Chapter 11

activated charcoal - action, indications, contraindications, routes, side effects, interactions, adult dose & administration concerns

(p.467) - activated charcoal helps in event of poison; medications bind to the charcoal, making it so less poison is absorbed into body -action: adsorbs toxic substances in digestive tract -indications: most oral poisonings; overdose -contraindications: decreased level of consciousness, overdose of corrosives, caustics or petroleum substances -routes: PO -side effects: nausea, vomiting, constipation, black stool interactions: bonds with & inactivates most medications/substances in digestive tract -adult dose: 1-2 g/kg -administration concerns: stains (protect patient and provider clothing); do not given when giving other PO medications

general procedure for EpiPen administration

(p471) 1. grasp unit with tip pointing downward 2. form a fist around the unit. do not place your thumb over either head of the unit 3. with the other hand, pull off the activation cap 4. hold the tip near the outer part of the patient's thigh 5. insert firmly into the outer thigh so that the unit is perpendicular (at a 90 degree angle) to the thigh. do not allow the unit to bounce 6. hold firmly in the thigh for several seconds 7. immediately place unit in an appropriate sharps container after administration

Nitorglycerin - action, indications, contraindications, routes, side effects, interactions, adult dose & administration concerns

Nitroglycerin (p.468) -action: dilates blood vessels -indications: chest pain of cardiac origin -contraindications: hypotension; use of erectile dysfunction medication in last 24 hours; head injury -routes: SL tablet or spray -side effects: headache, burning under tongue, hypotension, nausea -adult dose: 0.3-0.4 mg SL/0.4mg spray -administration concerns: ensure ALS is en route

You are dispatched to the residence of a 68 year old man who is complaining of a "crushing" chest pain radiating down his left arm and trouble breathing for the past hour. He is pale, cool, diaphoretic and is very nauseated. He tells you he had a heart attack several years ago and takes nitrogylcerin as needed. he took two tablets prior to your arrival and reports no releif. how would you best manage this patient?

Place the position is position of comfort. Give 100% oxygen via nonbreathing mask. Check blood pressure! (cannot give nitroglycerin if systolic BP <100). Check expiration of nitroglycerin. Contact medical control for permission to assist patient with 1 nitroglycerin tablet, SL. Monitor vital signs - provide rapid transport

_____ ______ are the effects that are undesirable but pose little risk to the patient.

Unintended effects (p.456) ^type of side effect other type: untoward effects - effects that can be harmful to a patient

You are called to the home of a 34 year old male who is unresponsive. When you arrive, you find the patient supine and unconscious on the living room floor with snoring respirations. The gov publication listing all drugs in the US is called the: a. "United States Pharmacopoeia" b. "Department of Transportation Reference Guide" c. "US Pharmacology" d. "Nursing Drug Rerference"

a. "United States Pharmacopoeia" (p456) - "United States Pharmacopoeia and the National Forumulary" (USP-NF) lists all medications that are licensed for use in the US

You are called to the beach for a 15 year old boy who is having trouble breathing. He tells you between gasps that he was stung by something and that his body feels "swollen." Just then, his mother runs up to you and puts an EpiPen in your hand, "Here," she says breathlessly. "This is his EpiPen, he needs this!!" Would you administered Epinephrine to this patient? a. Yes. Push the EpiPen firmly against the patient's thigh for several seconds b. No. The EpiPen will make his condition worse c. Yes. Use the sublingual route d. No. His signs and symptoms contraindicate an epinepherine injection

a. Yes. Push the EpiPen firmly against the patient's thigh for several seconds EpiPen -action: stimulates nervous system, causing bronchodilation -indications: anaphylactic rxn -contraindications: chest pain of cardiac origin; hypothermia; hypertension

