Objectives
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Objectives. Overview of General Pharmacology Develop a Basic Knowledge of medications used by BLS Providers Identify situations when each medication may be indicated. General Pharmacology. For every medication you may administer, you must thoroughly understand the following:. Actions

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Objectives

Objectives

  • Overview of General Pharmacology

  • Develop a Basic Knowledge of medications used by BLS Providers

  • Identify situations when each medication may be indicated


General pharmacology

General Pharmacology

  • For every medication you may administer, you must thoroughly understand the following:

  • Actions

  • Indications

  • Contraindications

  • Dosage

  • Route

  • Side effects


General pharmacology1

General Pharmacology

  • Right Time

  • Right Patient

  • Right Drug

  • Right Dose

  • Right Route


General pharmacology2

Generic name

Original chemical name

Trade name

Brand name given by manufacturer

General Pharmacology


General pharmacology3

General Pharmacology

Dosage Forms

  • Solutions

    • Liquid mixture of one or more substances

  • Nebulized Solution

    • Pressurized gas passed over a solution to create an aerosol mist, which is then inhaled


Anaphylaxis

Anaphylaxis

Epinephrine for

BLS Providers


Anaphylaxis1

An exaggerated immune response to an allergen

Sudden, rapid onset

Systemic involvement

Severe allergic reaction

Anaphylaxis


Common causes of allergic reactions

Common Causes of Allergic Reactions


Allergic reactions

Very Common

Range from mild and local to severe and systemic.

Mild reactions usually affect only one area of the body

Slow onset, and minor symptoms

Allergic Reactions


Mild allergic reactions

Mild Allergic Reactions

A mild, local reaction caused by a bee sting


Severe allergic reaction

A Clear History of Allergen Exposure AND Signs and Symptoms including:

Shock (hypoperfusion)

Respiratory Distress

Wheezing, stridor, cough

Chest / throat tightness

Severe Allergic Reaction


Severe allergic reaction1

Severe Allergic Reaction

  • Itching, skin flushing

  • Hives and/or swelling

    • (esp. face, extremities)


Severe allergic reaction2

Severe Allergic Reaction

  • Increased Pulse

  • Decreased Blood Pressure

  • Nausea & Vomiting

  • Altered Mental Status

  • Allergen exposure with history of anaphylaxis


Patient history

Patient History

  • Determine if the patient’s history includes:

    • Anaphylaxis

    • Severe allergic reactions

    • Recent exposure to a known or potential allergen


Focused physical assessment

Focused Physical Assessment

  • Assess ABCs

  • Breath Sounds

  • Vital Signs

  • O2 Saturation

  • Assess Respiratory System

  • Assess Cardiovascular System

  • Assess for Signs & Symptoms of Anaphylaxis


Epinephrine

Epinephrine

  • Generic Name

    • Epinephrine

  • Trade Name

    • EpiPen

    • EpiPen Jr.

    • Also called

    • Adrenalin


Epinephrine actions

EpinephrineActions

  • Dilates Bronchioles

  • Constricts Blood Vessels


Epinephrine indications

EpinephrineIndications

  • Signs and Symptoms of Severe Allergic Reaction


Epinephrine contraindications

EpinephrineContraindications

  • None

BUT MUST FOLLOW

NYS PROTOCOLS!


Epinephrine dosage

EpinephrineDosage

  • Adult

    • One Adult Auto-injector (0.3 mg)

  • Infant and Child

    (< 9 y/o or < 30 kg / 66 lbs.)

    • One Infant/Child Auto-injector (0.15 mg)


Epinephrine route

EpinephrineRoute

  • Deep Intramuscular Injection

  • Lateral thigh, midway between waist and knee


Epinephrine side effects

Increased pulse rate

Pallor

Dizziness

Chest Pain

EpinephrineSide Effects

  • Headache

  • Nausea

  • Vomiting

  • Excitability

  • Anxiety


Epi auto injector protocol

Epi auto-injectorProtocol

  • Call ALS

  • Administer Oxygen

  • Assess Respiratory Status

  • Assess Cardiac Status


Epi auto injector protocol1

Epi auto-injectorProtocol

If the patient has an epi auto-injector prescribed:

  • assist the patient in administering the auto-injector


Epi auto injector protocol2

Epi auto-injectorProtocol

  • If the patient’s epi auto-injector is not available or expired:

  • Administer the agency’s epi auto-injector Per Protocol


Epi auto injector protocol3

Epi auto-injectorProtocol

If no epi auto-injector has been prescribed:

  • Begin transport

  • Contact medical control for authorization to administer the agency’s epi auto-injector


Epi auto injector protocol4

Epi auto-injectorProtocol

If unable to contact Medical Control, and patient isless than 35 years of age:

  • Administer agency supplied epi auto-injector per protocol

  • Contact Medical Control ASAP


What is medical control

What IsMedical Control?

  • A REMO Physician

  • If no REMO Physician is available, contact ED Physician at the Destination Hospital

  • Document WHO you talked to


Epi auto injector protocol5

Epi auto-injectorProtocol

  • Medical Control MUST be contacted to administer a second auto-injector.

  • Be prepared to perform CPR if patient deteriorates.

  • Document history, vitals, and treatment on PCR.


Epi auto injector protocol6

Summary:

ALS must be called

Contact Medical Control

If Medical Control unavailable and patient is <35 years old, administer epi auto-injector

Epi auto-injectorProtocol


Epi auto injector administration

Epi auto-injector Administration

  • Remove safety cap from auto-injector

  • Hold auto-injector from center

    (DoNot place thumb over either end!)

  • Place against patient’s thigh

    • Lateral portion, midway between waist and knee


Epi auto injector administration1

Epi auto-injector Administration

  • Push until auto-injector activates

  • Hold until medication injected (10 seconds).

