Seattle/King County EMT-B Class Topics 1 Pharmacology: Chapter 10 Respiratory Emergencies: Chapter 11 Cardiovascular Emergencies: Chapter 1 1 Pharmacology
1 General Pharmacology You will be responsible for administering certain drugs. You will be responsible for assisting patients to self-administer other drugs. Not understanding how medications work places you and the patient in danger. 1 Pharmacology Definitions Pharmacology The science of drugs, including their ingredients, preparation, uses and actions on the body Dose Amount of medication given Action Therapeutic effects expected on the body 1 Pharmacology Definitions, cont'd Indications Therapeutic uses for a particular drug Contraindications Conditions in which a medication should not be given Side effects Actions of a drug other than the desired ones
1 Medication Names Trade name Brand name given by manufacturer Generic name Original chemical name 1 Medication Types Prescription drugs Given by pharmacists according to doctor s order Over-the-counter (OTC) drugs Available without a prescription 1 Routes of Administration Intravenous (IV) injection Injected directly into the vein Oral Taken by mouth; enters body through digestive system Sublingual Placed under the tongue; absorbed by mucous membranes
1 Routes of Administration, cont'd Intramuscular (IM) injection Injection into the muscle Intraosseous (IO) Injection into the bone marrow Subcutaneous (SC) injection Injection into tissue between skin and muscle 1 Routes of Administration, cont'd Transcutaneous Medications absorbed through the skin Inhalation Medications inhaled into the lungs Per rectum (PR) Administration by rectum 1 Dosage Forms Tablets Materials mixed with medication and compressed under pressure Capsules Gelatin shells filled with powdered or liquid medication
1 Dosage Forms, continued Solutions Liquid mixture of one or more substances Suspensions Mixture of fine particles distributed throughout a liquid by shaking 1 Dosage Forms, continued Metered-dose inhaler (MDI) Miniature spray canister, used to direct medication through the mouth into the lungs Topical medications Lotions, creams, and ointments applied to skin 1 Dosage Forms, continued Transcutaneous medications Designed to be absorbed through the skin Gels Semi-liquid substances administered orally Gases for inhalation Oxygen
1 Oxygen Required by all cells of the body Administered as a gas for inhalation Ignites easily, requiring caution near sources of ignition 1 Activated Charcoal Suspension used to absorb ingested poisons Often combined with a laxative Administered orally as a suspension 1 Oral Glucose Glucose is used by cells for energy. Patients with low blood glucose are hypoglycemic. It is administered orally as a gel.
1 Aspirin Reduces pain Reduces fever Reduces inflammation Cardiac uses 1 Epinephrine Increases heart rate and blood pressure Eases breathing problems in asthma or allergic reactions 1 Administering Epinephrine 1. Sterilize skin.. Insert needle.. Inject medication. 4. Dispose of needle. We will cover King County's EPI PEN protocol in more detail at a later time.
1 Metered-Dose Inhaler Medication should be delivered as the patient is inhaling. Device may include spacer (atomizing chamber). 1 Nitroglycerin Increases blood flow by causing arteries to dilate May decrease blood pressure Available in tablet or spray 1 Steps to Administer Medications Obtain orders from medical control. Verify proper medication and prescription. Verify form, dose, and route of the medication. Check expiration date and condition of the medication.
1 Steps to Administer Medications Reassess vital signs, especially heart rate and blood pressure, at least every 5 minutes or as the patient s condition changes. Document, document, document 1 Patient Medications Clue you in to patient conditions Especially helpful when patient has altered mental status Include over-the-counter medications and dietary supplements Respiratory Emergencies
Respiratory System Anatomy and Function of the Lung Adequate Breathing Normal rate and depth Regular breathing pattern Good breath sounds on both sides of the chest Equal rise and fall of chest Pink, warm, dry skin
Inadequate Breathing Pulmonary vessels become obstructed. Alveoli are damaged. Air passages are obstructed. Blood flow to the lungs is obstructed. Pleural space is filled. Signs of Inadequate Breathing Slower than 1 breaths/min or faster than 0 breaths/min Unequal chest expansion Decreased breath sounds Muscle retractions Pale or cyanotic skin Cool, damp (clammy) skin Shallow or irregular respirations Pursed lips Nasal flaring Dyspnea Shortness of breath or difficulty breathing Patient may not be alert enough to complain of shortness of breath.
