Bledsoe/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey Division 1 Introduction to Advanced Prehospital Care

Bledsoe/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey Chapter 7 Intravenous Access and Medication Administration Part 1 Principles and Routes of Medication Administration

Bledsoe/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey Topics Aseptic Technique Medication Administration Routes Medication Package Anatomy and Physiology Related to Medication Administration

Bledsoe/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey Six Rights of Drug Administration Right person Right drug Right dose Right time Right route Right documentation

Bledsoe/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey Knowing all drug administration protocols is essential.

Bledsoe/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey Always take appropriate Standard Precautions measures to reduce your risk of exposure during medication administration.

Bledsoe/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey Standard Precautions equipment

Bledsoe/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 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/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey Treat all blood and body fluids as potentially infectious.

Bledsoe/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 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/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 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/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey Percutaneous drug administration is drugs applied to and absorbed through the skin or mucous membranes.

Bledsoe/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey Transdermal Absorbed through the skin at a slow, steady rate Method –Standard Precautions –Clean administration site –Apply medication –Leave medication in place for required time. Monitor the patient for desirable or adverse effects.

Bledsoe/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey Mucous Membranes Absorbed through the mucous membranes at a moderate to rapid rate

Bledsoe/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey Place the pill or direct spray between the underside of the tongue and the floor of the oral cavity. Sublingual Medication Administration

Bledsoe/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey Place the medication between the patient’s cheek and gum. Buccal Medication Administration

Bledsoe/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey Use a medication dropper to place the prescribed dosage on the conjunctival sac. Eye Drop Administration

Bledsoe/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey Nasal Medication Administration

Bledsoe/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey Manually open the ear canal and administer the appropriate dose. Aural Medication Administration

Bledsoe/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey Pulmonary Drug Administration Medications are administered into the pulmonary system via inhalation or injection.

Bledsoe/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey Small volume nebulizer

Bledsoe/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey Nebulizer with attached face mask, bag-valve mask, and endotracheal tube

Bledsoe/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey Metered dose inhaler

Bledsoe/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey Enteral Drug Administration The delivery of any medication that is absorbed through the gastrointestinal tract

Bledsoe/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey Gastrointestinal tract

Bledsoe/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 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/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey Oral Drug Forms Capsules Tablets Pills Enteric-coated/ time-release capsules and tablets Elixirs Emulsions Lozenges Suspensions Syrups

Bledsoe/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey Equipment for Oral Administration Soufflé cup Medicine cup Medicine dropper Teaspoon Oral syringe Nipple

Bledsoe/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey General Principles of Oral Administration Use appropriate Standard Precautions 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/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey Gastric Tube Administration Gastric tubes provide access directly to the GI system.

Bledsoe/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey Confirm proper tube placement.

Bledsoe/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey Withdraw the plunger while observing for the presence of gastric fluid or contents.

Bledsoe/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey Instill the medication into the gastric tube.

Bledsoe/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey Gently inject the saline.

Bledsoe/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey Clamp off the distal tube.

Bledsoe/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 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/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey Catheter placement on needleless syringe

Bledsoe/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey Syringe attached to endotracheal tube

Bledsoe/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey Prepackaged enema container

Bledsoe/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey Parenteral Drug Administration Drug administration outside of the gastrointestinal tract

Bledsoe/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey Syringes and Needles SyringeHypodermic needle

Bledsoe/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey Kinds of Parenteral Drug Containers Glass ampules Single and multidose vials Nonconstituted syringes Prefilled syringes Intravenous medication fluids

Bledsoe/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey Ampules Vials Ampules and Vials

Bledsoe/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey Information on Drug Labels Name of medication Expiration date Total dose and concentration

Bledsoe/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey Obtaining Medication from a Glass Ampule

Bledsoe/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey Hold the ampule upright and tap its top to dislodge any trapped solution.

Bledsoe/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey Place gauze around the thin neck…

Bledsoe/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey …and snap it off with your thumb.

Bledsoe/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey Draw up the medication.

Bledsoe/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey Obtaining Medication from a Vial

Bledsoe/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey Confirm the vial label.

Bledsoe/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey Prepare the syringe and hypodermic needle.

Bledsoe/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey Cleanse the vial’s rubber top.

Bledsoe/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey Insert the hypodermic needle into the rubber top and inject the air from the syringe into the vial.

Bledsoe/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey The nonconstituted drug vial actually consists of two vials, one containing a powdered medication and one containing a liquid mixing solution.

Bledsoe/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey Nonconstituted drugs come in separate vials. Confirm the labels.

Bledsoe/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey Remove all solution from the vial containing the mixing solution.

Bledsoe/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey Cleanse the top of the vial containing the powdered drug and inject the solution.

Bledsoe/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey Agitate or shake the vial to ensure complete mixture.

Bledsoe/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey Prepare a new syringe and hypodermic needle.

Bledsoe/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey Withdraw the appropriate volume of medication.

Bledsoe/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey In the Mix-O-Vial system, the vials are joined at the neck. Confirm the labels.

Bledsoe/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey Squeeze the vials together to break the seal. Agitate or shake to mix completely.

Bledsoe/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey Withdraw the appropriate volume of medication.

Bledsoe/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 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/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey Parenteral Routes Intradermal injection Subcutaneous injection Intramuscular injection Intravenous access Intraosseous infusion

Bledsoe/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey Intradermal Injection

Bledsoe/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey Assemble and prepare the needed equipment.

Bledsoe/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey Check the medication.

Bledsoe/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey Draw up the medication.

Bledsoe/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey Prepare the administration site.

Bledsoe/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey Pull the patient’s skin taut.

Bledsoe/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey Insert the needle, bevel up at a 10-15º angle.

Bledsoe/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey Remove the needle and cover the puncture site with an adhesive bandage.

Bledsoe/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey Monitor the patient.

Bledsoe/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey Subcutaneous Injection 45º

Bledsoe/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey Subcutaneous Injection Sites

Bledsoe/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey Prepare the equipment. © Scott Metcalfe

Bledsoe/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey Check the medication. © Scott Metcalfe

Bledsoe/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey Draw up the medication. © Scott Metcalfe

Bledsoe/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey Prep the site. © Scott Metcalfe

Bledsoe/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey Insert the needle at a 45º angle. © Scott Metcalfe

Bledsoe/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey Remove the needle and cover the puncture site. © Scott Metcalfe

Bledsoe/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey Monitor the patient. © Scott Metcalfe

Bledsoe/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey Intramuscular Injection Sites Deltoid Dorsal gluteal Vastus lateralis Rectus femoris

Bledsoe/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey Intramuscular Injection 90º

Bledsoe/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey Intramuscular Injection Sites

Bledsoe/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey Prepare the equipment. © Scott Metcalfe

Bledsoe/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey Check the medication. © Scott Metcalfe

Bledsoe/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey Draw up the medication. © Scott Metcalfe

Bledsoe/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey Prepare the site. © Scott Metcalfe

Bledsoe/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey Insert the needle at a 90º angle. © Scott Metcalfe

Bledsoe/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey Remove the needle and cover the puncture site. © Scott Metcalfe

Bledsoe/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey Monitor the patient. © Scott Metcalfe

Bledsoe/Porter/Cherry, Essentials of Paramedic Care, Second Edition Update © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey Summary Aseptic Technique Medication Administration Routes Medication Package Anatomy and Physiology related to Medication Administration