AAOS. Bob Elling, MPA, REMT-P Hudson Valley Community College Andrew Jackson University Colonie EMS Department Schenectady, NY

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1 AAOS Andrew N. Pollak, MD, FAAOS Series Editor Medical Director, Baltimore County Fire Department Associate Professor University of Maryland School of Medicine Baltimore, MD Bob Elling, MPA, REMT-P Hudson Valley Community College Andrew Jackson University Colonie EMS Department Schenectady, NY Kirsten M. Elling Hudson Valley Community College Colonie EMS Department Schenectady, NY JONES AND BARTLETT PUBLISHERS Siuibury, Massachusetts BOSTON TORONTO SINGAPORE

1 General Pharmacology and Medication Administration 2 2 Trauma 42 3 Pulmonary and Respiratory Emergencies 80 4 Cardiovascular Emergencies 116 5 Neurologic Emergencies 188 6 Endocrine Emergencies 220

2 1 General Pharmacology and Medication Administration 2 2 Trauma 42 3 Pulmonary and Respiratory Emergencies 80 4 Cardiovascular Emergencies Neurologic Emergencies Endocrine Emergencies Allergic and Anaphylactic Emergencies Renal and Urologic Emergencies Toxicology and Behavioral Emergencies Environmental Emergencies Obstetric Emergencies Neonatal Emergencies Pediatric Emergencies Geriatric Emergencies Rescue Awareness, Operations, and Terrorism Response 438 Appendix A: The Metric System and Drug Calculations 462 Appendix B: Rapid Sequence Intubation 471 Appendix C: Medication Review 473 Index 507

3 General Pharmacology and Medication Administration. 2 Historical Milestones and Standards for Drugs The Role of the Food and Drug Administration (FDA) 6 Additional Resources on Newly Approved Drugs 7 Drug Profile Drugs: Names, Sources, Classes, and References 8 Drug Sources and Classifications X Drug References 10 Drug: Physiology, Receptors, Actions, and Interactions 10 Pharmacology and the Nervous System II Drug Response on the Body 13 Drug Forms and Routes of Drug Administration 15 Special Considerations: the Very Old, the Very Young, and Pregnancy 16 Paramedic Responsibilities and Pharmacology 17 Medication Administration: Anatomy, Physiology, Equipment, and Techniques 18 Metabolism and Excretion 22 Obtaining Blood Samples 23 Enteral Medication Administration Techniques 23 Oral Medication Administration 23 Administering Medication via the Gastric Tube 23 Rectal Medication Administration Parenteral Medication Administration Techniques 25 Adding Medication to an IV Bag Administering Medication via the Intravenous Bolus Route 26 Administering an IV Drip "Piggyback" into an Already Running IV Line...26 Intraosseous Medication Administration 27 Subcutaneous Medication Administration 28 Intramuscular Medication Administration Percutaneous Medication Administration Techniques 30 Iniruiuvil Medication Administration 30 Suhluiiiual l)ru;j Administration 30 Buccal Druii Administration 32 Inhalation Medication Administration Techniques 33 Small-Volume Nehuli/er Medication Administration 33 Drugs: The Legal Issues and the "Drug Rights" 34 Patient Management Pharmaceutical Plan 35 Infection Control During Medication Administration 36 Developing Paramedic Pharmacology Best Practices 37 Prep Kit 38 Trauma 42 Pharmacologic Agents and Trauma 44 Burn Trauma Causes of Burns 44 Total Bod> Surface Area 46 Burn Thickness "* Case Stud> I: Rill-Thickness Burns..49 Management of Specific Types of Burn Injuries Fluid Resuscitation Head and Face Trauma Types of Head Trauma - ) " Case Stud\ II: Hpidural Hematoma. -54 Management of Head Trauma * Types of face Trauma Spinal, Thoracic, and Abdominal Trauma 58 The Spinal Cord Spinal Cord Injuries Case Study 111: Spinal Cord Injury w Classification. Location, and Effects of Spinal Cord Injuries Treatment of Spinal Cord Injury Spinal Cord Injury in Children Musculoskeletal Trauma Case Studv IV: Musculoskeletal Injury &> Age-Associated Changes to Bones When Traction Is Part of the Treatment Case Study Answers Medication Review Prep Kit * M JJ

3 Pulmonary and Respiratory Emergencies 80 Medications Often Prescribed to Manage Respiratory Conditions 82 Respiratory Conditions Confronted by Paramedics in the Field 82 Asthma: A Major Health