  • Record Time

  • Record Response

  • Dispose of auto-injector in biohazard “sharps” container.


Reassessment strategy

Reassessment Strategy

  • Monitor A-B-Cs

  • Reassess Vitals

  • Oxygen!

  • Watch for changes in Patient Condition


Reassessment strategy1

If the patient deteriorates...

Oxygenate

Contact Medical Control for order for second dose

Prepare for resuscitation

Oxygenate

Treat for shock

ReassessmentStrategy

Oxygenate

Did we mention Oxygenate?


Asthma

Asthma

Albuterol for

BLS Providers


Asthma1

Asthma

  • A common but serious disease

    • Affects more than 10 million Americans.

    • Kills 4000 to 5000 Americans annually.


Asthma2

Asthma

  • Reversible smooth muscle spasm of the airway (bronchospasm) associated with hypersensitivity to various stimuli


Bronchospasm triggers

Allergy

Aspiration

Exertion

Infection

Stress

Temperature change

Seasonal changes

Bronchospasm Triggers


Asthma3

Signs and Symptoms

Dyspnea

Wheezing

Tachypnea

Tachycardia

Cyanosis

Cough

Asthma


Asthma4

Signs and Symptoms (cont.)

Accessory muscle use

Inability to speak in complete sentences

Anxiety (hypoxia)

Prolonged expiratory phase

Tripod positioning

Asthma


Patient history1

O

P

Q

R

S

T

Patient History

  • S

  • A

  • M

  • P

  • L

  • E


Patient history2

Patient History

  • Confirm Asthma History

  • “All That Wheezes Is Not Asthma”

  • Hospital visits for asthma in past year?

  • Any previous intubations due to asthma?


Physical exam

Position found

Pursed lip breathing

Vital signs

Ability to speak in complete sentences

Accessory muscle use

Physical Exam


Physical exam1

Physical Exam

  • Lung Sounds

    • Wheezing may or may not be present

    • Wheezes may be audible with or without a stethoscope

    • Decreased breath sounds (poor air movement)

  • Patient’s self-assessment

  • (0-10 scale)


Albuterol

Generic Name

Albuterol

Trade Names

Proventil

Ventolin

Albuterol


Albuterol actions

AlbuterolActions

  • Bronchodilation

  • Duration of effect is up to five hours.


Albuterol indications

History of Asthma

Respiratory Distress

AlbuterolIndications


Albuterol contraindications

Known hypersensitivity to albuterol

Respiratory Failure

AlbuterolContraindications


Albuterol dosage

AlbuterolDosage

  • Single-dose solution of 2.5 mg in 3 ml of normal saline for use in small volume nebulizer


Albuterol route

AlbuterolRoute

By Mouthpiece

Nebulized Medication

By Mask


Albuterol side effects

AlbuterolSide Effects

  • Nervousness

  • Tremors

  • Headache

  • Tachycardia

  • Palpitations

  • Muscle cramps

  • Weakness

  • Dizziness

  • Drowsiness

  • Flushing

  • Chest discomfort


Asthma severe respiratory distress

AsthmaSevere Respiratory Distress

  • Call for ALS

  • Do Notdelay transport to administer medication!

  • Do Not wait for ALS

  • Confirm No Signs of Imminent Respiratory Failure


Albuterol protocol

AlbuterolProtocol

  • If patient is in respiratory failure, assist ventilations with BVM

  • Determine if patient has self-administered any nebulized albuterol


Albuterol protocol1

AlbuterolProtocol

  • If patient is in respiratory failure, assist ventilations with BVM

  • Determine if patient has self-administered any nebulized albuterol


Albuterol protocol2

AlbuterolProtocol

If agency is approved to carry albuterol, and:

  • Patient age is 1 to 65 Years old

    and

  • Has previously been diagnosed with asthma


Albuterol protocol3

AlbuterolProtocol

  • Administer 2.5mg albuterol in 3cc normal saline (one unit dose) by nebulizer

  • If respiratory distress continues, administer second dose albuterol

  • Maximum of two doses may be given!


Albuterol protocol4

AlbuterolProtocol

If respiratory distress continues and ALS is not yet available:

  • Contact Medical Control for further orders


Nebulized albuterol

Nebulized Albuterol

aerosol tubing

“tee”

nebulizing chamber

mouthpiece

medication

oxygen supply tubing


Nebulized albuterol1

Nebulized Albuterol

Pour Unit Dose into Nebulizing Chamber


Nebulized albuterol2

Nebulized Albuterol

Assemble nebulizer, hook to oxygen regulator, and run between 6 and 10 L/min


Nebulized albuterol3

Nebulized Albuterol

Encourage the patient

to breath deeply.


Nebulized albuterol4

Nebulized Albuterol

If the patient is too tired to hold the mouthpiece, remove the facepiece from a non-rebreather mask, and connect it firmly to the top of the nebulizing chamber.


Nebulized albuterol5

Nebulized Albuterol

  • Place the mask on the patient normally.

  • Both children and some elderly may require a pediatric non-rebreather mask for the treatment


Nebulized albuterol6

Nebulized Albuterol

Try to avoid inhaling the excess aerosol mist while assessing the patient.


Reassessment strategy2

Reassessment Strategy

  • Monitor A-B-Cs

  • Position of Comfort

  • Reassess Vitals

  • Oxygen by NRB

  • Watch for changes in Patient Condition


Documentation

Documentation

  • Vital signs before and after meds are given.

  • Current and Past medical histories

  • Any changes in patient condition


Words of wisdom

Words of Wisdom

DON’T FORGET:

  • A-B-C’S

  • Good BLS

  • Call ALS

  • Frequent Reassessment

  • Detailed Documentation

  • Medical Control


Objectives

Questions?


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