"I think she's drunk!" A bystander yells as you & your partner arrive on the scene of an unknown medical problem. You observe an approximately 45-year-old woman stumbling between several cars in the parking lot of a grocery store. As you catch up to the woman you ask her if she is diabetic. She nods clumsily & leans against one of the cars. You test her blood glucose & obtain a reading of 49 mg/dL. What should you do? A) Administer glucose gel orally B) Ask the bystanders if anyone knows her medical history C) Restrain her onto the gurney to keep her from hurting herself or others D) Request an ALS response so glucose can be administered intravenously

a. administer glucose gel orally (p.468) -between 70-140 mg/dl is an average glucose level -below 70 is hyperglycemia (extremely low glucose level); can be caused by excess insulin - the oral glucose combats this contraindications of glucose: decreased level of consciousness, vomiting, nausea (in this case woman is not at that point yet, however if she were, it'd be wise to call for ASL for alternative glucose administration)

Nitroglycerin relieves pain because its purpose is to increase blood flow by relieving the spasms or causing the arteries to: a. dilate b. constrict c. thicken d. contract

a. dilate p.468

Nitroglycerin relieves the squeezing or crushing pain associated with angina by: a. dilating the arteries to increase the oxygen supply to the heart muscle b. causing the heart to contract hard and increase cardiac outt c. causing the heart to beat faster to supply more oxygen to the heart d. causing the heart to beat faster and more efficiently

a. dilating the arteries to increase the oxygen supply to the heart muscle p. 468 - nitroglycerin relieves pain of angina; typically the only med you'll help to administer sublingually; nitrogylcerin increases blood flow by relieving spasms/causing arteries to dilate (does this by relaxing muscular walls of coronary arteries and veins); this does returns less blood to heart so make sure to take BP - make sure systolic pressure >100

The fastest way to deliver a chemical substance is by the ____ route. a. intravenous b. oral c. sublingual d. intramuscular

a. intravenous p. 457 - fastest way to get chemical into body (into veins); cannot be used for aspririn, oxygen and charcoal

The brand name that a manufacturer gives to a medication is called the ____ name a. trade b. generic c. chemical d. prescription

a. trade p.456 -- ex: Tylenol (trade name) vs acetaminophen (generic)

dose

amount of medication given

side effect

any action of a drug other than the desired one

What medication is commonly administered in a metered-dose inhaler (MDI)? a. nitroglycerine b. albuterol c. activated charcoal d. naloxone

b. albuterol ---> asthma inhalers! (P.475) common prescriptions of MDI's: -albuterol (Proair, Proventil, and Ventolin) -inpratropium (Atrovent) -levalbuterol (Xopenex)

You are called to the home of a 34 year old male who is unresponsive. When you arrive, you find the patient supine and unconscious on the living room floor with snoring respirations. Oral glucose is _____ for this patient. a. indicated b. contraindicated c. not normally given d. prescribed

b. contraindicated oral glucose (Glutose) contraindications: decreased level of consciousness, nausea, vomitting

Which of the following is considered a relative contraindication to the administration of aspirin? a. hypersensitivity to aspirin b. history of asthma c. preexisting liver damage d. history of nausea

b. history of asthma p.468 - aspirin is an antipyretic (fever reducer), analgesic (pain reducer), and anti-inflammatory medication that inhibits platelet aggregation (clumping) [why some people get prescribed baby aspirin - helps prevent heart attack]; don't give to kids bc of association with Reye syndrome *contraindications* for aspirin include: -hypersensitivity to aspririn (absolute) -preexisting liver damage (absolute) -bleeding disorders (relative) -asthma (relative)

Outside a hospital, a(n) _______ is the preferred method of giving oxygen to patients who are experiencing significant respiratory distress: a. nasal cannula b. nonbreathing mask c. bag-valve mask d. endotracheal tube

b. nonbreathing mask p471 - oxygen is by far most commonly administered med in prehospital setting; in general, you will be giving oxygen via a *nonbreathing mask at 10-15 L/min* --preferred method in field, esp for patients you suspect experiencing shock if avail/possible, give 2-6 L/min using nasal cannula; bag valve mask required if patient not ventilating properly;

