1. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Paramedic Care: Principles & Practice Volume 1 Introduction to Advanced Prehospital Care

2. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Chapter 10 Intravenous Access and Medication Administration

3. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Chapter 10, Part 1 Principles and Routes of Medication Administration

4. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Part 1 Topics General Principles Percutaneous Drug Administration Pulmonary Drug Administration Enteral Drug Administration Parenteral Drug Administration

5. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ General Principles

6. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ General Principles The paramedic is responsible for ensuring that all emergency drugs are in place and ready for immediate use. –Know your local drug distribution system. Document the administration and restocking of narcotics. –Federal, state, and local laws mandate this.

7. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ General Principles Six Rights of Drug Administration: –Right person –Right drug –Right dose –Right time –Right route –Right documentation

8. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ General Principles You will be responsible for the safe and appropriate delivery of medications. –Medical control should be used. Echo procedure

9. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Medical Direction The medical director determines which medications you will use and the routes by which you will deliver them. Knowing all drug administration protocols is essential.

10. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Standard Precautions Gloves Goggles Mask Gown Frequent handwashing

11. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Medical Asepsis Sterilization –Free of all forms of life –Heat or chemical sterilization –Medically clean techniques involve the careful handling of sterile equipment to prevent contamination.

12. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Medical Asepsis Disinfectants and Antiseptics –Disinfectants are toxic to living tissue. Use them only on nonliving surfaces or objects. –Antiseptics are not toxic to living tissue. Common antiseptics include alcohol and iodine preparations.

13. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Disposal of Contaminated Equipment and Sharps Minimize the tasks performed in a moving ambulance. Immediately dispose of used sharps in a sharps container. Recap needles only as a last resort. Every medical organization must have a biological hazard exposure plan.

14. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Medication Administration and Documentation Record all information concerning the patient and medication including: – Indication, dosage, and route delivered – Patient response to the medication The routes of drug administration fall into four basic categories: –Percutaneous, pulmonary, enteral, and parenteral

15. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Percutaneous Drug Administration

16. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Percutaneous Drug Administration Transdermal administration –The transdermal route promotes slow, steady absorption. Nitroglycerin, hormones, and analgesics –Thin skin, overdose, or penetrating solvents can increase the absorption rate.

17. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Mucous Membranes Absorbed through the mucous membranes at a moderate to rapid rate Sublingual, buccal, ocular, nasal, and aural administration

18. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Sublingual Medication Sublingual Medication Administration –Place the pill or direct spray between the underside of the tongue and the floor of the oral cavity. Permits rapid absorption with systemic delivery Nitroglycerin

19. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Buccal Medication Administration Buccal medications —generally tablets Administer in theoral cavity between the cheek and gums Hormonal and enzyme preparations

20. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Ocular Administration Medications for alleviating eye pain, treating infection, decreasing intraocular pressure, or lubricating the eyelid Packaged as drops or ointments

21. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Nasal Administration Nasal medications — usually drops or sprays intended for local effect Emergency medications via the intranasal route –Fentanyl, midazolam, naloxone Rapidly absorbed

22. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Aural Medication Administration Aural medications primarily treat local infections and ear pain. Manually open the ear canal and administer the appropriate dose.

23. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Pulmonary Drug Administration

24. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Pulmonary Drug Administration Medications are administered into the pulmonary system via inhalation or injection. Promote bronchodilation for respiratory emergencies. Other inhaled drugs are mucolytics, antibiotics, and topical steroids.

25. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Pulmonary Drug Administration Small volume nebulizer Patient must have an adequate tidal volume and respiratory rate

26. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Pulmonary Drug Administration Metered Dose Inhaler –Handheld devices produce a medicated spray for inhalation –Some metered dose inhalers come equipped with a spacer

27. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Endotracheal Tube Several medications can be administered through an endotracheal tube: –Lidocaine –Epinephrine –Vasopresin –Atropine –Naloxone Increase conventional IV dosages from two to two-and-one-half times. Dilute the medication in normal saline to create 10 mL of solution.

28. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Enteral Drug Administration

29. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Enteral Drug Administration The delivery of any medication that is absorbed through the gastrointestinal tract –Orally, through a gastric tube, or rectally

30. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Oral Drug Administration An oral drug is any medication taken by mouth and swallowed into the GI tract. Be sure the patient has an adequate level of consciousness to prevent aspiration.

31. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 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

32. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Equipment for Oral Administration Soufflé cup Medicine cup Medicine dropper Teaspoon Oral syringe Nipple

33. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Gastric Tube Administration Gastric tubes provide access directly to the GI system. Used in instances of drug overdose, trauma, and upper gastrointestinal bleeding.

34. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Rectal Administration The rectum’s extreme vascularity promotes rapid drug absorption. Medications administered rectally do not travel through the liver and are not subject to hepatic alteration. EMS may administer rectally diazepam (Valium), lorazepam (Ativan), or midazolam (Versed) for protracted seizures or aspirin for cardiac or neurologic emergencies.

35. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Rectal Administration Suppositories and Enemas –Catheter placement on needleless syringe –Syringe attached to endotracheal tube –Prepackaged enema container

36. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Parenteral Drug Administration

37. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Parenteral Drug Administration Drug administration outside of the gastrointestinal tract. The parenteral route involves the use of needles as medications are injected into the circulatory system or tissues. Parenteral drug delivery affords the most rapid drug delivery and absorption.

38. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Syringes and Needles A syringe is a plastic tube with which liquid medications can be drawn up, stored, and injected. The hypodermic needle is a hollow metal tube used with the syringe to administer medications. –Gauge describes its diameter photos © Scott Metcalfe

39. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Medication Packaging Glass ampules Single and multidose vials Nonconstituted syringes Prefilled syringes Intravenous medication fluids

40. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Medication Packaging Information on Drug Labels: –Name of medication –Expiration date –Total dose and concentration Always use them to confirm the correct medication.

41. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Medication Packaging Ampule –Breakable glass vessel containing liquid medication

42. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Medication Packaging Single and Multidose Vials –The medication inside the vial is packaged in a vacuum. –This permits multiple access with a syringe and hypodermic needle.

43. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Medication Packaging Nonconstituted Drug Vial –Extends the viability and storage time of drugs –Must mix it, or reconstitute it –May have to place multiple medications into one syringe for a single delivery

44. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Medication Packaging In the Mix-O-Vial system, the vials are joined at the neck. Confirm the labels.

45. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Medication Packaging Prefilled or Preloaded Syringes –Tamperproof containers with the medication already in the syringe –Consists of two parts: A syringe A glass tube prefilled with liquid medication –Pushing the glass container into the syringe barrel expels the medication.

46. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Medication Packaging Intravenous Medication Solutions –Medications packaged in an IV bag and administered as an IV infusion –May be premixed or you may have to mix them

47. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Parenteral Routes Parenterally administered drugs can be absorbed locally or systemically. Parenteral delivery bypasses the digestive tract. Routes: –Intradermal injection –Subcutaneous injection –Intramuscular injection –Intravenous access –Intraosseous infusion

48. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Parenteral Routes Intradermal Injection –Injections deposit medication into the dermal layer of the skin. –The amount of medication placed in the dermal layer is quite small. Less than 1cc –Useful for allergy testing and tuberculin skin testing.

49. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Parenteral Routes Intradermal Injection –Prepare equipment –25- to 27-gauge needle, up to 1 inch long –Insert needle at 10- 15° angle with bevel up

50. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Parenteral Routes Subcutaneous Injection –Promotes slow, sustained absorption, which prolongs a drug’s effect on the body –No more than 1.0 mL of medication –Sites

51. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Parenteral Routes Subcutaneous Injection (cont.) –Prepare equipment –24- to 26-gauge hypodermic needle, to 1 inch long –45° angle with the bevel up © Scott Metcalfe

52. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Parenteral Routes Intramuscular Injection –Permits systemic delivery at a moderate absorption rate –Several sites are used for intramuscular injections Deltoid 2.0 mL Dorsal gluteal 5.0 mL of medication or more Vastus lateralis 5 mL of medication Rectus femoris Up to 5 mL

53. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Intramuscular Injection Sites

54. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Parenteral Routes Intramuscular Injection (cont.) –Prepare equipment –21- to 23-gauge hypodermic needle, to 1 inch long –90° angle with the bevel up © Scott Metcalfe

55. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Intramuscular Injection 90º

56. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Part 1 Summary General Principles Percutaneous Drug Administration Pulmonary Drug Administration Enteral Drug Administration Parenteral Drug Administration