Upper or Lower Airway Infection Infectious diseases may affect all parts of the airway. The problem is some form of obstruction to the air flow or the exchange of gases. Acute Pulmonary Edema Fluid build-up in the lungs Signs and symptoms Dyspnea Frothy pink sputum History of chronic congestive heart failure Recurrence high COPD Chronic Obstructive Pulmonary Disease is the result of direct lung and airway damage from repeated infections or inhalation of toxic agents. Bronchitis and emphysema are two common types of COPD. Abnormal breath sounds may be present. Rhonchi and wheezes
Asthma Common, serious disease Acute spasm of the bronchioles. Wheezing may be audible without a stethoscope. Spontaneous Pneumothorax Accumulation of air in the pleural space Caused by trauma or some medical conditions Dyspnea and sharp chest pain on one side Absent or decreased breath sounds on one side Anaphylactic Reactions An allergen can trigger an asthma attack. Asthma and anaphylactic (allergic) reactions can be similar. Hay fever is a seasonal response to allergens.
Pleural Effusion Caused by irritation, infection, cancer, or trauma (bruised lung) Collection of fluid outside lung Causes dyspnea Eased if patient is sitting up Obstruction of the Airway Be prepared to treat quickly. Obstruction may result from the position of head, the tongue, aspiration of vomit, or a foreign body. Opening the airway with the head tilt-chin lift maneuver may solve the problem. Pulmonary Embolism A blood clot that breaks off and circulates through the venous system Signs and symptoms: Dyspnea Acute pleuritic pain Hemoptysis Cyanosis Tachypnea Hypoxia
Hyperventilation Over-breathing resulting in a decrease in the level of carbon dioxide Signs and symptoms: Anxiety Numbness A sense of dyspnea despite rapid breathing Dizziness Tingling in hands and feet Scene Size-up 1. Scene Size-up Is the patient coughing? If yes, wear a HEPA mask and be ready to put one on them as well. Initial Assessment 1. Scene Size-up. Initial Assessment Decide SICK/NOT SICK. Perform initial assessment. Place the patient on oxygen. If patient is in respiratory distress, ventilate. Check pulse.
Focused History/Physical Exam 1. Scene Size-up. Initial Assessment. Focused History/ Physical Exam O saturation Full set of vital signs Bilateral breath sounds Detailed Physical Exam 1. Scene Size-up. Initial Assessment. Focused History/ Physical Exam 4. Detailed Physical Exam Performed only once life threats are addressed. May not be able to do if busy treating airway or breathing problems. Ongoing Assessment 1. Scene Size-up. Initial Assessment. Focused History/ Physical Exam 4. Detailed Physical Exam 5. Ongoing Assessment Carefully watch patients for shortness of breath. Reassess vital signs. Ask patient if treatment has made a difference. Check for accessory muscle use.
COPD Patients COPD patients cannot handle pulmonary infections well Usually age 50 or older History of recurring lung problems Long-term smokers Tightness in chest/constant fatigue Signs and Symptoms Difficulty breathing Altered mental status Anxiety or restlessness Increased or decreased respirations Increased heart rate Irregular breathing Cyanosis Honestly, Don Signs and I've Symptoms, never cont'd smoked a day in Pale conjunctivae my life Abnormal breath sounds Difficulty speaking Use of accessory muscles Coughing Tripod position Barrel chest
Medications in MDI Trade names Proventil Ventolin Alupent Metaprel Brethine Generic names Albuterol Metaproterenol Terbutaline Prescribed Inhalers Actions Relax the muscles surrounding the bronchioles Enlarge the airways leading to easier passage of air Side effects Increased pulse rate Nervousness Muscle tremors Prior to Administration Read label carefully. Verify it has been prescribed by a physician for this patient. Consult medical control. Make sure the medication is indicated. Check for contraindications.
Contraindications for MDI Patient unable to help coordinate inhalation. Inhaler not prescribed for patient. No permission from medical control. Maximum dose prescribed has been taken. Reassessment Carefully watch for shortness of breath. 5 minutes after administration: Obtain vital signs again. Perform focused reassessment. Transport and continue to assess breathing. Upper or Lower Airway Infection Administer oxygen. Do not attempt to suction the airway or insert an oropharyngeal airway in a patient with suspected epiglottitis. Transport patient in position of comfort.
Acute Pulmonary Edema Administer 100% oxygen. Suction secretions. Transport in appropriate position (as opposed to position of comfort). For example, a 70-year-old male with a BP of 78/palp who claims he would feel better sitting up. Good or bad? COPD Assist with prescribed inhaler if patient has one. Transport promptly in position of comfort. Spontaneous Pneumothorax Administer oxygen. Transport in position of comfort. Monitor closely.
Asthma Obtain history. Assess vital signs. Assist with inhaler if patient has one. Administer oxygen. Transport promptly. Pleural Effusion Definitive treatment is performed in a hospital. Administer oxygen and support measures. Transport promptly. Obstruction of the Airway Clear airway. Administer oxygen. Transport promptly.