Which of the following is NOT a characteristic of epinephrine? a. dilating passages in the lungs b. secreted naturally by the pituitary gland c. increasing the heart rate and blood pressure d. dilating blood vessels

b. secreted naturally by pituitary gland p. 470 - epinephrine main hormone that control's body's fight or flight response & primary med you'll deliver via intramuscular (IM) route. it is: -secreted naturally by the adrenal glands -dilates passages in the lungs -constricts blood vessels, increasing BP & heart rate

You are called to the home of a 34 year old male who is unresponsive. When you arrive, you find the patient supine and unconscious on the living room floor with snoring respirations. Which of the following statements about oxygen is false: a. most commonly administered medication in prehospital setting b. should be administered to all patients c. is not flammable d. is considered a suspension

b. should be administered to all patients oxygen contraindications: -very rarely used for patients with COPD (chronic obstructive pulmonary disease) -do not use near open flames, as oxygen will support combustion (oxygen itself is not flammable but supports flames) *oxygen is not helpful/may be harmful for patients who are having a heart attack or stroke when their breathing is at 94% or greater*

You are dispatched to the county fair for a 54 year old woman complaining of chest pain. You arrive to find her pressing on the center of her chest and note that she has pale, clammy skin. You ask if she has any cardiac history and she tells you "No, I just have arthritis and my doctor says that I am prediabetic." Would you give this patient aspirin? a. No. Nitroglycerin would be more appropriate b. Yes. Her signs and symptoms indicate a cardiac problem and aspirin could help c. No. Aspirin is contraindicated for arthritis d. Yes. Its analgesic properties may help with her discomfort

b. yes, her signs and symptoms indicate a cardiac problem and aspirin could help (p.468) - "during potential heart attack, aspirin may be life saving"; aspirin is anti-inflammatory, fever reducing, and prevents platelets from clumping

Which of the following routes of administration involves medication being absorbed in the fat tissue between the skin and muscle? a. intravenous (IV) b. intramuscular (IM) c. subcutaneous (SC) d. intranasal (IN)

c. *subcutaneous* (p457) subcutaneous injection: under the skin - given into the fatty tissue between the skin and the muscle. no blood here, so medications generally absorbed more slowly but effects last longer

You are called to the home of a 34 year old male who is unresponsive. When you arrive, you find the patient supine and unconscious on the living room floor with snoring respirations. Which medication commonly comes in gel form? a. naloxone b. epinephrine c. glucose d. activated charcoal

c. glucose (p.460) - oral glucose gel common to have for EMT's - usually give 1/2 to 1 tube to help with low blood glucose (hypoglycemia)

The most common technique for naloxone administration is via the: a. oral route b. intramuscular route c. intranasal route d. intravenous route

c. intranasal route p. 471 - most common for Narcan to be offered via the intranasal route to EMS providers (other common routes are intramuscular and intravenous)

You are called to the home of a 34 year old male who is unresponsive. When you arrive, you find the patient supine and unconscious on the living room floor with snoring respirations. Which of the following medications *might* be useful in this situation? a. nitroglycerin b. activated charcoal c. naloxone d. aspirin

c. naloxone (p.471) nitroglycerin - dilates blood vessels; use with chest pain of cardiac origin (SL tablet or spray route) activated charcoal - absorbs toxic substances in digestive tract; use with most oral poisonings or overdose (PO route) naloxone - reverses respiratory depression secondary to opioid overdose (IM or IN route usually) aspirin - anti-inflammatory, anti-fever & platelet clumping prevention; use for relief of mild pain, headache, muscle aches or chest pain of cardiac origin (PO route)

Which of the following is taken into consideration when determining the dose of a medicine? a. sex b. occupation c. ability to swallow d. age

d. age p. 455 - "dose often depends on the patient's weight or age" (and also desired action of drug)

Your patient is a 73 year old man who complains of severe chest pressure with trouble breathing while having dinner at a local diner. He has a small vial of Nitroglycerin in his pocket, but says that he has not taken any in several days and needs you to help him open the vial. After administering oxygen, what is the first thing that you should do? a. Obtain the patient's blood pressure and ensure his systolic pressure is not below 110 mmHg b. Begin assisting the patient with ventilations c. place him in the recovery position d. ask if he has taken any erectile dysfunction medication in the last 24 hours

d. ask him if he has taken any erectile dysfunction medication in the last 24 hours (p.469) - erectile dysfunction medications can have potentially fatal interactions with nitroglycerin (can cause dramatic drop in BP); always ask patients who have been prescribed nitroglycerin if they've used any medication for erectile dysfunction in the last 24 hours (for men and women!!)

