EMT Drugs Flashcards
Medication Names Prescribed Inhaler
- Generic: albuterol, isoetharine, metaproterenol
2. Trade: Proventil, Ventolin, Bronkosol, Bronkometer, Alupent, Metaprel
Indications Prescribed Inhaler
Meets all the following criteria:
- Patient exhibits signs and symptoms of respiratory emergency.
- Patient has physician-prescribed hand held inhaler.
- Medical direction gives specific authorization to use.
Contrandications Prescribed Inhaler
- Patient is unable to use the device(e.g.,notalert).
- Inhaler is not prescribed for the patient.
- No permission has been given by medical direction.
- The patient has already taken the maximum prescribed dose prior to the EMT’s arrival.
Medication Form Prescribed Inhaler
Handheld metered-dose inhaler
Dosage Prescribed Inhaler
Number of inhalations based on medical direction’s order or physician’s order.
Administration Prescribed Inhaler
- Obtain an order from medical direction, either on-line or off-line.
- Ensure the right patient, nighttime, right medication, right dose, right route, and patient is alert enough to use the inhaler.
- Check the expiration date of the inhaler.
- Check if the patient has already taken any doses.
- Ensure the inhaler is at room temperature or warmer.
- Shake the inhaler vigorously several times.
- Have the patient exhale deeply.
- Have the patient put her lips around the opening of the inhaler.
- Have the patient depress the hand held inhaler as she begins to inhale deeply.
- Instruct the patient to hold her breath for as long as she comfortably can so the medication can be absorbed.
- Put the oxygen back on the patient.
- Allow the patient to breathe a few times and repeat the second dose if so ordered by medical direction.
- If the patient has a spacer device for use with her inhaler (device for attachment between inhaler and patient to allow for more effective use of medication), it should be used.
Actions Prescribed Inhaler
Beta-agonist bronchodilator dilates bronchioles, reducing airway resistance.
Side Effects Prescribed Inhaler
- Increased pulse rate
- Tremors
- Nervousness
Reassessment Strategies Prescribed Inhaler
- Gather vital signs.
- Perform a focused reassessment of the chest and respiratory function.
- Observe for deterioration of the patient; if breathing becomes inadequate, provide artificial respirations.
Medication Names: Nitroglycerin
- Generic: nitroglycerin
2. Trade: NitrostatTM, Nitrolingual®
Indications Nitroglycerin
All the following conditions must be met:
- Patient complains of chest pain.
- Patient has a history of cardiac problems.
- Patient’s physician has prescribed nitroglycerin (NTG).
- Systolic blood pressure is greater than 90 to 100 systolic.
- Medical direction authorizes administration of the medication.
Contraindications Nitroglycerin
- Patient has hypotension, or a systolic blood pressure below 90 to 100
- Patient has a head injury
- Patient is and infant or child
- Patient has already taken the maximum prescribed dose.
- Patient has recently taken Viagra, Cialis, Levitra or another erectile dysfunction drug.
Medication Form Nitroglycerin
Tablet, sublingual (under the tongue) spray
Medication Dosage
One dose. Repeat in 5 minutes, if less than complete relief, if systolic blood pressure remains above 90 to 100, and if authorized by medical direction, up to a maximum of three doses. One dose .4 mg
Administration Nitroglycerin
- Perform a focused assessment for the cardiac patient.
- Take the patients blood pressure. (Systolic pressure must be above 90 to 100.)
- Contact medical direction, if no standing orders.
- Ensure the right patient, right time, right medication, right dose, and right route. Check the expiration date.
- Ensure the patient is alert.
- Question the patient on the last dose taken and effects. Ensure understanding of the route of administration.
- Ask the patient to lift his tongue, and place the tablet or spray dose under the tongue (while wearing gloves) or have the patient place the tablet or spray under the tongue.
- Have the patient keep his mouth closed with the tablet under the tongue (without swallowing) until dissolved and absorbed.
- Recheck the patient’s blood pressure within 2 minutes.
- Record the administration, route, and time.
- Reassess the patient.
Actions Nitroglycerin
- Relaxes blood vessels
2. Decreases the work of the heart
Side Effects Nitroglycerin
- Hypotension (lowers blood pressure)
- Headache
- Pulse Rate changes
Reassessment Strategies Nitroglycerin
- Monitor Blood Pressure
- Ask patient about effect on pain relief
- Seek medical direction before read ministering
- Record assessments.
Medication Name: Aspirin
- Generic: aspirin
2. Trade: many available
Indications: Aspirin
All of the following conditions must be met:
1. Patient complains of chest pain.
2. Patient is not allergic to aspirin.
3. Patient has no history of asthma.
4. Patient is not already taking any medications to
prevent clotting.
