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• Overview of General Pharmacology

• Develop a Basic Knowledge of medications used by BLS Providers

• Identify situations when each medication may be indicated

Objectives

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General Pharmacology

• For every medication you may administer, you must thoroughly understand the following:

• Actions

• Indications

• Contraindications

• Dosage

• Route

• Side effects

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General Pharmacology

• Right Time• Right Patient• Right Drug• Right Dose• Right Route

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General Pharmacology

• Generic name– Original chemical name

• Trade name– Brand name given by manufacturer

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General Pharmacology

Dosage Forms• Solutions

– Liquid mixture of one or more substances

• Nebulized Solution– Pressurized gas passed over a

solution to create an aerosol mist, which is then inhaled

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Anaphylaxis

Epinephrine forBLS Providers

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Anaphylaxis

• An exaggerated immune response to an allergen

• Sudden, rapid onset• Systemic involvement• Severe allergic reaction

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Common Causes of Allergic Reactions

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Allergic Reactions

• Very Common

• Range from mild and local to severe and systemic.– Mild reactions usually affect only one

area of the body

– Slow onset, and minor symptoms

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Mild Allergic Reactions

A mild, local reaction

caused by a bee sting

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Severe Allergic Reaction

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

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• Itching, skin flushing

• Hives and/or swelling–(esp. face, extremities)

Severe Allergic Reaction

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• Increased Pulse• Decreased Blood Pressure• Nausea & Vomiting• Altered Mental Status• Allergen exposure with history

of anaphylaxis

Severe Allergic Reaction

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Patient History

• Determine if the patient’s history includes:–Anaphylaxis–Severe allergic reactions–Recent exposure to a known or

potential allergen

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Focused Physical Assessment

• Assess ABCs• Breath Sounds• Vital Signs

• O2 Saturation

• Assess Respiratory System

• Assess Cardiovascular System

• Assess for Signs & Symptoms of Anaphylaxis

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Epinephrine• Generic Name

–Epinephrine• Trade Name

–EpiPen–EpiPen Jr.•Also called– Adrenalin

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EpinephrineActions

• Dilates Bronchioles• Constricts Blood Vessels

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EpinephrineIndications

• Signs and Symptoms of Severe Allergic Reaction

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EpinephrineContraindications

• None

BUT MUST FOLLOW NYS PROTOCOLS!

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EpinephrineDosage

• Adult• One Adult Auto-injector (0.3 mg)

• Infant and Child

(< 9 y/o or < 30 kg / 66 lbs.)• One Infant/Child Auto-injector (0.15

mg)

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EpinephrineRoute

• Deep Intramuscular Injection

• Lateral thigh, midway between waist and knee

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Epinephrine Side Effects

– Increased pulse rate

–Pallor–Dizziness–Chest Pain

–Headache–Nausea–Vomiting–Excitability–Anxiety

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Epi auto-injectorProtocol

• Call ALS• Administer Oxygen• Assess Respiratory Status• Assess Cardiac Status

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Epi auto-injectorProtocol

If the patient has an epi auto-injector prescribed:

• assist the patient in administering the auto-injector

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Epi auto-injectorProtocol

• If the patient’s epi auto-injector is not available or expired:

• Administer the agency’s epi auto-injector Per Protocol

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Epi auto-injectorProtocol

If no epi auto-injector has been prescribed:

• Begin transport• Contact medical control for

authorization to administer the agency’s epi auto-injector

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Epi auto-injectorProtocol

If unable to contact Medical Control, and patient is less than 35 years of age:

• Administer agency supplied epi auto-injector per protocol

• Contact Medical Control ASAP

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What IsMedical Control?

1. A REMO Physician2. If no REMO Physician is

available, contact ED Physician at the Destination Hospital

3. Document WHO you talked to

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Epi auto-injectorProtocol

• Medical Control MUST be contacted to administer a second auto-injector.

• Be prepared to perform CPR if patient deteriorates.

• Document history, vitals, and treatment on PCR.

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Epi auto-injectorProtocol

Summary:• ALS must be called• Contact Medical Control• If Medical Control unavailable

and patient is <35 years old, administer epi auto-injector

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Epi auto-injector Administration

• Remove safety cap from auto-injector

• Hold auto-injector from center (Do Not place thumb over either end!)

• Place against patient’s thigh– Lateral portion, midway between waist

and knee

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Epi auto-injector Administration

• Push until auto-injector activates

• Hold until medication injected (10 seconds).