You and your rookie partner are dispatched to a home on the east side of town for a possible poisoning. Upon arrival, you are met by a frantic mother who carries her crying 4-year-old boy up to your truck. "Please help him!" she pleads. "I was cleaning the garage and before I could stop him he drank a jar of gasoline that my husband uses to clean car parts." Your partner puts the truck in park and sets the parking brake. "I'll grab the activated charcoal," he says, climbing out of the cab. You should: A) administer the activated charcoal and transport the child immediately D) ask to see the jar to determine how much gasoline was swallowed C) contact online medical direction while administering the activated charcoal D) not administer the activated charcoal

d. do not administer activated charcoal (p.467) activated charcoal helps in event of poison; medications bind to the charcoal, making it so less poison is absorbed into body *-contraindications: decreased level of consciousness, overdose of corrosives, caustics, or petroleum substances*

action

effect the drug is supposed to have

_____ is the main hormone that controls the body's fight or flight response

epinephrine (p.470)

T/F: sublingual medications are rapidly absorbed to the digestive tract

false - (p.458) SL meds are given under the tongue and are absorbed into bloodstream in minutes (faster than oral route and protects medications from chemicals in digestive system that could weaken the med)

T/F: epinephrine is a hormone produced by the body to aid in digestion

false - aids in fight or flight response, produced by adrenal glands

T/F: Glucose may be administered to an unconscious patient in order to save his or her life

false - do NOT give glucose to an unconscious patient (contraindication of oral glucose)

T/F: enteral medications enter the body through the skin

false - enteral medications enter the body through the digestive system; paretneral medications enter body by route other than digestive tract, skin or mucous membranes (often liquid form and generally administered using syringes or needles)

T/F: Nitroglycerin should be administered only when the patient's systolic BP is below 100 mmHg

false - should only be given when patient's systolic BP is above 100mmHg (because drug itself decreases BP, so you don't want this to lower it to dangerous level)

T/F: oxygen is a flammable substance

false!! (but does support combustion if near open flame)

capsules

gelatin shells filled with powdered or liquid medication

____ is a simple sugar that is readily absorbed by the bloodstream

glucose (p.468)

topical meications

lotions, creams and ointments

A ______ is a chemical substance that is used to treat or prevent disease or relieve pain.

medication (p.455)

You are dispatched to a "difficulty breathing" at one of your town's many parks. As you near the park entrance, you see a crowd of people who frantically wave for you. You arrive to find a city employee who was apparently mowing the park grounds when he accidentally mowed over a yellow jacket nest. He was wearing coveralls, but was repeatedly stung around his neck and face. He appears somewhat confused ; you can hear stridor with each inspiration and is BP is 80/40. Your local protocols allow EMTs to carry EpiPens. How do you best manage this patient?

*Stridor is noisy breathing that occurs due to obstructed air flow through a narrowed airway this patient is in serious trouble. the history of events combined with his level of consciousness, stridor and hypotension are obvious signs of anaphylactic shock. You must immediately administer epinephrine (an EpiPen) to counteract the effects of the stings. if available, ALS providers should be requested. if not, transport to nearest appropriate facility without delay. patient will likely need multiple doses of epinephrine since so many stings, as well as administration of antihistamines, breathing treatments and possibly advanced airway manuevers. your partner should apply high-flow oxygen and remove any remaining stingers in face or neck by scraping them from the skin; prompt action is essential to patient survival

oral glucose - action, indications, contraindications, routes, side effects, interactions, adult dose & administration concerns

-action: when absorbed, provides glucose for cell use -indications: low blood glucose (hypoglycemia) -contraindications: decreased level of consciousness, vomiting, nausea -routes: PO -side effects: nausea, vomiting -interactions: none -adult dose: 1/2 to full tube -administration concerns: patient must be awake, have control of airway and be able to follow commands

What are the steps for administering intranasal naloxone?

