Medical I Refresher Lecture

1. Medical I Refresher Lecture Aaron J. Katz, AEMT-P, CIC www.es26medic.net

2. Pharmacology • The study of drugs • Sources, characteristics and effects • Always refer to drugs as medications

3. EMTs can deliver some medications and can assist the patient in delivering some other medications

4. Meds EMTs can deliver • Oxygen • Oral Glucose • Activated Charcoal • Epinephrine injectors (“EpiPen”) • Aspirin

5. Meds that EMTs can assist • Prescribed inhalers • Nitroglycerin

6. Drug Names • Chemical • Generic • E.g. Ibuprofin, Nitroglycerin • Trade • E.g. Advil, Nitrostat

7. Important terms • Action • The therapeutic effect that a drug is expected to have on the body • Indications • Signs/Symptoms/Conditions for which a particular medication should be used • Contraindications • Signs/Symptoms/Conditions or patient for which a particular medication should NOT be used • Side effects • Any actions of a medication other thanthe desired ones

8. Drug Administration • Before administering any drug, know the “four rights” • Right patient • Right medication • Right dose • Right “route”

9. Medication Routes • Intravenous (“IV”) • Oral (“PO”) • Sublingual (“SL”) • Intramuscular (“IM”) • Intraosseous (“IO”) • Subcutaneous (“SC”) • Transcutaneous • Inhalation • Rectal (“PR”)

10. References • PDR • USP • Merck Manual • The Pill Book • Not an “official” guide, but a very good source • ePocrates

11. Survey of commonly used drugs

12. Anti-hypertensives

13. Diuretics • Lasix (Furosemide) • Bumex • Diazide • HCTZ • Hydrodiuril

14. Combination HTN, diuretics • Zestoretic • Prinzide • Vasaretic

15. Potassium supplements • K-Dur • K-Tab • Slo-K

16. Cholesterol Lowering • Lipitor • Mevacor • Lopid • Pravachol • Zocor • Crestor

17. Antianginals

18. Oral Anti-hyperglycemics

19. Injected Anti-hyperglycemics • Humulin • Humalog • Lente • Lantus • And many others

20. Anti-epilepsy • Dilantin • Phenobarbitol • Depakote • Tegratol • Nerontin

21. Some cardiac meds • Lanoxin • Digoxin • Coumadin • Warfarin • Many of the anti-hypertensives and anti-anginals are used for cardiac conditions

22. Assorted respiratory inhalers • Atrovent • Combivent/Duoneb • Alupent • Proventil, Ventolin (Albuterol) • Intal • Serevant • Beclovent • Advair • Azmacort • Aerobid

23. Respiratory Emergencies

24. Review of airway anatomy • Nose/Mouth • Oropharynx/Nasopharynx • Epiglottis • Trachea • Cricoid cartilage • Larynx/vocal cords

25. Review of airway anatomy-2 • Bronchi • Bronchioles • Lungs • Alveoli • Diaphragm

32. Physiology • Inspiration • Expiration

33. Signs of normal breathing • Normal rate & depth • Regular pattern of inhaling/exhaling • “Good” breath sounds bilaterally • Regular rise and fall of the chest – bilaterally • “Some” movement of the abdomen

34. Signs of abnormal breathing • RR<8 or RR>24 • Excessive respiratory muscle usage • Pale or cyanotic skin • Cool, diaphoretic (“clammy”) skin • Shallow or irregular respiration • Pursed lips

35. Signs of abnormal breathing • Pursed lips • Nasal flaring • Tripod positioning • Tachycardia • Altered mental status (“AMS”) • Agitated  sleepy • Look for the yawn!

36. Some terms • Dyspnea • Difficulty breathing • Shortness of breath (SOB) • Apnea • No breathing • Hypoxia • Not enough oxygen

37. What causes us to breath • Normal individuals • Excessive CO2 levels in arterial blood • COPD patients • Low levels of O2 in arterial blood • COPD • Chronic Obstructive Pulmonary Disease • Emphysema • Chronic bronchitis

38. Causes of dyspnea • Obstructed lower airways • Due to fluid, infection, collapsed alveoli • Damaged alveoli • Damaged cilia in lower airways • Spasms, mucus plugs, floppy airways • Obstructed blood flow to lungs • Pleural space filled with air or fluid

39. Common respiratory disorders causing dyspnea • Airway infections • Acute Pulmonary Edema (“APE”) • COPD • Spontaneous pneumothorax • Asthma, allergies, anaphylaxis • Pleural effusion • Prolonged seizures • FBAO • Pulmonary embolism • Hyperventilation syndrome • Severe pain

40. Infections • Colds/flu • Bronchitis • Bronchiolitis • Pneumonia • Croup • Epiglottitis •  History will often “tell the story”

41. Acute pulmonary edema • Not really a respiratory problem • A cardiac problem • Congestive Heart Failure (“CHF”) • TBD with cardiac emergencies • Severe dyspnea • Pink frothy, blood-tinged sputum

43. COPD • Almost always caused by • Long-term smoking • Long term inhalation of “bad things” • Chronic bronchitis • Emphysema

46. Chronic bronchitis • Damaged respiratory pathway cilia • Excessive mucus production • Can’t “cough out” effectively • Very frequent bronchitis/pneumonia

47. Emphysema • Loss of alveolar elasticity and shape • Air pockets • Can not expel CO2

48. COPD • Most have elements of both diseases • Prolonged expiratory phase • Most common lung sound • Expiratory wheeze • Minor respiratory problemd exacerbates COPD • Patient is usually old

49. COPD • Altered mental state over time • Due to CO2 retention • Barrel shaped chest • Well developed respiratory muscles • Long term COPD may cause heart failure

50. Spontaneous pneumothorax • Collapsed portion of lung due to weakness in lung tissue • No apparent cause • Sudden SOB • Pleuritic chest pain • Common in asthmatic/COPD • Common in tall thin men