EMT Basic Pharmacology EMT 151 Spring 2006

Basic Pharmacology • Medications that the EMT Basic is allowed to administer by Oregon statute: • Epinephrine 1: 1, 000 • Activated charcoal • Oxygen • Aspirin • Glucose

Pharmacology • Medications that the EMT Basic is allowed to assist a patient with administration: • Nitroglycerin • Inhaler/Bronchodilator

Pharmacology Basic drug information • Chemical- 1, 2, 3 propanetriol trinitrate • Generic-nitroglycerin tablets • Trade-Nitrostat • Official – nitroglycerin tablets, U. S. P.

Pharmacology • Routes of medications: • PO (by mouth) • IV (intravenous) • IM (intramuscularly) • SQ (subcutaneous) • SL (sub-lingual) • IO (intraosseous) • Inhalation

Pharmacology • Forms • Solution • Topical • Tablet • Capsule • Suspension • Transdermal • Inhalation

Pharmacology • Indications • Contraindications • Dose • Route • Action • Side effects

Pharmacology • Nitroglycerin – suspected MI • Epinephrine - anaphylaxis • Oxygen – medical/trauma conditions • Activated Charcoal – poisoning/OD • Inhalers – asthma, emphysema • Glucose - hypoglycemia

Case #1 • You are dispatched to a report of a 52 y/o male c/o sudden onset chest pain while at rest. You arrive to find this anxious patient sitting on his couch. He is CAO PPTE, skin is pale and diaphoretic, B/P 152/94, HR 76, RR 30. • PMH: AMI in 1995; NIDDM, HTN. • Meds: NTG, Glucaphage,

Case #1, cont. • What is your DDX? • What is your immediate tx? • Which of his medications can you assist him in taking? • Any other concerns?

Patients Medication • Physician order • Read the Label CAREFULLY • • • Patients Name of Drug Medication Strength Number of Pills Route and Directions • Record this Information Clearly • Write carefully and neatly

Allergies To Medications • ALWAYS ASK “Are you allergic to any medications? ” • Remember this – Once you give a medication, it may be impossible to get it out of the patient. So it better not be one they are allergic to! Always ask BEFORE giving a drug.

5 “rights” of medication administration (or is it 6? ) • • • Right Right patient medication route dose date • Right to refuse

Now, reassess the pt. • • Mentation Airway patency Respiratory rate, quality Pulse rate, quality Skin color, temperature, condition B/P Change in patient complaint & s/s Side effects

Oxygen • Basic need by all cells • Inhaled, absorbed through lungs • Needs red blood cells to carry to body • Careful around flames • May reduce HYPOXIC drive in COPD • 2 -15 lpm via mask or n/c

Glucose • Basic need by all cells • Good at proper levels (80 -110) • Too High is bad • Too Low is bad • Not for those with compromised Gag • Not good in the lungs • Oral intake (25 grams) • Paste or in drink

Activated Charcoal • Binds chemicals to it • Don’t use in patients with compromised gag reflex • Good in stomach • Bad in lungs • Yucky Black Stuff • Challenge to get kids to drink it • 25 -100 grams in suspension

Nitroglycerine • Dilates Veins and coronary arteries • Causes hypotension and a headache (migraine like) • Don’t give if already hypotensive • Sublingual spray or tablets • Don’t shake the bottle (Boom!) • Just kidding, but don’t shake the bottle

Administ. Of NTG, cont. • Assess vitals • B/P >90 systolic • PMH – ulcers, GI bleed, Alcohol abuse • Meds – Viagra? • Have pt. Sit or lie down • Sl spray or tablet – just one spray • Wait 5 min. consider another spray • Wait 5 min. , consider another spray

Epinephrine • • • Constricts arteries Dilates Bronchioles Increases Heart Rate Increases Blood Pressure Use with caution Always useful in True Anaphylaxis • Sub-Q 0. 3 -0. 5 ml 1: 1000 dilution

So what is true anaphylaxis? • An Extreme Allergic Reaction • Symptoms of • Flushing, swelling of tongue, lips, extremities • Wheezing, SOB, Coughing, Hoarseness • Headache • Nausea, Vomiting, abdominal cramps • Sense of Impending Doom, decreased mentation

Ouch! • 22 g

Inhalers • Albuterol, Proventil, Terbutaline, etc. • Open up the airways • Inhaled by puffer or nebulizer • Similar effects to body as epi. • Safer than epi, multiple dosing with less side effects • Use of conserving devices common • Remember this “They have to be breathing well enough to get the meds into lungs!”

