1. Copyright (c) The McGraw-Hill Companies, Inc. Permission required for reproduction or display. 11-1 Chapter 11 Emergency Medications

2. 11-2 Objectives

3. Administered Medications 11-3

4. Administered Medications Activated charcoal Aspirin Oral glucose Oxygen 11-4

5. Activated Charcoal 11-5

6. Activated Charcoal Generic name –activated charcoal Trade names –Liqui-Char, Actidose, InstaChar, SuperChar, and others Activated charcoal can only bind a drug that is not yet absorbed from the gastrointestinal tract 11-6

7. Activated Charcoal Action Acts as an adsorbent Binds with many (but not all chemicals) Slows down or blocks absorption of the chemical 11-7

8. Activated Charcoal Indications Some ingested poisons 11-8

9. Activated Charcoal Contraindications Patient has an altered mental status Patient is unable to swallow Medical direction does not give authorization Patient has ingested acids or alkalis 11-9

10. Activated Charcoal Adverse Effects Abdominal cramping Constipation Black stools Nausea, vomiting 11-10

11. Activated Charcoal Dosage Dosage –1 gram of activated charcoal per kilogram of body weight –Usual adult dose: 25 to 50 grams –Usual infant/child dose: 12.5 to 25 grams 11-11

12. Activated Charcoal Before giving activated charcoal, you must determine if your patient can follow directions and swallow safely. Activated charcoal looks like tar, stains any material with which it comes in contact, and doesn’t taste good. –Be prepared for the patient to spit out the medication. 11-12

13. Giving Activated Charcoal 11-13

14. Giving Activated Charcoal 11-14

15. Giving Activated Charcoal 11-15

16. Giving Activated Charcoal 11-16

17. Aspirin 11-17

18. Aspirin Generic name –Acetylsalicylic acid Trade names –Bayer, Ecotrin, Empirin, and others Nonnarcotic pain reliever Fever reducer Anti-inflammatory medication 11-18

19. Aspirin Action Inhibits platelet clumping, thus interfering with blood clotting 11-19

20. Aspirin Indications Chest pain or other signs/symptoms suspected to be of cardiac origin –(Unless hypersensitive to aspirin) If ordered by medical direction, aspirin should be given as soon as possible after the patient’s onset of chest discomfort. 11-20

21. Aspirin Contraindications Known allergy or sensitivity to aspirin Bleeding ulcer or bleeding disorders Children and adolescents 11-21

22. Aspirin Adverse Effects Rapid pulse Flushing Wheezing Nausea, vomiting Gastrointestinal bleeding Diarrhea Heartburn Loss of appetite Ringing in the ears (tinnitus) Rash Hives Bruising 11-22

23. Aspirin Dosage Adult –Two to four 81-mg tablets (baby aspirin), chewed and swallowed 11-23

24. Aspirin Special Considerations Use with caution in a patient who has any of the following: –Asthma –Nasal polyps –Nasal allergies 11-24

25. Aspirin Administration Open the container Pour the correct number into the inside cap of the container Transfer the tablets by pouring them into the patient’s hand –Do not to contaminate the inside cap of the container Carefully recap the container 11-25

26. Oral Glucose 11-26

27. Oral Glucose Action When administered, oral glucose increases the amount of sugar available for use as energy by the body. 11-27

28. Oral Glucose Indications Patients with an altered mental status who have a known history of diabetes controlled by medication and can swallow 11-28

29. Oral Glucose Contraindications Medical direction does not give permission Unresponsive Unable to swallow Known allergy to the glucose preparation 11-29

30. Oral Glucose Adverse Effects Nausea May be aspirated by the patient without a gag reflex 11-30

31. Oral Glucose Dosage One tube 11-31

32. Oral Glucose Special Considerations Ensure signs and symptoms of altered mental status with a known history of diabetes Make sure the patient is responsive, can swallow, and can protect his airway Obtain order from medical direction Use appropriate personal protective equipment Practice the six rights of drug administration 11-32

33. Giving Oral Glucose 11-33

34. Giving Oral Glucose 11-34

35. Giving Oral Glucose 11-35

36. Giving Oral Glucose 11-36

37. Oxygen 11-37

38. Oxygen Action Giving oxygen increases the amount available in the bloodstream for use by the body’s cells 11-38

39. Oxygen Indications Cardiac or respiratory arrest Suspected low oxygen levels from any Any suspected cardiopulmonary emergency, especially complaints of shortness of breath or chest pain 11-39

40. Oxygen Adverse Effects May reduce the respiratory drive in some patients with chronic obstructive pulmonary disease Drying of the mucous membranes 11-40

41. Oxygen Dose Nasal cannula –1 to 6 L/min Nonrebreather mask –15 L/min Cardiac or respiratory arrest: positive-pressure ventilation with 100% oxygen 11-41

