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Related Chapters
Core Concepts
20 Allergic Reaction
21 Poisoning and Overdose Emergencies
Standards
Pharmacology (Content Areas: Principles of
Pharmacology; Medication Administration; Emergency
Medications)
Competency
Applies fundamental knowledge of the medications
that the EMT may assist with/administer to a patient
during an emergency.
Objectives
After reading this chapter, you should be able to :
16.1. Define key terms introduced in this chapter.
16.2. List the drugs in your scope of practice.
(pp. 443-450)
16.3. For each medication you may administer or
assist a patient in self-administering, describe
the following :
a. Generic and common trade names (p. 450)
b. lndication(s) (p. 451)
c. Contra indications (p . 451)
Key Terms
aspirin, p. 444
atomizer, p. 449
contraindications,
enteral, p. 45 7
p. 45 7
epinephrine, p. 448
indications, p. 45 7
inhaler, p. 446
naloxone, p. 449
nitroglycerin, p. 447
oral glucose, p. 444
oxygen, p. 444
parenteral, p. 45 7
pharmacodynamics, p. 453
pharmacology, p. 443
side effect, p. 45 7
untoward effect, p. 45 7
1)What 6 medications
2)
can be administered by
EMT?
You will be able to administer or assist with at least these six medications in the field: aspi- pharmacology
aspirin
rin , oral glucose, oxygen, prescribed bronchodilator inhalers, nitroglycerin, and epinephrine (FARM-uh-KOL-uh-je)
oral glucose
auto-injectors. Some systems permit EMTs to administer certa in additi onal drugs, including the study of drugs, their sources,
oxygen
prescribed
activated charcoa l and naloxone. The information that follows is a bri ef introduction to their characteristics, an d their effects.
bronchodilator inhaler each of these drugs.
nitroglycerin
epinephrine auto-injectors.
Chapter 16 General Pharmacology
443
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Aspirin is
administered to patients with
chest pain of a suspected cardiac
origin.
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Your local system may allow addition to this medication list. It is beyond the scope of
this text to include all the pote ntial possibilities. However, if yo ur system uses medication
that are not covered here, be sure to obtain th appropriate information and ed uca tion for
those medica tion before administering the m to a patie nt.
aspirin
a medication used to reduce the
clotting ability of blood to prevent
and treat clots associated with
myocardial infarction.
As an EMT, yo u will carry aspirin , oral glucose, and oxygen (and in some sy terns, as noted
earlie r, activated charcoal) on the ambulance. U nde r specific circumstance that will be
described later, yo u will be a ble to administer these medications to patie nts.
Aspirin
Yo u may have taken a simple aspirin to relieve a headache or treat a fever. In the world of
EMS, howeve r, as pirin ha a much more importa nt role. As a n EMT, yo u will administer
a pirin to patie nts with che t pain of a uspected cardiac origin (Figure 16-1). In the event a
heart attack is occurring, aspirin reduces the blood's ability to clot and works to prevent the
clo t formation tha t causes damage to the hea rt. It is an exceptio nally importa nt medication
unde r these circumstances. Fortunately it is also very simple to administer. As many ambulances do not carry drinking water, most services will carry chewable children's aspirin , and
5) the patient will simply be asked to chew a nd swallow the appropriate dose. There are very
few reasons no t to administer aspirin to a patie nt havi ng che t pain of a suspected card iac
origin. However, some pa tie nts do have allergies, and o thers have gastro intesti nal bleeding
that can be made worse by the administration of as pirin. Always follow yo ur loca l protocols
for ad mini tration guide lines.
4)
Oral Glucose
6)
Glucose is a kind of suga r. Oral glucose i a form of glucose that can be taken by mo uth
oxygen
444
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ing oral glucose will be found in th e chapter titl ed "Di a betic E me rgencies a nd Altered
Me nta l Sta tus."