So, when do I administer an Inhaler? • Obvious respiratory distress • S/s • • Audible wheezing Wheezing on auscultation Previously used inhaler? What if it doesn’t work?

Aspirin – Special circumstances • Pathophysiology of acute myocardial infarction • Occurs when blood supply to the myocardium (heart muscle) is interrupted long enough that the muscle dies • Coronary artery disease (CAD), Angina pectoris, AMI

Pharmacology • Administration • AHA ACLS guidelines indicate that aspirin should be given immediately for the general treatment of chest pain suggestive of ischemia. • The action of ASA when given in AMI has shown to decrease mortality.

Aspirin – Actions • Inhibits platelet aggregation • Mild analgesic and antiinflammatory agent

Aspirin • Contraindications • Known allergy or ASA induced asthma • Hx of active bleeding disorder • Current ulcer or GI bleed • Taking ASA within last 24 hours • Check local protocol • Receiving anticoagulation therapy • Possibility of aortic dissection

Aspirin • Side effects • GI distress (cramping, heartburn, mild nausea) • May exacerbate bleeding disorders • GI bleeding – signs and symptoms • Low grade toxicity may cause; ringing in the ears, headache, dizziness, flushing, tachycardia

Aspirin • Precautions – use with caution in patients with renal failure or vitamin K deficiency • Dose/route – 162 -324 mg (2 -4) chewable baby aspirin • Quickest route vs swallowing

So, when do I give Aspirin? • Signs and symptoms – AMI • Pain/pressure - Angina vs. AMI • Silent AMI • Indicated in unstable angina and AMI • Chest pain not relieved by NTG or lasting more than 15 minutes

S/S AMI, cont. • • Diaphoresis (profuse sweating) Dyspnea (difficulty breathing) Nausea/vomiting Weakness Dizziness Palpitations Feeling of impending doom Denial

S/S, cont. • General appearance • Anxious • Frightened • In pain • Poor color (gray, pale, cyanosis)

Assessment • Vital signs • Respirations • Level of consciousness • Pulse • Blood pressure • Pulse oximetry

Tx • General approach to the patient • ABC’s • Oxygen therapy • Vital signs • Prepare for immediate transport • Nitroglycerin • Aspirin • Prepare for the worst! • Extra hands for CPR maybe?

Scenario 1 • 45 yo male, sitting in truck on side of road. Truck parked the wrong way on a small side street. Man is confused and tired looking. He repeatedly refuses any care. His speech is slurred and you notice nothing else remarkable about his appearance. When asked about where he is headed, he asks directions to Turner, over and over again. He cannot get his cigarette lighter to work and is frustrated. • What do you do?

Scenario 2 • You arrive at a home with an elderly woman who called you because she is having chest pain and is short of breath. She has no medication in the house and is otherwise very healthy. This has been going on for 30 minutes and is getting more uncomfortable. • What drugs may be useful for her?

Scenario 3 • Elderly man complaining of SOB. He has a history of COPD. All he wants is some oxygen and he will be fine. You give him some oxygen and he gets better. He assures you that if you leave the tank of oxygen, he will see his doctor tomorrow. • Do you see anything wrong with this?

Scenario 4 • Your neighbor has eaten some lima beans by mistake. She is allergic to them and is now having hives all over her. She is very uncomfortable and itches badly. She asks you to help her with her epinephrine shot. • Are you comfortable with helping her with the shot?

Scenario 5 • A child at a T-ball game becomes Short of Breath after running the bases during a home run hit. He is wheezing terribly and laboring to breath. He has a proventil puffer and wishes help to use it. Mother is anxious and hands you the puffer. • What is the next course of action?

Scenario 6 • Little Le. Roy has done it again. This time he has eaten all of Grandpa’s percocet tablets. Mom caught him doing it just minutes ago and called you. Mom has Poison Control on the phone as you arrive. • What is Poison Control going to want to know about the child? What do you suppose they will suggest doing?

Scenario 7 • Mr. Jones is feeling great. He is returning from a jog and has become SOB and has Chest Pain at 8/10 scale. He doesn’t understand this, he had a pre-marriage physical exam last month and at 84 years of age, he is “fit as a fiddle”. • What might you ask Mr. Jones before giving him any medication?