4 3 Pulmonary and Respiratory Emergencies 80 Medications Often Prescribed to Manage Respiratory Conditions 82 Respiratory Conditions Confronted by Paramedics in the Field 82 Asthma: A Major Health Problem Other Options for Management of Respiratory Conditions 86 Case Study I: Asthma Attack 87 Pulmonary Embolism 94 Signs and Symptoms of Pulmonary Embolism 94 Case Study II: Pulmonary Embolism.95 Pulmonary Edema 98 Signs and Symptoms of Pulmonary Edema 98 Congestive Heart Failure (CHF) 98 Case Study III: Acute Pulmonary Edema 100 Case Study Answers 105 Medication Review 108 Prep Kit Cardiovascular Emergencies 116 Acute Coronary Syndrome (ACS) 118 The Value of Aspirin in ACS 118 Case Study I: A Potential Candidate for Fibrinolysis 118 Why Is It Necessary to Get a Good History? 124 Other Acute Coronary Syndrome Issues. 125 The 12-Lead ECG 125 The Window of Opportunity 126 Patients with Symptomatic Arrhythmias and Cardiac Arrest 126 Case Study II: Ventricular Fibrillation/ Ventricular Tachycardia 127 Sudden Cardiac Arrest Risk Factors.133 Adjuncts to Assist in CPR 134 Teamwork: An Essential Resuscitation Skill 136 The Role of Code Team Members The Role of The Code Team Leader.137 Defibrillation or Compressions: Which Comes First? 138 Case Study III: Asystole/Pulseless Electrical Activity 139 Chest Compressions: Do Not Disturb! 143 Expansion of the Use of Intraosseous Access 143 Termination in the Field 143 Defibrillation and the Hypothermic Patient 143 Successful Implementation of Public Access Defibrillation 144 Case Study IV: Third-Degree Heart Block/Transcutaneous Pacing 144 Dangerously Slow Heart Rate 149 Nausea and Vomiting 150 Alpha and Beta Receptors 151 Pacemakers 152 Using a Pacer in the Field 154 Rapid Heart Rate: Too Much Coffee or a Life-Threat? 154 Case Study V: Atrial Fibrillation 157 Vagus Nerve Stimulation 160 Cardioversion Technique 161 Wolff-Parkinson-White (WPW) Syndrome 161 Acute Pulmonary Edema: Not Just a Cardiac Condition 162 Hypotension or Cardiogenic Shock 162 Case Study VI: Cardiogenic Shock/ Hypotension 163 Dopamine [Intropin] 166 Cardiogenic Shock 166 Cardiology: Hypertension (not eligible for fibrinolytic therapy) 167 Case Study VII: Hypertension 169 Case Study Answers 173 Medication Review 179 Prep Kit Neurologic Emergencies Suspected Stroke 190 Case Study I: Possible Stroke 191 ACE Inhibitors 195 Stroke Management 195 Blood Clots and Travel 195 Seizures 195 Case Study II: Status Epilepticus 198

5 Febrile Seizures 203 Neoplasms and Seizure 203 Other Neurologic Emergencies 203 Head Pain: Where Does It Hurt? 204 Medications Prescribed for Serious Headaches 204 Case Study III: Head Pain 2nh Nervous System Disorders 208 Case Study Answers 209 Medication Review 212 Prep Kit Endocrine Emergencies Overview to Endocrine Emergencies Conditions of the Thyroid Gland..222 Conditions of the Pituitary and Adrenal Glands 222 Conditions of the Pancreas 223 Diabetic Patients 223 Types of Diabetes Mellitus 223 Hyperglycemia and Hypoglycemia..224 Case Study I: Hypoglycemia 225 Using a Glucometer 230 Oral Glucose Administration 230 Physiology of Glucagon 232 Insulin 232 Insulin Pumps 23" 1 Type 2 Oral Hypoglycemic Agents..233 Examples of Oral Hypoglycemic Agents 233 Case Study Answers 234 Medication Review 236 P'epKit Allergic and Anaphylactic Emergencies 240 Mild and Severe Reactions 242 Pathophysiology of Allergic Reaction Adverse Reactions 243 Adverse Reaction to Cimetidine [Tagamet] 243 Treating Allergies 245 Case Study I: Severe Allergic Reaction... -., 246 TheEpiPen 252 Steps i,! I s;: ::'.;[; pilvn aiwl a I;.;-;.a! ReJioii.tl Protocol IV.imi! MleiL'ies 253 I..ite\ MleiL'ies m Health Care l'[,.sideis 253 Case Study Answers 254 Medication Review 255 Prep Kit Renal and Urologic Emergencies 258 Pathophysiology of Renal and Urologic Conditions 260 kidnev SUMU-S 260 ( '.isc Stu.h I Possible kulnev St,.,n-s ' 261 A uu" Renal I ailuu" 266 ('hioiik Renal (.iiimt- 267 Case Study Answers 268 Medication Review 269 Prep Kit Toxicology and Behavioral Emergencies Toxicology Accidental or Purposeful Poisoning bv Overdose " 177 Treatment of Overdose " 778 Poison by Ingestion and Injection "" Management of Poison by Ingestion and Injection " Case Study 1: Poison bv Injection.. - 7y Poison by Surface Absorption and Inhalation Management ot Poison bv Surface Absorption and Inhalation Other Medications Used in Poisoning Cases The Subject In-Custody Risk Assessment Scale (SICRAS) 286 Behavioral Emergencies 87 Case Study II: Patient Restraint. Case Study Answers Medication Review Prep Kit " i