Oxygen
Oxygen is a gas commonly found in the a tmo phe re. Pure oxygen is u ed as a drug to treat
any patie nt wh ose medical o r traumatic condition ca uses him to be hypoxic (low in oxygen)
or in da nger of becoming hypoxic (Figure 16-3). Throughout this text, yo u have learned -
and will continue to learn- many situation in which a patient should be given oxygen.
Specific methods of administering oxygen were explained in the "Re piration and Artificial
Ventilation' chapter.
Activated Charcoal
NOTE: Many systems allow the admini tration of activated charcoal. Therefore,
although it is not one of our six commonly carried medications, we will discuss it here.
Always consult local protocol to confirm which medications you are allowed to carry
and administer.
10)
Activated charcoaJ is a powder prepared fro m charred wood , usually premixed with water
to form a lurry for use in the field (Figure 16-4).1t is used to treat a poisoning or overdose
when a substance is swallowed and i in the patient's digestive tract. Activated charcoal will
absorb some poisons (bind them to the urfaces of the charcoal) and he lp prevent them
from being absorbed by the body. The procedure for administering activated charcoal will
be found in the chapter titled "Poisoning and Overdose Emergencies.'
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Chapter 16
I General Pharmacology
. 445
POINT of VIEW
"I woke up and checked my blood sugar. It was a little
higher than I expected. I ate a light breakfast and took a
few extra units of insulin as my endocrinologist explained
for me to do.
"The next thing I know, my husband was looking
very concerned. Then the ambulance showed up. I
remember the EMTs being there, but I couldn't make
out what they were saying. I remember wanting so
much to talk to them, but the words weren't coming
out right.
"I saw the sugar. They put it in my mouth on the tongue
blade. I am not sure how long it took. I was pretty out of it.
But suddenly the world was again in focus-like someone
adjusted the camera lens and everything was clear.
Prescribed Medications
CORE CONCEPT
11)
The three medications described next - prescribed inha ler, nitroglycerin, and epinephrine
auto-injector - are drugs that you, as an EMT may assi t the patient in taking if they have
been prescribed for the patient by a physician.
Bronchodilator Inhalers
Patients can carry various medications to help them through a period of difficulty breathMost often patients with diseases such as asthma emphysema, or chronic bronchitis
carry a "bronchodilator," a medication designed to enlarge constricted bronchial tubes,
making breathing easier. Many of these medications can be carried in an inhaler, which
contains an aerosol form of a medication the pati nt can spray directly into his airway
(Figure 16-5). Examples of these medications include albuterol (Ventolin , Proventil ,
Volmax) and leva lbuterol (Xopenex).
Since many bronchodi lators also have an effect on the heart, an increased heart rate and
patient jitteriness are common side effects of treatment.
Be sure to determine that the inhaler is actually the patient's and not that of a family
member or bystander. You may need to have permission from medical direction to help a
patient self-administer a prescribed inhaler. This permission from medical direction may
come by phone or radio, or there may be a standing medical order that permits you to assist
a patient with this kind of medication. Always comply with the protocols of your EMS system. More details on the u e of a prescribed inhaler will be found in the " Respiratory Emergencies" chapter.
12)ing.
13)
inhaler
a spray device with a mouthpiece
that contains an aerosol form of a
medication that a patient can spray
into his airway.
446
14)
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(A) A prescribed inhaler may help a patient who has respiratory problems. (B) A spacer attached to the inhaler
helps the patient by allowing the medication to be released into the spacer, where it remains airborne for a time so the patient
can inhale it without feeling rushed-as he wou ld be if inhaling it directly, without the spacer.
(A)
15) Many patients with
Nitroglycerin
problems such as recurrent
Many patient with problems such as recurrent chest pain or a history of heart attack carry
chest pain or a history
nitroglycerin pills or spray. Nitroglycerin (Figure 16-6) is a drug that helps to dilate the
of heart attack carry
what drug?
coronary vessels, which supply the heart muscle with blood. It is often called just "nitro." A
NITROGLYCERIN PILLS OR
common trade name is Nitrostat.
