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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



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



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