1. 1 Overview of General PharmacologyOverview of General Pharmacology Develop a Basic Knowledge of medications used by BLS ProvidersDevelop a Basic Knowledge of medications used by BLS Providers Identify situations when each medication may be indicatedIdentify situations when each medication may be indicated Objectives

2. 2 General Pharmacology For every medication you may administer, you must thoroughly understand the following:For every medication you may administer, you must thoroughly understand the following: Actions Indications Contraindications Dosage Route Side effects

3. 3 General Pharmacology Right TimeRight Time Right PatientRight Patient Right DrugRight Drug Right DoseRight Dose Right RouteRight Route

4. 4 General Pharmacology Generic nameGeneric name –Original chemical name Trade nameTrade name –Brand name given by manufacturer

5. 5 General Pharmacology Dosage Forms SolutionsSolutions –Liquid mixture of one or more substances Nebulized SolutionNebulized Solution –Pressurized gas passed over a solution to create an aerosol mist, which is then inhaled

6. 6 Anaphylaxis Epinephrine for BLS Providers

7. 7 Anaphylaxis An exaggerated immune response to an allergenAn exaggerated immune response to an allergen Sudden, rapid onsetSudden, rapid onset Systemic involvementSystemic involvement Severe allergic reactionSevere allergic reaction

8. 8 Common Causes of Allergic Reactions

9. 9 Allergic Reactions Very CommonVery Common Range from mild and local to severe and systemic.Range from mild and local to severe and systemic. –Mild reactions usually affect only one area of the body –Slow onset, and minor symptoms

10. 10 Mild Allergic Reactions A mild, local reaction caused by a bee sting

11. 11 Severe Allergic Reaction A Clear History of Allergen Exposure AND Signs and Symptoms including:A Clear History of Allergen Exposure AND Signs and Symptoms including: –Shock (hypoperfusion) –Respiratory Distress –Wheezing, stridor, cough –Chest / throat tightness

12. 12 Itching, skin flushingItching, skin flushing Hives and/or swellingHives and/or swelling –(esp. face, extremities) Severe Allergic Reaction

13. 13 Increased PulseIncreased Pulse Decreased Blood PressureDecreased Blood Pressure Nausea & VomitingNausea & Vomiting Altered Mental StatusAltered Mental Status Allergen exposure with history of anaphylaxisAllergen exposure with history of anaphylaxis Severe Allergic Reaction

14. 14 Patient History Determine if the patient’s history includes:Determine if the patient’s history includes: –Anaphylaxis –Severe allergic reactions –Recent exposure to a known or potential allergen

15. 15 Focused Physical Assessment Assess ABCsAssess ABCs Breath SoundsBreath Sounds Vital SignsVital Signs O 2 SaturationO 2 Saturation Assess Respiratory SystemAssess Respiratory System Assess Cardiovascular SystemAssess Cardiovascular System Assess for Signs & Symptoms of AnaphylaxisAssess for Signs & Symptoms of Anaphylaxis

16. 16 Epinephrine Generic NameGeneric Name –Epinephrine Trade NameTrade Name –EpiPen –EpiPen Jr. Also calledAlso called –Adrenalin

17. 17 Epinephrine Actions Dilat es BronchiolesDilat es Bronchioles Constricts Blood VesselsConstricts Blood Vessels

18. 18 Epinephrine Indications Signs and Symptoms of Severe Allergic ReactionSigns and Symptoms of Severe Allergic Reaction

19. 19 Epinephrine Contraindications NoneNone BUT MUST FOLLOW NYS PROTOCOLS!

20. 20 Epinephrine Dosage Adult Adult One Adult Auto-injector (0.3 mg) One Adult Auto-injector (0.3 mg) Infant and Child Infant and Child (< 9 y/o or < 30 kg / 66 lbs.) One Infant/Child Auto-injector (0.15 mg) One Infant/Child Auto-injector (0.15 mg)

21. 21 Epinephrine Route Deep Intramuscular InjectionDeep Intramuscular Injection Lateral thigh, midway between waist and kneeLateral thigh, midway between waist and knee

22. 22 Epinephrine Side Effects –Increased pulse rate –Pallor –Dizziness –Chest Pain –Headache –Nausea –Vomiting –Excitability –Anxiety