17)
SPRAY.
This drug is taken by the patient when he begins to have chest pain he believes to be
cardiac in origin. It i not uncommon for EMTs to treat patients who have already taken a
nitroglycerin pill or who are carrying a bottle of nitroglycerin tablet and have not thought
to try one. (Many patients are instructed by their physician to take up to three nitroglycerin
pills for their chest pain and, if the chest pain persi ts, to call EMS.)
Be ure to determine that the nitroglycerin is actually the patient's and not that of a
18) family member or bystander. Also determine whether the patient has recently taken anything to treat erectile dysfunction, such as sildenafil (Yiagra), vardenafil (Levitra), tadalafil
(Cialis), or similar medication. If so he should not take nitroglycerin because of the possibility of a serious negative interaction with these drug .
19)
Since nitroglycerin causes a dilation of blood vessels, a drop in the patient's blood pressure is always a potential side effect of admini tration. If this should occur, you may also
need to lay the patient flat as you contact medical direction again for advice.
You may need to seek permission from medical direction by phone or radio, or there may
be a standing medical order that permits you to as ist a patient with nitroglycerin administration. Always comply with the protocols of your EMS system. More information on assisting a
patient in taking nitroglycerin will be found in the "Cardiac Emergencie "chapter.
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16)
nitroglycerin
(NYE-tro-GLIS-uh-rin)
a drug that helps to dilate the
coronary vessels that supply the
heart muscle with blood.
Nitroglycerin is often prescribed for chest pain. Forms of nitroglycerin include (A) tablets or (B) a spray.
Chapter 16
I General Pharmacology
447
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(A)
(C)
Epinephrine Auto-Injectors
When a patient is highly allergic to something such as hell fish , penicillin, or a bee sti ng, he
may have a very severe reaction that may cause life-threa tening change in the ai rway and
epinephrine (ep-uh-NEF-rin)
circulation. The reaction can be rever ed by u ing epinephrine, a med ication that will help
a drug that helps to constrict the
to con trict the blood vessels and relax airway pa sage .
blood vessels and relax passages of
Beca use evere allergic reactions may reach a life-threa te ning tage in a very short
the airway. It may be used to counter
time, epinephrine must be administered quickly. Many patient who are prone to evere
a severe allergic reaction.
alle rgic reactions carry an ep inephrine auto-injector (Figure 16-7). Thi i a syringe with a
spring-loaded needle that will rel ea e and inj ect epin ephrine into the mu cle when the
auto-injector i pu hed aga in t the thigh. There are everal different varieties of auto21)EPINEPHRINE AUTO0INJECTOR:
injector on the market. Epi-Pen is the trade name of a commonly carried epinephrine
A syringe with a spring-loaded needle that will
auto-i nj ector. Auvi-QTM i the trade nam of a n epinephrine auto-inj ector that gives voice
release and inject epinephrine into the muscle
when the auto-injector is pushed against the thigh. in tructions for it use. Twinject is the trade name of an auto-inj ector that contains two
do es of epinephri ne. If you need to assist a patient with the use of an epi ne phrine a utoinj ector, be sure to determine that the auto-injector is actually the patient's and not that
of someone el e.
22)
Since epinephrine has a potent effect on the heart and vascular syste m, increased heart
rate and blood pres ure commonly occur after it admini tration to the patient.
You may need to seek permi sion from medical direction or there may be a tanding
order permitting you to a i t a patient who ha an epinephrine auto-injector. In orne ystem , EMT carry and are trained to u e e pinephrine auto-injectors to treat patients with
a naplylaxis. Always comply with the protocols of your EMS system. More information on
a isting a patient in usi ng an epin phrine auto-inj ector is in the "Allergic Reaction" chapter.
