Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Division 1 Introduction to Advanced Prehospital Care

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Chapter 7 Intravenous Access and Medication Administration Part 1 Principles and Routes of Medication Administration

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Topics Aseptic Technique Medication Administration Routes Medication Package Anatomy and Physiology Related to Medication Administration

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Six Rights of Drug Administration Right person Right drug Right dose Right time Right route Right documentation

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Knowing all drug administration protocols is essential.

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Always take appropriate body substance isolation measures to reduce your risk of exposure during medication administration.

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Body substance isolation equipment

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Medical Asepsis It is important to keep the ambulance and all the equipment clean. Sterile –Free of all forms of life Medically clean –Involves careful handling to prevent contamination

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Treat all blood and body fluids as potentially infectious.

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Needle Handling Precautions Minimize the tasks performed in a moving ambulance. Immediately dispose of used sharps in a sharps container. Recap needles only as a last resort.

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Medication Administration and Documentation Record all information concerning the patient and medication including: – Indication for drug administration – Dosage and route delivered – Patient response to the medication Both positive and negative

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Percutaneous drug administration is drugs applied to and absorbed through the skin or mucous membranes.

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Transdermal Absorbed through the skin at a slow, steady rate Method: –BSI –Clean administration site –Apply medication –Leave medication in place for required time. Monitor the patient for desirable or adverse effects.

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Mucous Membranes Absorbed through the mucous membranes at a moderate to rapid rate

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Place the pill or direct spray between the underside of the tongue and the floor of the oral cavity. Sublingual Medication Administration

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Place the medication between the patient’s cheek and gum. Buccal Medication Administration

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Use a medication dropper to place the prescribed dosage on the conjunctival sac. Eye Drop Administration

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Nasal Medication Administration

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Manually open the ear canal and administer the appropriate dose. Aural Medication Administration

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Pulmonary Drug Administration Medications are administered into the pulmonary system via inhalation or injection.

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Small volume nebulizer

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Nebulizer with attached face mask, bag-valve mask, and endotracheal tube

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Metered dose inhaler

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Endotracheal Tube Several medications can be administered through an endotracheal tube: – Lidocaine – Epinephrine – Atropine – Naloxone

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Enteral Drug Administration The delivery of any medication that is absorbed through the gastrointestinal tract

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Gastrointestinal tract

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Oral Drug Administration Any medication taken by mouth and swallowed into the GI tract. Be sure the patient has an adequate level of consciousness to prevent aspiration.

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Oral Drug Forms Capsules Tablets Pills Enteric coated/ time release capsules and tablets Elixirs Emulsions Lozenges Suspensions Syrups

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Equipment for Oral Administration Soufflé cup Medicine cup Medicine dropper Teaspoon Oral syringe Nipple

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ General Principles of Oral Administration Use appropriate BSI measures. Note whether to administer medication with food or on empty stomach. Gather any necessary equipment. Have patient sit upright when not contraindicated. Place the medication into your patient’s mouth. Allow self-administration; assist when needed. Follow administration with 4-8 ounces of water and ensure that patient has swallowed the medication.

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Gastric Tube Administration Gastric tubes provide access directly to the GI system.

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Confirm proper tube placement.

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Withdraw the plunger while observing for the presence of gastric fluid or contents.

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Instill the medication into the gastric tube.

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Gently inject the saline.

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Clamp off the distal tube.

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Rectal Administration The rectum’s extreme vascularity promotes rapid drug absorption. Medications do not travel through the liver, and are not subject to hepatic alteration.

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Catheter placement on needleless syringe

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Syringe attached to endotracheal tube

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Prepackaged enema container

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Parenteral Drug Administration Drug administration outside of the gastrointestinal tract

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Syringes and Needles SyringeHypodermic needle

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Kinds of Parenteral Drug Containers Glass ampules Single and multidose vials Nonconstituted syringes Prefilled syringes Intravenous medication fluids

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Ampules Vials Ampules and Vials

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Information on Drug Labels Name of medication Expiration date Total dose and concentration

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Obtaining Medication from a Glass Ampule

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Hold the ampule upright and tap its top to dislodge any trapped solution.

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Place gauze around the thin neck…

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ …and snap it off with your thumb.

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Draw up the medication.

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Obtaining Medication from a Vial

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Confirm the vial label.

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Prepare the syringe and hypodermic needle.

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Cleanse the vial’s rubber top.

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Insert the hypodermic needle into the rubber top and inject the air from the syringe into the vial.

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ The nonconstituted drug vial actually consists of two vials, one containing a powdered medication and one containing a liquid mixing solution.

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Nonconstituted drugs come in separate vials. Confirm the labels.

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Remove all solution from the vial containing the mixing solution.

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Cleanse the top of the vial containing the powdered drug and inject the solution.

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Agitate or shake the vial to ensure complete mixture.

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Prepare a new syringe and hypodermic needle.

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Withdraw the appropriate volume of medication.

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ In the Mix-O-Vial system, the vials are joined at the neck. Confirm the labels.

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Squeeze the vials together to break the seal. Agitate or shake to mix completely.

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Withdraw the appropriate volume of medication.

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Prefilled or Preloaded Syringes Confirm medication indications and patient allergies. Confirm prefilled syringe label (name, dose, and expiration date). Assemble the prefilled syringe. Remove the pop-off caps and screw together. Reconfirm indication, drug, dose, and route of administration. Administer appropriately via the indicated route. Properly dispose of the needle and syringe.

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Parenteral Routes Intradermal injection Subcutaneous injection Intramuscular injection Intravenous access Intraosseous infusion

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Intradermal Injection

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Assemble and prepare the needed equipment.

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Check the medication.

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Draw up the medication.

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Prepare the administration site.

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Pull the patient’s skin taut.

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Insert the needle, bevel up at a 10-degree to 15-degree angle.

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Remove the needle and cover the puncture site with an adhesive bandage.

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Monitor the patient.

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Subcutaneous Injection 45º

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Subcutaneous Injection Sites

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Prepare the equipment. © Scott Metcalfe

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Check the medication. © Scott Metcalfe

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Draw up the medication. © Scott Metcalfe

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Prep the site. © Scott Metcalfe

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Insert the needle at a 45-degree angle. © Scott Metcalfe

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Remove the needle and cover the puncture site. © Scott Metcalfe

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Monitor the patient. © Scott Metcalfe

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Intramuscular Injection Sites Deltoid Dorsal gluteal Vastus lateralis Rectus femoris

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Intramuscular Injection 90º

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Intramuscular Injection Sites

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Prepare the equipment. © Scott Metcalfe

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Check the medication. © Scott Metcalfe

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Draw up the medication. © Scott Metcalfe

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Prepare the site. © Scott Metcalfe

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Insert the needle at a 90-degree angle. © Scott Metcalfe

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Remove the needle and cover the puncture site. © Scott Metcalfe

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Monitor the patient. © Scott Metcalfe

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Summary Aseptic Technique Medication Administration Routes Medication Package Anatomy and Physiology related to Medication Administration