23. 23 Epi auto-injector Protocol Call ALSCall ALS Administer OxygenAdminister Oxygen Assess Respiratory StatusAssess Respiratory Status Assess Cardiac StatusAssess Cardiac Status

24. 24 Epi auto-injector Protocol If the patient has an epi auto-injector prescribed: assist the patient in administering the auto- injectorassist the patient in administering the auto- injector

25. 25 Epi auto-injector Protocol If the patient’s epi auto- injector is not available or expired:If the patient’s epi auto- injector is not available or expired: Administer the agency’s epi auto-injector Per ProtocolAdminister the agency’s epi auto-injector Per Protocol

26. 26 Epi auto-injector Protocol If no epi auto-injector has been prescribed: Begin transportBegin transport Contact medical control for authorization to administer the agency’s epi auto-injectorContact medical control for authorization to administer the agency’s epi auto-injector

27. 27 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 protocolAdminister agency supplied epi auto-injector per protocol Contact Medical Control ASAPContact Medical Control ASAP

28. 28 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

29. 29 Epi auto-injector Protocol Medical Control MUST be contacted to administer a second auto-injector.Medical Control MUST be contacted to administer a second auto-injector. Be prepared to perform CPR if patient deteriorates.Be prepared to perform CPR if patient deteriorates. Document history, vitals, and treatment on PCR.Document history, vitals, and treatment on PCR.

30. 30 Epi auto-injector Protocol Summary: ALS must be calledALS must be called Contact Medical ControlContact Medical Control If Medical Control unavailable and patient is <35 years old, administer epi auto-injectorIf Medical Control unavailable and patient is <35 years old, administer epi auto-injector

31. 31 Epi auto-injector Administration Remove safety cap from auto- injectorRemove safety cap from auto- injector Hold auto-injector from centerHold auto-injector from center (Do Not place thumb over either end!) Place against patient’s thighPlace against patient’s thigh –Lateral portion, midway between waist and knee

32. 32 Epi auto-injector Administration Push until auto- injector activatesPush until auto- injector activates Hold until medication injected (10 seconds).Hold until medication injected (10 seconds). Record TimeRecord Time Record ResponseRecord Response Dispose of auto-injector in biohazard “sharps” container.Dispose of auto-injector in biohazard “sharps” container.

33. 33 Reassessment Strategy Monitor A-B-CsMonitor A-B-Cs Reassess VitalsReassess Vitals Oxygen!Oxygen! Watch for changes in Patient ConditionWatch for changes in Patient Condition

34. 34 Reassessment Strategy If the patient deteriorates... OxygenateOxygenate Contact Medical Control for order for second doseContact Medical Control for order for second dose Prepare for resuscitationPrepare for resuscitation OxygenateOxygenate Treat for shockTreat for shock Oxygenate Did we mention Oxygenate?

35. 35 Asthma Albuterol for BLS Providers

36. 36 Asthma A common but serious diseaseA common but serious disease –Affects more than 10 million Americans. –Kills 4000 to 5000 Americans annually.

37. 37 Asthma Reversible smooth muscle spasm of the airway (bronchospasm) associated with hypersensitivity to various stimuliReversible smooth muscle spasm of the airway (bronchospasm) associated with hypersensitivity to various stimuli

38. 38 Bronchospasm Triggers AllergyAllergy AspirationAspiration ExertionExertion InfectionInfection StressStress Temperature changeTemperature change Seasonal changesSeasonal changes

39. 39 Asthma Signs and SymptomsSigns and Symptoms –Dyspnea –Wheezing –Tachypnea –Tachycardia –Cyanosis –Cough

40. 40 Asthma Signs and Symptoms (cont.)Signs and Symptoms (cont.) –Accessory muscle use –Inability to speak in complete sentences –Anxiety (hypoxia) –Prolonged expiratory phase –Tripod positioning

41. 41 Patient History O P Q R S T S A M P L E

42. 42 Patient History Confirm Asthma History “All That Wheezes Is Not Asthma” Hospital visits for asthma in past year? Any previous intubations due to asthma?