20)
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23)
Inside Outside
HOW MEDICATIONS FOR ASTHMA AND
ANAPHYLAXIS WORK
Medications are valuable tools to help patients in t he most
serious of medica l emergencies. Some medications are
carried by EMTs, whereas others belong to the patients. You
Condition
Pathophysiology
Action of Medications
Asthma
Anaphylaxis
.,_
r":i il
Epinephrine also causes bronchodilation to open conThe allergic reaction (begun when an antigen meets
antibodies within the body) causes the body to release stricted bronchioles through the beta receptors in the
sympathetic nervous system.
a variety of substances, including histamine, which
cause vasodilatation and shock as well as bronchoconstriction .
These substances also alter vascular permeability,
allowing fluid to enter and swell the airways, lips,
tongue, and throat.
A n increasing number of states are expanding the scope of practice to allow the E MT and
even lay people to carry and use an e pinephrine auto-inj ecto r to treat life-threa tening allergic reactio ns or naloxone with an atomizer to treat a narcotic overdose. The authority to
administer e pine phrine or naloxone to the pa tient, rather tha n to assist a patient in the use
of his own a uto-inj ector is norma lly granted by the Medical Director only after the EMT
has received additional educatio n and testing.
23)
atomizer
a device attached to the end of a
syringe that atomizes medication
(turns it into very fine droplets).
Naloxone
When someone takes too much of a narcotic, the person can lose consciousness, become
unable to pro tect the airway a nd , most important of all, go into respiratory failure with slow,
shallow breathing. Narcotics, especially in large doses, slow the re piratory dri ve and can
26) even ca use respirato ry arrest. Naloxone, trade name Narcan, one of the few antidotes in
medicine, ca n reve r e the effects of a narcotic ve ry quickly (Figure 16-8). Although it is usually inj ected, naloxone is also effective when administered as a fine spray into the nose. The
mucous membranes in the nose can absorb very fine drople ts of ce rtain medications and
feed them into the circula tory system, allowing them to exe rt an effect in o ther parts of the
27) body. If you give naloxone to someone who is unconscious and in respiratory fa ilure but
Chapter 16
24)
naloxone
an antidote for narcotic overdoses.
I General Pharmacology
449
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Naloxone,
trade name Narcan, one of the
few antidotes in medicine, can
reverse the effects of a narcotic
very quickly. Narcan with syringe
and atomizer at left; prefilled
syringe and atomizer at right.
who ha no t had a na rcotic, it will have no effect. Even if a pa tient ha taken a narcotic, if
the mucou me mbranes a re damaged o r bl ocked , intrana al ad mini tratio n will no t work
and yo u will need to u e yo ur airway management kills. More de ta il o n the use of ato mized naloxone will be fo und in the cha pte r ' Poisoning a nd O verdose Eme rge ncies."
General Information
about Medications
28) U.S. Pharmacopoeia (USP):
A comprehensive government publication with every drug or medication
listed.
29) Each drug has at least three names:
the chemical name
the generic name
trade (brand) name
450
Drug Names
Eve ry drug o r medica tio n is listed in a compre hensive governme nt publication ca lled the
U.S. Pharmacopoeia (U SP). Each drug is li ted by its gene ric na m (a genera l name that is
no t the bra nd name of any manu fac ture r). H owe ve r, each drug actually has at least three
names: the che mica l na me, the generic name, a nd one o r mo re trade (brand) names given
th e drug by va ri o us ma nufacture rs. Fo r exa mple, epinephrine is a gene ric drug name. It
che mica l name is B-(3 , 4 dih yd roxy phe nyl)-a-me th yla minoetha nol. (Che mica l na mes are
technica l fo rmulas used o nly by scie ntists o r ma nufacture r .) As me ntioned ea rl ier, Epi- Pen
is the trade na me of a n epine phrine auto-inj cto r.