• Record Time• Record Response

• Dispose of auto-injector in biohazard “sharps” container.

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Reassessment Strategy

• Monitor A-B-Cs• Reassess Vitals• Oxygen!• Watch for changes in

Patient Condition

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ReassessmentStrategy

If the patient deteriorates...• Oxygenate• Contact Medical Control for order

for second dose• Prepare for resuscitation• Oxygenate• Treat for shock

Oxygenate

Did we mention Oxygenate?

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Asthma

Albuterol forBLS Providers

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Asthma

• A common but serious disease–Affects more than 10 million

Americans.–Kills 4000 to 5000 Americans

annually.

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Asthma

• Reversible smooth muscle spasm of the airway (bronchospasm) associated with hypersensitivity to various stimuli

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Bronchospasm Triggers

• Allergy• Aspiration• Exertion• Infection• Stress• Temperature change• Seasonal changes

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Asthma

• Signs and Symptoms– Dyspnea– Wheezing– Tachypnea– Tachycardia– Cyanosis– Cough

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Asthma

• Signs and Symptoms (cont.)

– Accessory muscle use– Inability to speak in complete

sentences– Anxiety (hypoxia)– Prolonged expiratory phase– Tripod positioning

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Patient History

• O• P• Q• R• S• T

•S•A•M•P•L•E

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Patient History

• Confirm Asthma History• “All That Wheezes Is Not

Asthma”• Hospital visits for asthma in

past year?• Any previous intubations due

to asthma?

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Physical Exam

• Position found• Pursed lip breathing• Vital signs• Ability to speak in complete

sentences• Accessory muscle use

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Physical Exam• Lung Sounds

• Wheezing may or may not be present

• Wheezes may be audible with or without a stethoscope

• Decreased breath sounds (poor air movement)

• Patient’s self-assessment (0-10 scale)

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Albuterol

• Generic Name• Albuterol

• Trade Names• Proventil• Ventolin

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AlbuterolActions

• Bronchodilation

• Duration of effect is up to five hours.

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AlbuterolIndications

• History of Asthma

• Respiratory Distress

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AlbuterolContraindications

• Known hypersensitivity to albuterol

• Respiratory Failure

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AlbuterolDosage

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

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AlbuterolRoute

By Mouthpiece By Mask

Nebulized Medication

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AlbuterolSide Effects

• Nervousness• Tremors• Headache• Tachycardia• Palpitations

• Muscle cramps• Weakness• Dizziness• Drowsiness• Flushing• Chest discomfort

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Asthma Severe Respiratory Distress

• Call for ALS• Do Not delay transport to

administer medication!• Do Not wait for ALS

Ø Confirm No Signs of Imminent Respiratory Failure

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AlbuterolProtocol

• If patient is in respiratory failure, assist ventilations with BVM

• Determine if patient has self-administered any nebulized albuterol

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AlbuterolProtocol

• If patient is in respiratory failure, assist ventilations with BVM

• Determine if patient has self-administered any nebulized albuterol

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AlbuterolProtocol

If agency is approved to carry albuterol, and:• Patient age is 1 to 65 Years old

and• Has previously been diagnosed

with asthma

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AlbuterolProtocol

• Administer 2.5mg albuterol in 3cc normal saline (one unit dose) by nebulizer

• If respiratory distress continues, administer second dose albuterol

• Maximum of two doses may be given!

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AlbuterolProtocol

If respiratory distress continues and ALS is not yet available:• Contact Medical Control for

further orders

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Nebulized Albuterol

aerosol tubing

mouthpiece

“tee” nebulizing chamber

oxygen supply tubing

medication

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Nebulized Albuterol

Pour Unit Dose into Nebulizing Chamber

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Nebulized Albuterol

Assemble nebulizer, hook to oxygen regulator, and run between 6 and 10 L/min

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Nebulized Albuterol

Encourage the patientto breath deeply.

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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.

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Nebulized Albuterol

• Place the mask on the patient normally. • Both children and some elderly may require a

pediatric non-rebreather mask for the treatment

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Nebulized Albuterol

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

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Reassessment Strategy

• Monitor A-B-Cs• Position of Comfort• Reassess Vitals• Oxygen by NRB• Watch for changes in

Patient Condition

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Documentation

• Vital signs before and after meds are given.

• Current and Past medical histories

• Any changes in patient condition

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Words of Wisdom

DON’T FORGET: • A-B-C’S

• Good BLS• Call ALS

• Frequent Reassessment• Detailed Documentation

• Medical Control

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