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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

  • 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

  • Indications

  • Contraindications

  • Dosage

  • Route

  • Side effects


General Pharmacology

  • Right Time

  • Right Patient

  • Right Drug

  • Right Dose

  • Right Route


Generic name

Original chemical name

Trade name

Brand name given by manufacturer

General Pharmacology


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

Epinephrine for

BLS Providers


An exaggerated immune response to an allergen

Sudden, rapid onset

Systemic involvement

Severe allergic reaction

Anaphylaxis


Common Causes of 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

A mild, local reaction caused by a bee sting


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 Reaction

  • Itching, skin flushing

  • Hives and/or swelling

    • (esp. face, extremities)


Severe Allergic Reaction

  • Increased Pulse

  • Decreased Blood Pressure

  • Nausea & Vomiting

  • Altered Mental Status

  • Allergen exposure with history of anaphylaxis


Patient History

  • Determine if the patient’s history includes:

    • Anaphylaxis

    • Severe allergic reactions

    • Recent exposure to a known or potential allergen


Focused Physical Assessment

  • Assess ABCs

  • Breath Sounds

  • Vital Signs

  • O2 Saturation

  • Assess Respiratory System

  • Assess Cardiovascular System

  • Assess for Signs & Symptoms of Anaphylaxis


Epinephrine

  • Generic Name

    • Epinephrine

  • Trade Name

    • EpiPen

    • EpiPen Jr.

    • Also called

    • Adrenalin


EpinephrineActions

  • Dilates Bronchioles

  • Constricts Blood Vessels


EpinephrineIndications

  • Signs and Symptoms of Severe Allergic Reaction


EpinephrineContraindications

  • None

BUT MUST FOLLOW

NYS PROTOCOLS!


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)


EpinephrineRoute

  • Deep Intramuscular Injection

  • Lateral thigh, midway between waist and knee


Increased pulse rate

Pallor

Dizziness

Chest Pain

EpinephrineSide Effects

  • Headache

  • Nausea

  • Vomiting

  • Excitability

  • Anxiety


Epi auto-injectorProtocol

  • Call ALS

  • Administer Oxygen

  • Assess Respiratory Status

  • Assess Cardiac Status


Epi auto-injectorProtocol

If the patient has an epi auto-injector prescribed:

  • assist the patient in administering the auto-injector


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-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-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 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-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.


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

  • 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 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

  • Monitor A-B-Cs

  • Reassess Vitals

  • Oxygen!

  • Watch for changes in Patient Condition


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

Albuterol for

BLS Providers


Asthma

  • A common but serious disease

    • Affects more than 10 million Americans.

    • Kills 4000 to 5000 Americans annually.


Asthma

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


Allergy

Aspiration

Exertion

Infection

Stress

Temperature change

Seasonal changes

Bronchospasm Triggers


Signs and Symptoms

Dyspnea

Wheezing

Tachypnea

Tachycardia

Cyanosis

Cough

Asthma


Signs and Symptoms (cont.)

Accessory muscle use

Inability to speak in complete sentences

Anxiety (hypoxia)

Prolonged expiratory phase

Tripod positioning

Asthma


O

P

Q

R

S

T

Patient History

  • S

  • A

  • M

  • P

  • L

  • E


Patient History

  • Confirm Asthma History

  • “All That Wheezes Is Not Asthma”

  • Hospital visits for asthma in past year?

  • Any previous intubations due to asthma?


Position found

Pursed lip breathing

Vital signs

Ability to speak in complete sentences

Accessory muscle use

Physical Exam


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)


Generic Name

Albuterol

Trade Names

Proventil

Ventolin

Albuterol


AlbuterolActions

  • Bronchodilation

  • Duration of effect is up to five hours.


History of Asthma

Respiratory Distress

AlbuterolIndications


Known hypersensitivity to albuterol

Respiratory Failure

AlbuterolContraindications


AlbuterolDosage

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


AlbuterolRoute

By Mouthpiece

Nebulized Medication

By Mask


AlbuterolSide Effects

  • Nervousness

  • Tremors

  • Headache

  • Tachycardia

  • Palpitations

  • Muscle cramps

  • Weakness

  • Dizziness

  • Drowsiness

  • Flushing

  • Chest discomfort


AsthmaSevere Respiratory Distress

  • Call for ALS

  • Do Notdelay transport to administer medication!

  • Do Not wait for ALS

  • Confirm No Signs of Imminent Respiratory Failure


AlbuterolProtocol

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

  • Determine if patient has self-administered any nebulized albuterol


AlbuterolProtocol

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

  • Determine if patient has self-administered any nebulized albuterol


AlbuterolProtocol

If agency is approved to carry albuterol, and:

  • Patient age is 1 to 65 Years old

    and

  • Has previously been diagnosed with asthma


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!


AlbuterolProtocol

If respiratory distress continues and ALS is not yet available:

  • Contact Medical Control for further orders


Nebulized Albuterol

aerosol tubing

“tee”

nebulizing chamber

mouthpiece

medication

oxygen supply tubing


Nebulized Albuterol

Pour Unit Dose into Nebulizing Chamber


Nebulized Albuterol

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


Nebulized Albuterol

Encourage the patient

to breath deeply.


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 Albuterol

  • Place the mask on the patient normally.

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


Nebulized Albuterol

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


Reassessment Strategy

  • Monitor A-B-Cs

  • Position of Comfort

  • Reassess Vitals

  • Oxygen by NRB

  • Watch for changes in Patient Condition


Documentation

  • Vital signs before and after meds are given.

  • Current and Past medical histories

  • Any changes in patient condition


Words of Wisdom

DON’T FORGET:

  • A-B-C’S

  • Good BLS

  • Call ALS

  • Frequent Reassessment

  • Detailed Documentation

  • Medical Control


Questions?


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