30)
Every drug has an indication or indications, that is, pecific signs, symptoms, or circumstances under which it is appropriate to administer the drug to a patient. For example,
nitroglycerin is indicated when a patient has chest pain or squeezing, dull pressure. Each
drug also has contraindications, or specific signs, symptoms, or circumstances under
which it is not appropriate and may be harmful to administer the drug to the patient. For
example, nitroglycerin is contraindicated (shou ld not be given) if the patient has low
blood pressure beca use nitroglycerin , in dilating the blood vessels, causes a slight drop in
the systolic blood pressure. As noted earlier, nitroglycerin is also contraindicated if the
patient has recently taken Viagra or a similar medication because of possible serious negative interactions.
A side effect is any action of a drug other than the desired action. Some ide effects
are predictable, such as th e drop in blood pressure from nitroglycerin. If you were not
aware of the side effect of a drop in blood pre ure and gave the drug to a patient who
started out with low blood pressure, the results could be devastating. The patient's blood
pressure might " bottom out," which i definitely not a desirab le effect for a cardiac
pati ent. Often medications have unintended effects; that is, effects that occur in addition
to th e specific reason the drug was administered. Occasionall y these effects can be classified as untoward effects, or effects that are not only unexpected, but also potentially
harmful to the patient.
34)
Medications come in many different form . A few examples are:
Compressed powders or tablets, such as nitroglycerin pills.
Liquids for u e out ide the digestive tract, such as in an injection. This route is called the
parenteral route and refers to bypassing the GI tract. An example of this type of medication would be epinephrine from an auto-injector.
Liquids to be taken orally (such as a cough syrup). This route uses the digestive tract to
reach the bloodstream and is known as an enteral route.
Liquid that is vaporized, such as a fixed-dose nebulizer.
Gels, such a the paste in a tube of oral glucose.
indications
specific signs or circumstances under
which it is appropriate to administer
a drug to a patient.
31)
contraindications
(KON -truh-in-duh-KAY-shunz)
specific signs or circumstances under
which it is not appropriate and may
be harmful to administer a drug to a
patient.
CORE CONCEPT
What to consider when
administering any medication
32)
side effect
any action of a drug other than the
desired action.
33)
37)
I General Pharmacology
45 1
Medication Authorization
CORE CONCEPT
The role of medical direction
in medication administration
38)
As an EMT, you are authorized to adm inister medications by your Medical Director. This
Medical Director may be service level regional level, or even state level. The authorization
to administer medications can come in two different manners:
1. Off-line medical direction. In thi case, you will not actually speak to a physician to
ask permission. Off-line medical direction uses "standing orders"; that is, orders written
down in the form of protocols. Providers learn these protocols and admini ter medications guided by the pecific circumstances and conditions previously outlined in their
rules and regulations.
2. On-line medical direction. In this case you will need to peak directly to a physician
(or his designee) to obtain verbal permission to administer a medication. Verbal confirmation i required. As an EMT, you should always be diligent to ensure you have heard
and correctly understand the instructions. A useful technique to employ is the "echo technique." In this technique you will listen to the order and repeat the order back. The physician then hould give you a verbal confirmation that what you have heard is correct. Use
of this process significantly reduces medication error . If at any time you are confused or
have a question , speak up. Asking for clarification while on-line always is appropriate.
1. Do I have the right patient? Doe this medication belong to the patient? Is this the
same patient medical direction approved a medication order for?
2. Is it the right time to administer this medication? Have I made the right decision
to administer the medication based on what I am seeing? Is it appropriate under these
circum tances to give this particular medication?
3. Is this the right medication? Did I pick up the right bottle? Am I sure this is the
correct medication?
4. Is this the right dose? Have I double-checked? Am I ure I am giving the correct amount?
5. Am I giving this medication by the right route of administration?
Routes of Administration
41)
TI1e route by which the drug is administered affects the rate that the medication enter the
bloodstream and arrives at its target organ to achieve its desired effect. EMTs use the following routes of administration:
Oral, or swallowed This route is very afe and ha few complications associated with
42) EMTs use the following routes of
administration:
Sublingual, or dissolved under the tongue This route also accesses the body
through the mouth ; however, in this case the medication is typically placed under the
tongue and allowed to dissolve. As it dissolves, the medication is absorbed by the vascular soft tissue of the mouth. This route is faster than swa llowing pills, but absorption
sometime is difficult if circulation is poor (as in shock). More information on a si ting a
patient with sublingual nitroglycerin can be fou nd in the chapter " Cardiac Emergencies."