42. Assisted Medications 11-42

43. Assisted Medications An EMT can assist a patient in taking the following physician-prescribed medications when authorized by medical direction: –Epinephrine auto-injector –Inhaled bronchodilators –Nitroglycerin 11-43

44. Epinephrine 11-44

45. Epinephrine Generic name –epinephrine Trade name –Adrenalin 11-45

46. Epinephrine Actions Relaxes the bronchial passages of the airway Constricts blood vessels 11-46

47. Epinephrine Indications All of the following criteria must be met: –Patient shows signs and symptoms of a severe allergic reaction –Epinephrine is prescribed for patient or EMS system authorizes you to carry it –Medical direction authorizes use for the patient 11-47

48. Epinephrine Contraindications There are no contraindications when an epinephrine auto-injector is used in a life-threatening situation 11-48

49. Epinephrine Adverse Effects Rapid heart rate Anxiety Excitability Nausea, vomiting Chest pain or discomfort Headache Dizziness 11-49

50. Epinephrine Dosage Adult –One adult auto-injector (0.3 mg) Infant and child –One infant/child auto-injector (0.15 mg) 11-50

51. Epinephrine Special Considerations Use appropriate personal protective equipment Practice the six rights of medication administration. Use a pulse oximeter Give oxygen by nonrebreather mask Assess lung sounds 11-51

52. Epinephrine Special Considerations 11-52

53. Epinephrine Auto-Injector Procedure 11-53

54. Epinephrine Auto-Injector Procedure 11-54

55. Epinephrine Auto-Injector Procedure 11-55

56. Epinephrine Auto-Injector Procedure 11-56

57. Epinephrine Auto-Injector Procedure 11-57

58. Epinephrine Auto-Injector Procedure 11-58

59. Inhaled Bronchodilators 11-59

60. Prescribed Metered-dose Inhaler 11-60

61. Inhaled Bronchodilators Action Generic (trade) names –albuterol (Proventil, Ventolin) –isoetharine (Bronkosol) –metaproterenol (Alupent, Metaprel) Dilate bronchioles, reducing airway resistance 11-61

62. Inhaled Bronchodilators Indications An EMT can assist a patient in taking a prescribed inhaler if all of the following criteria are met: –Patient has signs and symptoms of a respiratory emergency –Patient has a physician prescribed handheld inhaler –No contraindications to giving the medication –Specific authorization by medical direction 11-62

63. Inhaled Bronchodilators Contraindications The patient is unable to use the device. The inhaler is not prescribed for the patient. Permission is not received from medical direction. The patient has already met the maximum prescribed dose before your arrival. 11-63

64. Inhaled Bronchodilators Adverse Effects Increased heart rate Shaking or tremors Restlessness Nervousness Nausea Headache Dizziness 11-64

65. Inhaled Bronchodilators Dosage Number of inhalations based on medical direction’s order or physician’s order based upon consultation with the patient 11-65

66. Inhaled Bronchodilators Special Considerations Use appropriate personal protective equipment. Practice the six rights of medication administration. Assist the patient in finding his MDI if it is not readily available. Assess lung sounds Reassess vital signs and patient’s degree of breathing difficulty. 11-66

67. Inhaled Bronchodilators 11-67

68. Inhaled Bronchodilators 11-68

69. Inhaled Bronchodilators 11-69

70. Inhaled Bronchodilators 11-70

71. Inhaled Bronchodilators 11-71

72. Inhaled Bronchodilators 11-72

73. Nitroglycerin 11-73

74. Nitroglycerin Generic name –nitroglycerin Trade names –Nitrostat, Nitrobid, Nitrolingual, Nitroglycerin Spray Action –Relaxes (dilates) the smooth muscle of blood vessel walls –Decreases the workload of the heart 11-74

75. Nitroglycerin Indications An EMT can assist a patient in taking nitroglycerin if all of the following criteria are met: –Patient has signs and symptoms of chest discomfort suspected to be of cardiac origin –Patient has physician prescribed sublingual tablets or spray –No contraindications –Specific authorization by medical direction 11-75

76. Nitroglycerin Contraindications Medical direction does not give permission Medication is not prescribed for the patient Patient has taken maximum prescribed dose Blood pressure below 100 mm Hg systolic Heart rate 100 beats/min Head injury (recent) or stroke (recent) Infants and children Erectile dysfunction drug within last 24-48 hours 11-76

77. Nitroglycerin Adverse Effects Hypotension Tachycardia Bradycardia Headache Palpitations Fainting 11-77

78. Nitroglycerin Dosage One tablet or one spray under the tongue Dose may be repeated in 3 to 5 minutes (maximum of three doses) if: –Patient experiences no relief, –Patient’s systolic blood pressure remains above 100 mm Hg systolic –Patient’s heart rate remains between 50 and 100 beats/minute –No other contraindications –Medical direction okays another dose 11-78

79. Nitroglycerin Special Considerations Recheck the patient’s vital signs within two minutes. Reassess the patient’s degree of discomfort. 11-79