6 O Environmental Emergencies.300 Environmental Conditions 302 Heat Illnesses 302 Case Study I: Heat Stroke 303 Heatstroke 307 Cold Illness 307 Hypothermia 307 Altitude Sickness 308 Drowning or Submersion 311 Diving Injuries 311 Case Study Answers 313 Medication Review 314 Prep Kit Obstetric Emergencies Delivery in the Field 320 Case Study I: Normal Childbirth 321 Assessment of the Patient 325 The FDA Pregnancy Labeling System 325 Medications to Treat Nausea and Vomiting 326 Drugs Used During Labor and Delivery 326 Teratogens 326 Fetal Alcohol Syndrome (FAS) 327 Drug-Induced Teratogenesis 327 Smoking During Pregnancy 327 Abnormal Deliveries 327 Breech Presentation 328 Prolapsed Umbilical Cord 328 Complications 328 Prenatal Care 328 Pregnancy and Hypertension 329 Case Study II: Eclampsia 330 Predisposition to Eclampsia or Preeclampsia 335 Trauma in Pregnancy 335 Case Study Answers 336 Medication Review 338 Prep Kit Neonatal Emergencies Resuscitation Age Groups 344 Case Study I: Prematurity and Hypothermia 344 Neonatal Resuscitation 351 Medication Administration in Neonatal Resuscitation 351 Intubation 351 Bradycardia: An Ominous Sign in Neonates 352 Hypothermia 352 Hypoglycemia 352 Other Conditions 352 Acidosis 352 Mothers Treated Acutely with Narcotics 352 Not Recommended for Children or the Fetus! 353 Case Study Answers 354 Medication Review 355 Prep Kit Pediatric Emergencies The Pediatric Patient 360 Pediatric Doses 360 Respiratory Emergencies 374 Bronchodilators 376 Case Study I: Respiratory Emergency 377 Beware When Suctioning a Child Toxicology Emergencies 381 Cardiovascular Emergencies 383 Arrhythmias 383 Medical Emergencies 383 Febrile Seizure 383 Trauma 384 Pain Management 384 Case Study II: Pain Management Burns 389 Case Study Answers 390 Medication Review 392 Prep Kit Geriatric Emergencies Drugs and the Geriatric Population 404 Geriatric Medication Concerns 404 Case Study I: A Syncopal Episode..405 Polypharmacy 408 Medication Non-Compliance 409

7 Dosing Errors Drug Sensitivity 4(l<) 4 " v Toxicology and the Geriatric Patient. 409 Case Study II: Sick with the Chill- -il" Management of Toxicology Emergencies 4' Digitalis Toxicity 4 ' " Falling A Serious Health Problem Other Concerns With Falling 41" Management of Specific Conditions Case Study III: Suspected Stroke,. 41 x Chronic Pain 422 Eye Medications 423 Sleep Aids 423 Temporal Arteritis 423 Case Study Answers 424 Medication Review 427 Prep Kit Rescue Awareness, Operations, and Terrorism Response 438 The Rescue Process 440 Crush Syndrome 440 Crush Syndrome Management 441 Case Study I: Crush Syndrome 442 Response to Terrorism 449 Nerve Agents 449 Antidotes for Nerve Agents 450 Case Study II: Organophosphate Exposure 45] Methyl Parathion 455 Anhydrous Ammonia 455 Case Study Answers 456 Medication Review 458 Prep Kit 461 Appendix A: The Metric System and Drug Calculations Introduction Wh ;. \u- WUL!,: aiu!\.. umc ( on'.c-rsi,.;; V-.c-ar> ' 464 Converting a Patient's Weight from Pounds to Kilograms 465 Calculating Medication Doses 465 Dose and Rate for a Medication Infusion 465 Questions 466 Answers 461 Appendix B: Rapid Sequence Intubation * Sample Procedure For Rapid Sequence Intubation Appendix C: Medication Review Index Photo Credits 473 L

Skills: Recall the incidence of seizures Recall the causes of seizures Describe types of seizures List signs and symptoms of seizure patients

Skills: Recall the incidence of seizures Recall the causes of seizures Describe types of seizures List signs and symptoms of seizure patients Medical 1 Resuscitation Describe the morbidity and mortality associated with sudden cardiac arrest List the chain of survival for sudden cardiac arrest as identified by the American Heart Association Discuss