5. Patient has no other contraindications to aspirin.
6. Patient is able to swallow without endangering the
airway.
7. Medical direction authorizes administration of the
medication.
Contraindications: Aspirin
- Patient is unable to swallow without endangering the airway.
- Patient is allergic or sensitive to aspirin.
- Patient has a history of asthma (many people with asthma are allergic to aspirin).
- Patient has gastrointestinal ulcer or recent bleeding.
- Patient has a known bleeding disorder.
- Medical direction may decide if the benefit of giving aspirin to a patient who has one of the following conditions outweighs the risk:
a. Is already taking medication to prevent clotting
(including aspirin)
b. Pregnancy
c. Recent surgery
Medication Form: Aspirin
Tablet; many EMS systems use baby aspirin, usually supplied as 81 mg chewable tablets.
Administration: Aspirin
- Gather a history and perform a physical exam
appropriate for a cardiac patient. - Contact medical direction, if no standing orders.
- Ensure the right medication, right patient, right time, right dose, and right route. Check the expiration date.
- Ensure the patient is alert.
- Ask the patient to chew (if directed by protocol) and swallow tablets.
- Record the administration, route, and time.
- Perform reassessment.
Actions: Aspirin
- Prevents blood from clotting as quickly, leading to increased survival after myocardial infarction.
- When administered to cardiac patients, aspirin is not being used to relieve pain.
Side Effects: Aspirin
- Nausea
- Vomiting
- Heartburn
- If patient is allergic, bronchospasm and wheezing
- Bleeding
Reassessment Strategies
- Perform reassessment.
- Evaluate the patient for new onset of difficulty
breathing from bronchospasm. - Any bleeding resulting from the aspirin is very unlikely to occur before the patient arrives at a hospital.
- Record the assessments.
Medication Name: Oral Glucoses
- Generic: Glucose, oral
2. Trade: Glutose, Insta-glucose
Indications: Oral Glucose
Patients with altered mental status and a known history of diabetes mellitus
Contraindications: Oral Glucose
- Unconsciousness
- Known diabetic who has not taken insulin for days
- Unable to swallow
Medication Form: Oral Glucose
Gel, in toothpaste-type tubes
Dosage: Oral Glucose
One Tube 15 gm
Administration: Oral Glucose
- Ensure signs and symptoms of altered mental status
with a known history of diabetes. - Ensure patient is conscious.
- Administer glucose.
a. Place on tongue depressor between cheek and
gum, or
b. Have patient self-administer between cheek
and gum. - Perform reassessment.
Actions: Oral Glucose
Increases blood sugar
Side Effects: Oral Glucose
None when given properly. May be aspirated by the patient without a gag reflex.
Reassessment Strategies: Oral Glucose
If patient loses consciousness or seizes, remove tongue depressor from mouth.
Medication Name: Activated Charcoal
- Generic: activated charcoal
2. Trade: SuperChar, InstaChar, Actidose, Liqui-Char, and others
Indications: Activated Charcoal
Poisoning by mouth
Contraindications: Activated Charcoal
- Altered mental status
- Ingestion of acids or alkalis
- Inability to swallow
Medication Form: Activated Charcoal
- Premixed in water, frequently available in a plastic bottle containing 12.5 grams of activated charcoal
- Powder—should be avoided in the field
Administration: Activated Charcoal
- Consult medical direction.
- Shake container thoroughly.
- Since medication looks like mud, the patient may need to be persuaded to drink it. Providing a covered container and a straw will prevent the patient from seeing the medication and so may improve patient compliance.
- If the patient does not drink the medication right away, the charcoal will settle. Shake or stir it again before administering.
- Record the name, dose, route, and time of administration of the medication.
Actions: Activated Charcoal
- Activated charcoal adsorbs (binds) certain poisons and prevents them from being absorbed into the body.
- Not all brands of activated charcoal are the same. Some adsorb much more than others, so consult medical direction about the brand to use.
Actions: Activated Charcoal
- Activated charcoal adsorbs (binds) certain poisons and prevents them from being absorbed into the body.
- Not all brands of activated charcoal are the same. Some adsorb much more than others, so consult medical direction about the brand to use.
Side Effects: Activated Charcoal
- Some patients have black stools.
- Some patients may vomit, particularly those who have ingested poisons that cause nausea. If the patient vomits, repeat the dose once.
Reassessment Strategies: Activated Charcoal
- Be prepared for the patient to vomit or further deteriorate.
Medication Name: Oxygen
Oxygen U.S.P.
