Download General Pharmacology

Objectives
• Overview of General
Pharmacology
• Develop a Basic Knowledge of
medications used by BLS
Providers
• Identify situations when each
medication may be indicated
1
General
Pharmacology
• For every medication you may
administer, you must thoroughly
understand the following:
•Actions
•Dosage
•Indications
•Route
•Contraindications •Side effects
2
General
Pharmacology
•
•
•
•
•
Right
Right
Right
Right
Right
Time
Patient
Drug
Dose
Route
3
General
Pharmacology
• Generic name
– Original chemical name
• Trade name
– Brand name given by manufacturer
4
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
5
Anaphylaxis
Epinephrine for
BLS Providers
6
Anaphylaxis
• An exaggerated
immune response to an
allergen
• Sudden, rapid onset
• Systemic involvement
• Severe allergic
reaction
7
Common Causes of
Allergic Reactions
8
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
9
Mild Allergic
Reactions
A mild, local
reaction
caused by a
bee sting
10
Severe Allergic
Reaction
• A Clear History of Allergen
Exposure AND Signs and
Symptoms including:
–
–
–
–
Shock (hypoperfusion)
Respiratory Distress
Wheezing, stridor, cough
Chest / throat tightness
11
Severe Allergic
Reaction
• Itching, skin
flushing
• Hives and/or
swelling
–(esp. face,
extremities)
12
Severe Allergic
Reaction
•
•
•
•
•
Increased Pulse
Decreased Blood Pressure
Nausea & Vomiting
Altered Mental Status
Allergen exposure with
history of anaphylaxis
13
Patient History
• Determine if the patient’s
history includes:
– Anaphylaxis
– Severe allergic reactions
– Recent exposure to a known
or potential allergen
14
Focused
Physical Assessment
• Assess ABCs • Assess Respiratory
System
• Breath Sounds
• Assess
• Vital Signs
Cardiovascular
• O2 Saturation
System
•Assess for Signs & Symptoms
of Anaphylaxis
15
Epinephrine
• Generic Name
–Epinephrine
• Trade Name
–EpiPen
–EpiPen Jr.
•Also called
– Adrenalin
16
Epinephrine
Actions
• Dilates Bronchioles
• Constricts Blood Vessels
17
Epinephrine
Indications
• Signs and Symptoms of
Severe Allergic Reaction
18
Epinephrine
Contraindications
•
None
BUT MUST FOLLOW
NYS PROTOCOLS!
19
Epinephrine
Dosage
• 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)
20
Epinephrine
Route
• Deep Intramuscular
Injection
• Lateral thigh, midway
between waist and knee
21
Epinephrine
Side Effects
– Increased
pulse rate
– Pallor
– Dizziness
– Chest Pain
–Headache
–Nausea
–Vomiting
–Excitability
–Anxiety
22
Epi auto-injector
Protocol
• Call ALS
• Administer Oxygen
• Assess Respiratory
Status
• Assess Cardiac Status
23
Epi auto-injector
Protocol
If the patient has an epi
auto-injector prescribed:
• assist the patient in
administering the autoinjector
24
Epi auto-injector
Protocol
• If the patient’s epi autoinjector is not available or
expired:
• Administer the agency’s
epi auto-injector Per
Protocol
25
Epi auto-injector
Protocol
If no epi auto-injector has
been prescribed:
• Begin transport
• Contact medical control
for authorization to
administer the agency’s
epi auto-injector
26
Epi auto-injector
Protocol
If unable to contact Medical
Control, and patient is less
than 35 years of age:
• Administer agency supplied
epi auto-injector per
protocol
• Contact Medical Control
ASAP
27
What Is
Medical Control?
1. A REMO Physician
2. If no REMO Physician is
available, contact ED
Physician at the
Destination Hospital
3. Document WHO you
talked to
28
Epi auto-injector
Protocol
• 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.
29
Epi auto-injector
Protocol
Summary:
• ALS must be called
• Contact Medical Control
• If Medical Control
unavailable and patient is
<35 years old, administer
epi auto-injector
30
Epi auto-injector
Administration
• Remove safety cap from autoinjector
• Hold auto-injector from center
(Do Not place thumb over either
end!)
• Place against patient’s thigh
– Lateral portion, midway between
waist and knee
31
Epi auto-injector
Administration
• Push until autoinjector activates
• Hold until
medication
injected (10
seconds).
• Record Time
• Record Response
•Dispose of auto-injector in biohazard
“sharps” container.
32
Reassessment
Strategy
•
•
•
•
Monitor A-B-Cs
Reassess Vitals
Oxygen!
