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Seattle/King County EMT-B Class Topics 1 Pharmacology: Chapter 10 2 Respiratory Emergencies: Chapter 11 3 Cardiovascular Emergencies: Chapter 12 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. 2. Insert needle. 3. 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 2 Respiratory Emergencies 2 Respiratory System 2 Anatomy and Function of the Lung 2 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 2 Inadequate Breathing • Pulmonary vessels become obstructed. • Alveoli are damaged. • Air passages are obstructed. • Blood flow to the lungs is obstructed. • Pleural space is filled. 2 Signs of Inadequate Breathing • Slower than 12 breaths/min or faster than 20 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 2 Dyspnea • Shortness of breath or difficulty breathing • Patient may not be alert enough to complain of shortness of breath. 2 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. 2 Acute Pulmonary Edema • Fluid build-up in the lungs • Signs and symptoms – Dyspnea – Frothy pink sputum • History of chronic congestive heart failure • Recurrence high 2 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 2 Asthma • Common, serious disease • Acute spasm of the bronchioles. • Wheezing may be audible without a stethoscope. 2 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 2 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. 2 Pleural Effusion • Caused by irritation, infection, cancer, or trauma (bruised lung) • Collection of fluid outside lung • Causes dyspnea • Eased if patient is sitting up 2 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. 2 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 2 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 2 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. 2 Initial Assessment 1. Scene Size-up 2. Initial Assessment • Decide SICK/NOT SICK. • Perform initial assessment. • Place the patient on oxygen. • If patient is in respiratory distress, ventilate. • Check pulse. 2 Focused History/Physical Exam 1. Scene Size-up 2. Initial Assessment 3. Focused History/ Physical Exam • O2 saturation • Full set of vital signs • Bilateral breath sounds 2 Detailed Physical Exam 1. Scene Size-up • Performed only once life threats are addressed. 2. Initial • May not be able to do if Assessment busy treating airway or breathing problems. 3. Focused History/ Physical Exam 4. Detailed Physical Exam 2 Ongoing Assessment 1. Scene Size-up • Carefully watch patients for shortness of breath. 2. Initial • Reassess vital signs. Assessment • Ask patient if treatment has made a difference. 3. Focused History/ Physical Exam • Check for accessory muscle use. 4. Detailed Physical Exam 5. Ongoing Assessment 2 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 2 Signs and Symptoms • • • • • • • Difficulty breathing Altered mental status Anxiety or restlessness Increased or decreased respirations Increased heart rate Irregular breathing Cyanosis 2 Honestly, Don… I've never smoked a day in my life… • Pale conjunctivae Signs and Symptoms, cont'd • Abnormal breath sounds • Difficulty speaking • Use of accessory muscles • Coughing • Tripod position • Barrel chest 2 Medications in MDI Trade names • Proventil • Ventolin • Alupent • Metaprel • Brethine Generic names • Albuterol • Metaproterenol • Terbutaline 2 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 2 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. 2 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. 2 Reassessment • Carefully watch for shortness of breath. • 5 minutes after administration: – Obtain vital signs again. – Perform focused reassessment. • Transport and continue to assess breathing. 2 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. 2 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? 2 COPD • Assist with prescribed inhaler if patient has one. • Transport promptly in position of comfort. 2 Spontaneous Pneumothorax • Administer oxygen. • Transport in position of comfort. • Monitor closely. 2 Asthma • • • • • Obtain history. Assess vital signs. Assist with inhaler if patient has one. Administer oxygen. Transport promptly. 2 Pleural Effusion • Definitive treatment is performed in a hospital. • Administer oxygen and support measures. • Transport promptly. 2 Obstruction of the Airway • Clear airway. • Administer oxygen. • Transport promptly. 2 Pulmonary Embolism • Administer oxygen. • Place patient in comfortable position, usually sitting. • Assist breathing as necessary. • Keep airway clear. • Transport promptly. 2 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. 3 Cardiovascular Emergencies 3 Cardiovascular Emergencies • Cardiovascular disease (CVD) claimed 931,108 lives in the US during 2001. – 2,551 per day – Almost two people per minute! • CVD accounts for 38.5% of all deaths. – One of every 2.6 deaths 3 Blood Flow Through the Heart 3 Electrical System of the Heart 3 Coronary Arteries 3 Blood Flow 3 Atherosclerosis • Materials build up inside blood vessels. • This decreases or obstructs blood flow. • Risk factors place a person at risk. 3 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. 3 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 3 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. 3 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 3 Pain of Heart Attack • May or may not be caused by exertion • Does not resolve in a few minutes • Can last from 30 minutes to several hours • May not be relieved by rest or nitroglycerin 3 Sudden Death • 40% of AMI patients do not reach the hospital. • Heart may be twitching. Ventricular fibrillation 3 Arrythmias Bradycardia (heart rate less than 60) Ventricular tachycardia 3 Cardiogenic Shock • Heart lacks power to force blood through the circulatory system. • Onset may be immediate or not apparent for 24 hours after AMI. 3 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. 3 Scene Size-up 1. Scene Size-up • General impression • Is the patient responsive? 3 Initial Assessment 1. Scene Size-up 2. 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 3 Focused History/Physical Exam 1. Scene Size-up • SAMPLE • OPQRST 2. Initial • Medications are Assessment important! 3. Focused History/ • Medications often Physical Exam prescribed for CHF: – Furosemide – Digoxin – Amiodarone 3 Focused History/Physical Exam 1. Scene Size-up • Cardiac and respiratory systems. 2. Initial • Look for skin changes. Assessment • Check lung sounds. 3. Focused History/ • Baseline vital signs: Physical Exam – BOTH systolic and diastolic BP readings 3 Detailed Physical Exam 1. Scene Size-up • Perform if time allows. • Do not gather information 2. Initial unless: Assessment – Patient’s condition is stable 3. Focused History/ Physical Exam – Everything else is done 4. Detailed Physical Exam 3 Ongoing Assessment 1. Scene Size-up • Repeat initial assessment. • Reassess vital signs every 2. Initial 5 minutes. Assessment • Monitor closely. 3. Focused History/ • If cardiac arrest occurs, Physical Exam begin defibrillation or CPR immediately. 4. Detailed Physical • Record interventions, Exam instructions from medical control, patient’s 5. Ongoing response. Assessment 3 Communication • Relay history, vital signs, changes, medications, and treatments. 3 Aspirin • Administer according to local protocol. • Prevents clots from becoming bigger • Normal dosage is from 162 to 324 mg. 3 Nitroglycerin Forms • Pill, spray, skin patch Effects • Relaxes blood vessel walls • Dilates coronary arteries • Reduces workload of heart 3 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) 3 Assisting With Nitroglycerin • Obtain order from medical direction. • Take patient’s blood pressure. 3 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. 3 Assisting With Nitroglycerin • Administer tablet or spray under tongue. • Have patient keep mouth closed until tablet dissolves or is absorbed. 3 Assisting With Nitroglycerin • • • • Recheck blood pressure. Record each activity and time of application. Reevaluate and note response. May repeat dose in 3 to 5 minutes. 3 Heart Surgeries and Pacemakers • Coronary artery bypass graft (CABG) • Angioplasty • Cardiac pacemaker 3 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