Pulmonary Embolism Administer oxygen. Place patient in comfortable position, usually sitting. Assist breathing as necessary. Keep airway clear. Transport promptly. Hyperventilation Complete initial assessment and history of the event. Assume underlying problems. DO NOT have patient breathe into a paper bag. Give oxygen. Reassure patient and transport. Cardiovascular Emergencies
Cardiovascular Emergencies Cardiovascular disease (CVD) claimed 91,108 lives in the US during 001.,551 per day Almost two people per minute! CVD accounts for 8.5% of all deaths. One of every.6 deaths Blood Flow Through the Heart Electrical System of the Heart
Coronary Arteries Blood Flow Atherosclerosis Materials build up inside blood vessels. This decreases or obstructs blood flow. Risk factors place a person at risk.
Coronary Artery Disease (CAD) Coronary artery disease involves decreased blood flow to the heart and the potential for ischemia. Chest pain results from ischemia. If blood flow is not restored, the tissue dies. Angina Pectoris Pain in chest that occurs when the heart does not receive enough oxygen Typically crushing or squeezing pain Rarely lasts longer than 15 minutes Can be difficult to differentiate from heart attack Heart Attack Acute myocardial infarction (AMI) Pain signals death of cells. Opening the coronary artery within the first hour can prevent damage. Immediate transport is essential.
Signs and Symptoms Sudden onset of weakness, nausea, sweating without obvious cause Chest pain/discomfort Often crushing or squeezing Does not change with each breath Pain in lower jaw, arms, back, abdomen, or neck Sudden arrhythmia with syncope Shortness of breath or dyspnea Pulmonary edema Sudden death Pain of Heart Attack May or may not be caused by exertion Does not resolve in a few minutes Can last from 0 minutes to several hours May not be relieved by rest or nitroglycerin Sudden Death 40% of AMI patients do not reach the hospital. Heart may be twitching. Ventricular fibrillation
Arrythmias Bradycardia (heart rate less than 60) Ventricular tachycardia Cardiogenic Shock Heart lacks power to force blood through the circulatory system. Onset may be immediate or not apparent for 4 hours after AMI. Congestive Heart Failure CHF occurs when ventricles are damaged. Heart tries to compensate. Increased heart rate Enlarged left ventricle Fluid backs up into lungs or body as heart fails to pump.
Scene Size-up 1. Scene Size-up General impression Is the patient responsive? Initial Assessment 1. Scene Size-up. Initial Assessment Decide SICK/NOT SICK. Chief complaint on responsive patients A chief complaint of chest discomfort, shortness of breath, or dizziness must be taken seriously. ABCs Get oxygen started Focused History/Physical Exam 1. Scene Size-up. Initial Assessment. Focused History/ Physical Exam SAMPLE OPQRST Medications are important! Medications often prescribed for CHF: Furosemide Digoxin Amiodarone
Focused History/Physical Exam 1. Scene Size-up. Initial Assessment. Focused History/ Physical Exam Cardiac and respiratory systems. Look for skin changes. Check lung sounds. Baseline vital signs: BOTH systolic and diastolic BP readings Detailed Physical Exam 1. Scene Size-up. Initial Assessment. Focused History/ Physical Exam 4. Detailed Physical Exam Perform if time allows. Do not gather information unless: Patient s condition is stable Everything else is done Ongoing Assessment 1. Scene Size-up. Initial Assessment. Focused History/ Physical Exam 4. Detailed Physical Exam 5. Ongoing Assessment Repeat initial assessment. Reassess vital signs every 5 minutes. Monitor closely. If cardiac arrest occurs, begin defibrillation or CPR immediately. Record interventions, instructions from medical control, patient s response.
Communication Relay history, vital signs, changes, medications, and treatments. Aspirin Administer according to local protocol. Prevents clots from becoming bigger Normal dosage is from 16 to 4 mg. Nitroglycerin Forms Pill, spray, skin patch Effects Relaxes blood vessel walls Dilates coronary arteries Reduces workload of heart
Nitroglycerin Contraindications Systolic blood pressure of less than 100 mm Hg Head injury Maximum dose taken in past hour Cialis, Lavetra, and Viagra (Erectile Dysfunction [ED] drugs) Assisting With Nitroglycerin Obtain order from medical direction. Take patient s blood pressure. Assisting With Nitroglycerin Check that you have right medication, patient, and delivery route. Check expiration date. Find out last dose taken and effects. Be prepared to lay the patient down.
Assisting With Nitroglycerin Administer tablet or spray under tongue. Have patient keep mouth closed until tablet dissolves or is absorbed. Assisting With Nitroglycerin Recheck blood pressure. Record each activity and time of application. Reevaluate and note response. May repeat dose in to 5 minutes. Heart Surgeries and Pacemakers Coronary artery bypass graft (CABG) Angioplasty Cardiac pacemaker
Implantable Cardiac Defibrillators Maintains a regular heart rhythm and rate Monitors heart rhythm and deliver shocks as needed. Do not place AED patches over pacemaker. Questions What questions do you have? To review this presentation, go to: http://www.emsonline.net/emtb