Watch for changes in
Patient Condition
33
Reassessment
Strategy
If the patient deteriorates...
• Oxygenate
• Contact Medical Control for
order for second dose
• Prepare for resuscitation
• Oxygenate
• Treat for shock
Oxygenate
Did we mention Oxygenate?
34
Asthma
Albuterol for
BLS Providers
35
Asthma
• A common but serious disease
– Affects more than 10 million
Americans.
– Kills 4000 to 5000 Americans
annually.
36
Asthma
• Reversible smooth muscle
spasm of the airway
(bronchospasm) associated
with hypersensitivity to
various stimuli
37
Bronchospasm
Triggers
•
•
•
•
•
•
•
Allergy
Aspiration
Exertion
Infection
Stress
Temperature change
Seasonal changes
38
Asthma
• Signs and Symptoms
–
–
–
–
–
–
Dyspnea
Wheezing
Tachypnea
Tachycardia
Cyanosis
Cough
39
Asthma
• Signs and Symptoms
(cont.)
– Accessory muscle use
– Inability to speak in
complete sentences
– Anxiety (hypoxia)
– Prolonged expiratory phase
– Tripod positioning
40
Patient History
•O
•P
•Q
•R
•S
•T
•S
•A
•M
•P
•L
•E
41
Patient History
• Confirm Asthma History
• “All That Wheezes Is Not
Asthma”
• Hospital visits for asthma
in past year?
• Any previous intubations
due to asthma?
42
Physical Exam
• Position found
• Pursed lip breathing
• Vital signs
• Ability to speak in
complete sentences
• Accessory muscle use
43
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)
44
Albuterol
• Generic Name
•Albuterol
• Trade Names
•Proventil
•Ventolin
45
Albuterol
Actions
• Bronchodilation
• Duration of effect is up to
five hours.
46
Albuterol
Indications
• History of Asthma
• Respiratory Distress
47
Albuterol
Contraindications
• Known hypersensitivity to
albuterol
• Respiratory Failure
48
Albuterol
Dosage
Single-dose solution of 2.5 mg
in 3 ml of normal saline for use
in small volume nebulizer
49
Albuterol
Route
Nebulized Medication
By Mouthpiece
By Mask
50
Albuterol
Side Effects
•
•
•
•
•
Nervousness
Tremors
Headache
Tachycardia
Palpitations
•Muscle cramps
•Weakness
•Dizziness
•Drowsiness
•Flushing
•Chest discomfort
51
Asthma
Severe Respiratory Distress
• Call for ALS
• Do Not delay transport to
administer medication!
• Do Not wait for ALS
 Confirm No Signs of
Imminent Respiratory
Failure
52
Albuterol
Protocol
• If patient is in respiratory
failure, assist ventilations
with BVM
• Determine if patient has
self-administered any
nebulized albuterol
53
Albuterol
Protocol
• If patient is in respiratory
failure, assist ventilations
with BVM
• Determine if patient has
self-administered any
nebulized albuterol
54
Albuterol
Protocol
If agency is approved to carry
albuterol, and:
• Patient age is 1 to 65 Years old
and
• Has previously been diagnosed
with asthma
55
Albuterol
Protocol
• 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!
56
Albuterol
Protocol
If respiratory distress
continues and ALS is not yet
available:
• Contact Medical Control for
further orders
57
Nebulized Albuterol
aerosol tubing
“tee”
mouthpiece
nebulizing
chamber
medication
oxygen supply tubing
58
Nebulized Albuterol
Pour Unit Dose into Nebulizing Chamber
59
Nebulized Albuterol
Assemble nebulizer, hook to oxygen
regulator, and run between 6 and 10 L/min
60
Nebulized Albuterol
Encourage the patient
to breath deeply.
61
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.
62
Nebulized Albuterol
• Place the mask on the patient normally.
• Both children and some elderly may
require a pediatric non-rebreather mask
for the treatment
63
Nebulized Albuterol
Try to avoid
inhaling the
excess
aerosol
mist while
assessing
the patient.
64
Reassessment
Strategy
•
•
•
•
•
Monitor A-B-Cs
Position of Comfort
Reassess Vitals
Oxygen by NRB
Watch for changes in
Patient Condition
65
Documentation
• Vital signs before and after
meds are given.
• Current and Past medical
histories
• Any changes in patient
condition
66
Words of Wisdom
DON’T FORGET:
• A-B-C’S
• Good BLS
• Call ALS
• Frequent Reassessment
• Detailed Documentation
• Medical Control
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