-I) in order to administer any drug Lots of resistance was overcome to allow use of these life-saving drugs that means a lot of responsibility for us!