1. obtain medical direction per local protocol 2. confirm correct medication and expiration date 3. attempt to determine if patient is allergic to any medications 4. prepare the medication and attach the atomizer 5. place the atomizer in 1 nostril, pointing up and slowly outward 6. administer a half dose (1 mL max) into each nostril 7. reassess the patient and document properly (p472)

List 7 routes of medication administration

1. oral (PO) 2. sublingually (SL) - below tongue 3. intramuscular (IM) 4. intravenous (IV) 5. intranasal (IN) 6. subcuntaneous (SC) - below skin 7. topical/transcutaneous --> also per rectum (PR), inhalation, and intraosseous (IO)- into the bone

List 4 effects of nitroglycerin.

1. relaxes muscular walls of the coronary arteries to the heart 2. results in less blood returning to the heart 3. decreases blood pressure 4. relaxes arteries throughout entire body 5. often causes a mild headache and/or burning under the tongue after administration (p.469)

What are the "six rights" of medication administration

1. right person/patient 2. right time 3. right medication 4. right dose 5. right route/administration 6. right documentation

List 3 characteristics of epinephrine

1. secreted naturally by adrenal glands 2. stimulates "fight-or-flight" response 3. dilates lung passages 4. constricts blood vessels 5. increases heart rate and blood pressure

You are dispatched to an "unknown medical problem" at the Crosstown Mall. You were called after the police were summoned due to a combative male shopper. Police officers were able to calm him down but felt that something was "not right" about him. You arrive to find a calm but confused man who is sweaty and pale. He has no complaints but keeps repeating "I have to get home now." You notice a medical ID bracelet indicating this patient is an insulin-dependent diabetic. How would you best manage this patient

patient most likely suffering from hypoglycemia (low blood glucose); although patient is confused, he is able to talk and swallow. if local law allows for EMT to perform blood glucose test, do so - if not, get as much info regarding patient through physical signs and medical history (all indicative of low blood sugar). you should administer (at least) 1 tube of oral glucose & reassess his mentation and vital signs. provide treatment in line with local protocols Symptoms of a low blood sugar level: sweating. feeling tired. dizziness. feeling hungry. tingling lips. feeling shaky or trembling. a fast or pounding heartbeat (palpitations), becoming easily irritated, tearful, anxious or moody. high blood sugar symptoms: High blood sugar (hyperglycemia) Increased thirst. Frequent urination. Fatigue. Nausea and vomiting. Shortness of breath. Stomach pain. Fruity breath odor. A very dry mouth.

abosoroption

process by which medications travel through body tissues

indication

reason for which medication is given

Describe the action of activated charcoal and the steps of administration that are specific to this medication

reverses overdoses/poison; many meds adsorb (stick to) activated charcoal, preventing the drugs from being absorbed by the body it needs to be shaken bc its a suspension (med ground into fine particles that is evenly distributed in liquid by shaking or stirring) & should be given in a covered container with a straw

contraindication

situation in which a drug should not be given

When given by mouth, ____ may be absorbed from the stomach fairly quickly because the medication is already dissolved.

solutions (p.459) - a liquid mixture of one or more substances that cannot be separated by filtering or allowing mixture to stand; can be given in almost any route

Nitroglycerin is usually taken ______

sublingually (p.469) via dissolving tablet - also comes in metered dose spray (which is also sublingual)

pharmacology

the science of drugs and their ingredients, its uses and actions

Explain why metered-dose inhalers are often used with spacer.

to avoid misdirecting the spray of the MDI and ensure inhalation of all medication (p.474)

adsorption

to bind or stick to a surface

T/F: adsorption means to bind or stick to the surface

true

T/F: nitroglycerin decreases blood pressure

true - it dilates blood vessels