43. 43 Physical Exam Position foundPosition found Pursed lip breathingPursed lip breathing Vital signsVital signs Ability to speak in complete sentencesAbility to speak in complete sentences Accessory muscle useAccessory muscle use

44. 44 Physical Exam Lung SoundsLung Sounds Wheezing may or may not be presentWheezing may or may not be present Wheezes may be audible with or without a stethoscopeWheezes may be audible with or without a stethoscope Decreased breath sounds (poor air movement)Decreased breath sounds (poor air movement) Patient’s self-assessmentPatient’s self-assessment (0-10 scale) (0-10 scale)

45. 45 Albuterol Generic NameGeneric Name AlbuterolAlbuterol Trade NamesTrade Names ProventilProventil VentolinVentolin

46. 46 Albuterol Actions BronchodilationBronchodilation Duration of effect is up to five hours.Duration of effect is up to five hours.

47. 47 Albuterol Indications History of AsthmaHistory of Asthma Respiratory DistressRespiratory Distress

48. 48 Albuterol Contraindications Known hypersensitivity to albuterolKnown hypersensitivity to albuterol Respiratory FailureRespiratory Failure

49. 49 Albuterol Dosage Single-dose solution of 2.5 mg in 3 ml of normal saline for use in small volume nebulizer

50. 50 Albuterol Route By Mouthpiece By Mask Nebulized Medication

51. 51 Albuterol Side Effects NervousnessNervousness TremorsTremors HeadacheHeadache TachycardiaTachycardia PalpitationsPalpitations Muscle crampsMuscle cramps WeaknessWeakness DizzinessDizziness DrowsinessDrowsiness FlushingFlushing Chest discomfortChest discomfort

52. 52 Asthma Severe Respiratory Distress Call for ALSCall for ALS Do Not delay transport to administer medication!Do Not delay transport to administer medication! Do Not wait for ALSDo Not wait for ALS Ø Confirm No Signs of Imminent Respiratory Failure

53. 53 Albuterol Protocol If patient is in respiratory failure, assist ventilations with BVMIf patient is in respiratory failure, assist ventilations with BVM Determine if patient has self-administered any nebulized albuterolDetermine if patient has self-administered any nebulized albuterol

54. 54 Albuterol Protocol If patient is in respiratory failure, assist ventilations with BVMIf patient is in respiratory failure, assist ventilations with BVM Determine if patient has self-administered any nebulized albuterolDetermine if patient has self-administered any nebulized albuterol

55. 55 Albuterol Protocol If agency is approved to carry albuterol, and: Patient age is 1 to 65 Years oldPatient age is 1 to 65 Years oldand Has previously been diagnosed with asthmaHas previously been diagnosed with asthma

56. 56 Albuterol Protocol Administer 2.5mg albuterol in 3cc normal saline (one unit dose) by nebulizerAdminister 2.5mg albuterol in 3cc normal saline (one unit dose) by nebulizer If respiratory distress continues, administer second dose albuterolIf respiratory distress continues, administer second dose albuterol Maximum of two doses may be given!Maximum of two doses may be given!

57. 57 Albuterol Protocol If respiratory distress continues and ALS is not yet available: Contact Medical Control for further ordersContact Medical Control for further orders

58. 58 Nebulized Albuterol aerosol tubing mouthpiece “tee” nebulizing chamber oxygen supply tubing medication

59. 59 Nebulized Albuterol Pour Unit Dose into Nebulizing Chamber

60. 60 Nebulized Albuterol Assemble nebulizer, hook to oxygen regulator, and run between 6 and 10 L/min

61. 61 Nebulized Albuterol Encourage the patient to breath deeply.

62. 62 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.

63. 63 Nebulized Albuterol Place the mask on the patient normally. Both children and some elderly may require a pediatric non-rebreather mask for the treatment

64. 64 Nebulized Albuterol Try to avoid inhaling the excess aerosol mist while assessing the patient.

65. 65 Reassessment Strategy Monitor A-B-CsMonitor A-B-Cs Position of ComfortPosition of Comfort Reassess VitalsReassess Vitals Oxygen by NRBOxygen by NRB Watch for changes in Patient ConditionWatch for changes in Patient Condition

66. 66 Documentation Vital signs before and after meds are given.Vital signs before and after meds are given. Current and Past medical historiesCurrent and Past medical histories Any changes in patient conditionAny changes in patient condition

67. 67 Words of Wisdom DON’T FORGET: A-B-C’SA-B-C’S Good BLSGood BLS Call ALSCall ALS Frequent ReassessmentFrequent Reassessment Detailed DocumentationDetailed Documentation Medical ControlMedical Control

68. 68