80. Assisting with Prescribed Nitroglycerin 11-80

81. Assisting with Prescribed Nitroglycerin 11-81

82. Assisting with Prescribed Nitroglycerin 11-82

83. Assisting with Prescribed Nitroglycerin 11-83

84. Assisting with Prescribed Nitroglycerin 11-84

85. Assisting with Prescribed Nitroglycerin 11-85

86. Assisting with Prescribed Nitroglycerin 11-86

87. Assisting with Prescribed Nitroglycerin 11-87

88. Special Situations 11-88

89. Nerve Agents Chemical weapons Interrupt nerve signals causing a loss of consciousness within seconds and death within minutes of exposure 11-89

90. Antidote An antidote is a substance that neutralizes a poison. Nerve agent antidotes 11-90

91. Signs/Symptoms of Nerve Agent Exposure Mild –Tearing –Unexplained runny nose 11-91

92. Signs / Symptoms Moderate –Drooling –Excessive sweating –Nausea and/or vomiting –Abdominal cramps –Diarrhea –Tightness in chest –Muscle twitching at site of exposure –Pinpoint pupils resulting in blurred vision –Difficulty breathing, shortness of breath, wheezing 11-92

93. Signs / Symptoms Severe Strange or confused behavior Severe difficulty breathing or severe secretions from the airway Muscle twitching, jerking, staggering Drowsiness General weakness Headache Involuntary urination Involuntary defecation Seizures Apnea Unconsciousness 11-93

94. Nerve Agent Antidotes Atropine sulfate Pralidoxime chloride Packaged in auto-injectors –Mark I™ kits 11-94

95. Nerve Agent Antidotes Mark I™ kit –Contains two separate auto-injectors One for atropine One for pralidoxime chloride 11-95

96. Nerve Agent Antidotes DuoDote™ –Approved by the FDA in 2007 –Prefilled auto-injector –Delivers atropine and pralidoxime chloride in one intramuscular injection 11-96

97. Atropine Action Reverses some effects of nerve agent poisoning –Increases heart rate –Relaxes bronchioles –Dries secretions –Decreases gastric motility –Dilates pupils 11-97

98. Atropine Indications An EMT can self-administer or administer an atropine auto-injector to a peer if all of the following criteria are met: –The EMT or a peer has signs and symptoms consistent with nerve agent exposure. –The EMT has specific authorization by medical direction. 11-98

99. Atropine Contraindications None – in the face of life-threatening poisoning by chemical nerve agents 11-99

100. Atropine Adverse Effects Pain at site of injection Dryness of the mouth Blurred vision Confusion Headache Dizziness Tachycardia Palpitations Flushing Urinary hesitance or retention Constipation Nausea, vomiting 11-100

101. Atropine Dosage Adult –One auto-injector, which contains about 2 mg of atropine in 0.7 mL 11-101

102. Atropine Special Considerations More than one dose may be necessary 11-102

103. Pralidoxime Chloride Action Generic name: pralidoxime chloride Trade name: 2-PAM Chloride Action –Reverses some effects of nerve agent poisoning Muscle twitching Difficulty breathing 11-103

104. Pralidoxime Chloride Indications An EMT can self-administer or administer a 2-PAM auto-injector to a peer if all of the following criteria are met: –The EMT or a peer has signs and symptoms consistent with nerve agent exposure. –The EMT has specific authorization by medical direction. 11-104

105. Pralidoxime Chloride Contraindications None in the face of life-threatening poisoning by chemical nerve agents 11-105

106. Pralidoxime Chloride Adverse Effects Pain at injection site Tachycardia Hypertension Muscle weakness Nausea Blurred or double vision Dizziness Loss of coordination Headache Drowsiness 11-106

107. Pralidoxime Chloride Dosage Dosage (adult) –One auto-injector contains 600 mg pralidoxime chloride in 2 mL 11-107

108. Pralidoxime Chloride Special Considerations Three kits used for severe symptoms 11-108

109. Diazepam (Valium) Used to control seizures following severe exposure to nerve agents (and similar toxins) May be carried in a single auto-injector –Convulsant Antidote for Nerve Agent (CANA) 11-109

110. Diazepam (Valium) Action / Indications Action –Relaxes skeletal muscle and controls seizures Indications –Seizures that persist after three Mark I (or DuoDote) kits have been given and the EMT has specific authorization by medical direction 11-110

111. Diazepam (Valium) Contraindications Hypersensitivity to any component of the product 11-111

112. Diazepam (Valium) Adverse Effects Pain at injection site Dizziness Drowsiness Confusion Respiratory depression 11-112

113. Diazepam (Valium) Dosage One auto-injector contains 10 mg of diazepam 11-113

114. Diazepam (Valium) Special Considerations Relatively short-acting drug –Seizure activity may recur Onset of action is about 15 to 30 minutes Monitor blood pressure, pulse, and respiratory rate every 5 minutes. 11-114

115. Questions? 11-115