Treatmentstuff Flashcards
Indications for epinephrine
Signs & symptoms of known or suspected anaphylaxis (credible allergic exposure with itching, urticaria, agitation, abdominal pain, or distress etc.) with any of the following:
• Airway swelling or compromise
• Respiratory distress or arrest
• Shock
Contraindications for epinephrine
No absolute contraindication when used in life threatening anaphylaxis.
Medication is discolored, cloudy, precipitated, or expired.
Use cautiously (relative contraindication) in the setting of coronary disease or ischemia when jeopardy to airway, breathing, or circulation is unclear
Adverse effects of epinephrine
Anxiety
• Headache
• Nausea
• Hypertension
• Nervousness • Tremors
• Chest pain
• Cardiac arrhythmias
• Vomiting
Administration of epinephrine
Administer the auto-injector to the lateral thigh according to the manufacturer’s recommendations. (3 seconds)
• Assure the receiving hospital is notified.
• Properly dispose of auto-injector in a sharps container
Dose for epinephrine
0.15 mg to children younger than 4
0.3 mg to all other patients
Indications of aspirin
Patient experiencing atraumatic chest pain. (non trauma injury)
Contraindications for aspirin
• Known hypersensitivity or allergy to ASA
• 325mg ASA taken in the past 24 hours
• Bleeding or active bleeding disorder
• Pregnancy
• Suspicion of thoracic or AAA
• is expired
Adverse effects of aspirin
Anaphylaxis
• Nausea
• Bleeding
• Angioedema,
• Vomiting
• Stomach irritation
Administration of aspirin
Administer non-enteric coated tablets/powder to a cumulative dose of 324mg (using 81 or 162 mg tablets) or 325 mg (using regular adult tablets)
• Have the patient thoroughly chew then swallow the ASA tablets), even it the tablet is not
“chewable” ASA. A small sip of water may be given if the patient can’t chew well (e.g., dentures are not in)
* Minimize interrupting mask oxygen
What age for asprin
19 or older
Contraindications for nitro
• 3 doses of NTG within a 15-minute period prior to or during this episode
• Systolic BP <100
Recent head injury
• Phosphodiesterase (PDE) inhibitor (erectile dysfunction drugs süch as viagra® & cialis®)
use within 72 hours
• NTG is expired
Adverse effects of nitro
Headache
Cardiovascular collapse
• Lightheadedness
• Bradycardia
• Flushing
• Hypotension
• Methemoglobinemia
Administration of nitro
Assist with one tablet or spray under the tongue
• Reassess chest discomfort using 1-10 pain soale & Vital signs after 1-2 minutes
• Repeat one dose of NTG every 5 minutes until a maximum of three has been administered for any one episode
• Contact medical control if appropriate
Age for nitro
18 or older
Indications for naloxone (narcan)
Patients with respiratory depression or arrest secondary to known or suspected opiate overdose (as evidenced by pinpoint pupils, depressed mental status, elc..
Contraindications for naloxone
Hypersensitivity or allergy to naloxone (Narcan ®), nalmefene, or naltrexone
* Medication is discolored, cloudy, precipitated, or expired
* Use cautiously with cardiac disease, supraventricular arrhythmia, head trauma, brain tumor, or poly-substance overdose
Adverse effects of naloxone
• Agitation/Combative
• Nausea
Vomiting
Diarrhea
• Tremulousness
• Diaphoresis
Tachycardia Seizures
Dyspnea
• Abdominal cramps
• Increased Blood Pressure • Cardiac Arrest/Ventricular Fibrillation
Pulmonary Edema
Indications for metered dose inhaler/ nebulizer
Dyspnea & signs of respiratory distress associated with bronchospasm (breath sounds diminished or wheezing, retractions, etc.) a
• Alert patient physically able to use inhaler or nebulizer.
Contraindications for metered dose inhaler / nebulizer
Medication is expired:
• Known hypersensitivity or allergy to the medication.
• Inability of the patient to physically assist in using the device.
• Maximum prescribed dose has been met or exceeded prior to EMS arrival
SVN and/or HFN
Solution is discolored, cloudy, or precipitated
Adverse effects for metered dose inhaler / nebulizer
Hyperglycemia
• Anxiety
• Vomiting
• Hypertension
• Headache
• Throat irritation
• Hypokalemia
• Tremors
• Dry mouth
• Dyspepsia
• Palpitations
• Nausea
• Epitaxis (nose bleed)
• Insomnia
• Sinus tach
• Paradoxical bronchospasm
Age for CPAP
18 or older
Indications for cpap
Dyspnea & signs of respiratory distress associated with pulmonary edema (breath sounds diminished, wheezing, or significant rales, retractions; etc.)
• Continuation of CPAP therapy in progress prior to
EMS arrival or initiated by ALS.
Contraindications for cpap
Respiratory failure or apnea
• Hypotension (SBP < 100 mm Hg)
• Pneumothorax
• Facial, laryngeal, or pulmonary trauma
• Tracheosophageal fistula
• Recent tracheal, esophageal, or gastric surgery
• Active or anticipated vomiting or upper GI bleeding
• Failure to tolerate or completely seal CPAP mask
Adverse effects for cpap
Claustrophobia
• Epitaxis
• Chest discomfort
• Excessive cooling • Nausea
• Sinus discomfort
• Difficulty exhaling • Cardiac arrhythmia
• Pneumothorax
• Pneumomediastinum
• Edema
• Aerophagia
• Subcutaneous emphysema
Administration for MDI
Obtain & use spacer, if available
• Determine number of puffs that make one dose per physician order
• Coach the patient to exhale, depress canister while inhaling, hold breath as long as comfortable, then exhale slowly through pursed lips or nose
• Separate puffs within one dose with 30-60 seconds of oxygen
• May repeat one full dose once if indications remain after 5 minute reassessment unless the repeat dose would exceed the maximum prescribed dose
Administration of svn or hfn (nebulizer )
Select mouthpiece or mask delivery
• Assemble & supply O2 to SVN or HFN according to manufacturer’s specifications
• Coach patient to slowly & deeply inhale the mist, hold breath as long as comfortable & then exhale slowly
• Tap nebulizer as necessary to encourage solution to accumulate & settle into cup/bowl & sustain mist delivery
• Replace the original oxygen device after fog concludes
• May repeat once if indications remain after 5 minute reassessment unless the repeat dose would exceed the maximum prescribed dose
Administration of cpap
Limit CAP to no more than 10 cm H20 unless directed by medical control or patient prescription
• Brief patient on what to expect & how to cooperate when CAP mask is applied
• Assemble & supply O2 to CPAP device according to manufacturer’s specifications
• Assure a snug fit of CPAP mask & adequate Oz supply
• Reassess for tolerance of therapy, gastric distention, respiratory fatigue or failure, hypotension, &, if available, SpOz desaturation
• Be prepared to abandon CPAP & provide original O2 therapy or assisted ventilation
• If possible, notify receiving facility prior to arrival that patient is receiving CPAP