Indications: Oxygen
- Respiratory or cardiac arrest
- heart attacks and strokes
- Shock
- Blood loss
- Respiratory distress & lung diseases
- Head injuries, other serious injuries & more
Contrindications: Oxygen
-none in EMS setting
Medication Form: Oxygen
Gas
Dosage: Oxygen
Nasal Canula: 2-6 lpm O2 conc: 24-44%
Non-ReBreather: 12-15 lpm O2 conc: 80-90%
BVM: 15L/M O2 conc: nearly 100%
Administration: Oxygen
Preparing the Oxygen Delivery System
-Select the desired cylinder. Check for label “Oxygen U.S.P.”
-Place the cylinder in an upright position and stand to one side.
-Remove the plastic wrapper or cap protecting the
cylinder outlet.
-Keep the plastic washer (some set-ups).
-“Crack” the main valve for 1 second.
-Select the correct pressure regulator and flowmeter. Pin yoke is shown on the left, threaded outlet on the right.
-Place the cylinder valve gasket on the regulator
oxygen port.
-Make certain that the pressure regulator is
closed
-Align pins (left), or thread by hand (right).
-Tighten T-screw for pin yoke or . . . Tighten a threaded outlet with a nonferrous wrench.
-Attach tubing and delivery device.
Administering Oxygen
- Explain to the patient the need for oxygen.
- Open the main valve and adjust the flowmeter.
- Place an oxygen delivery device on the patient.
- Adjust the flowmeter.
- Secure the cylinder during transfer.
Discontinuing Oxygen:
- Remove the delivery device.
- Close the main valve.
- Remove the delivery tubing.
- Bleed the flowmeter.
Actions: Oxygen
increases the concentration of oxygen available for respiration
Side Effects: Oxygen
When administered with PPV:
- decreasing Cardiac Output
- Gastric Distention
- Hyperventilation
Effects rarely a problem in the field:
- oxygen toxicity or air sac collapse
- infant eye damage
- respiratory depression or respiratory arrest
vasoconstrictor - don’t give to a stroke pt unless Sat is below 94 then use NC - low flow
Reassessment Strategies: Oxygen
- monitor chest rise and fall
- monitor breathing rate, rhythm and quality
- monitor SpO2
Five Rights
- patient
- time
- med
- dose
- route
- documentation
- awake
- allergies
Epi-Pen
Need for EpiPen what has the pt come in contact with pt has respiratory distress / shock
Signs of anaphylaxis
- Moderate to severe dyspnea
- tightness in chest
- Generalized Hives
- Generalized flushed or pallor
- Swelling of face, lips, eyes, tongue, mouth, injection site
- tachycardia, hypotension, tachypnea, decrease O2 sat
- Feeling of impending doom
Determines need for Epi - Pen
Contact Medical control
-symptoms and vitals
HX of allergens What was the pt exposed to How exposed Signs & Symptoms Progression - how rapid Interventions
Provides high flow O2 with BVM
Secondary Assessment and Sample History
Vital Signs
Does pt have prescribed pen
Contact Medical Direction
Press against lateral thigh - hold several seconds
reassess & document
bring second dose if the pt has it
Adult Dose 0.3 mg
Pedi 0.15mg
discards in sharps / bihazard
Obtains Proper Dose Pen
What does epinephrine do:
vasoconstrictor
bronchodialator
Medication Name Epinephrine AutoInjector
Generic: epinehprine
Trade: Adrenalin
Delivery System: EpiPen (Jr) Twinject
Indications Epinephrine AutoInjector
- Pt exhibits sins of a sever allergic run including either respiratory distress or shock (hypo perfusion)
- medication is rx for the pt
- medical directions authorizes
Contraindications Epinephrine AutoInjector
None when used in life threatening situation
Dosage Epinephrine AutoInjector
Adult: 0.3mg
Infant / Child 0.15mg
Administration Epinephrine AutoInjector
- Obtain pt prescribed auto-inj.
- Ensure - for the pt
- medication is pt
- rx is not expired - Obtain medical directions
- Remove Safety Cap
- Grasp center
- Place against lateral thigh
- Push firmly until activates
- Hold in place (10sec)
- Record administration & time (lot & exp)
- Dispose Biohazard
Actions Epinephrine AutoInjector
Dilates to bronchioles
Constricts the blood vessels
Makes capillaries less permeable
Side Effects Epinephrine AutoInjector
Increased Heart Rate Pallor Dizziness Chest Pain Headache Nausea Vomiting Excitability, Anxiety
Reassessment Strategies Epinephrine AutoInjector
- Transport
- Continue Secondary assessment of airway, breathing circulatory status
If the pt condition worsens
obtain medical direction for second dose tx for shock
prepare for CPR / AED
if improves continue O2 tx for shock