Inhaled, or breathed into the lungs, usually as tiny aerosol particles (such as
from an inhaler) or as a gas (such as oxygen) Inhaled medications are breathed
in through the respiratory system, and the medication i absorbed into the bloodstream
through the alveoli. Thi is typically a simple process of putting a rna k on your patient
(as with oxygen). However, inhaled medications can be delivered via inhalers or
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nebulizers as well. More details on the use of a prescribed inhaler will be found in the
chapter "Respiratory Emergencies."
Intranasal, or sprayed into the nostrils To use the intrana at route, you spray very fine
droplets of medication into one or both nostril with an atomizer. If the capillarie in the
mucous membranes are intact and not blocked, certain medications can be absorbed into
the circulatory ystem and have an effect very similar in strength and speed to an injection
of the same medication. The intranasal route works only with certain medications. You use
it by attaching a special device (an atomizer) to the end of the medication-filled syringe.
Pushing firmly on the plunger forces the liquid out of the atomizer in very small droplets.
Intravenous, or injected into a vein The intravenous route is beyond the scope of
the EMT level. However, you should know that this is a fast and precise way to administer medications into the body by directly accessing the bloodstrea m through a vein.
Intramuscular, or injected into a muscle The intramuscular route injects medication directly into the muscle. There, blood vessels can rapidly absorb the medication and
transfer it to other parts of the body. This method of admini tration is very fast and
allows for the effects of medication to rapid ly occur. It can, however, be affected by
poor circulation (a in shock) and also has a much higher complication rate than the
oral or sublingua l routes. This route typically uses a needle, as in an auto-injector, to
deliver the medication . When you break the integrity of the kin's defenses with the
needle, infection are somewhat common. More information on assisting a patient in
using an auto-injector can be found in the "Allergic Reaction" chapter.
Subcutaneous, or injected under the skin Subcutaneo us injections are very similar to intramuscular injections except that they deliver medications into the layers of the
skin rather than into the muscle. This results in a slightly lower absorption than with
intramuscular injections.
Intraosseous, or injected into the bone marrow cavity New technology (the " 10
gun" or " 10 drill ") allows rapid placement of a rigid needle into the bone marrow cavities of lon g bones such as the tibia. This technology, with compelling research that shows
medications and fluids inj ected into the marrow reach the central circulation as fast as
those given IV, has made the IO route popular among ALS providers and emergency
physicians in emergency situation uch as cardiac arrests.
Endotracheal, or sprayed directly into a tube inserted into the trachea This
route is used in some ALS systems. Endotracheal medications are administered through
a tube inserted into the trachea to be absorbed by the tis ue of the lungs. Recent evidence has que tioned the effectiveness of thi route, however, because lung tissue has
very unpredictable absorption rate . Yet you may find this route still used as a last resort.
44) What questions should you
asked when administering a
medication?
"What effect will this medication
have, and how will it affect my
patient specifically?"
43)
49)
pharmacodynamics
(FARM -uh-KO-die-nam-ICS)
the study of the effects of
medications on the body.
General Pharmacology
453
medication , the route by which you administered it (be specific, as in "injected into the right
upper thigh") , the time of administration , and any effects you noted. Remember that the
hospital wi ll continue to give the patient medication and must know what ha already been
administered to carry out a safe treatment plan.
ii@'hJif.f j
It would be impossible to learn and carry around in your head all the type of medications
you might discover your patients are taking. However, the medications a patient is taking may
50)
be a clue to a preexi ting medical condition or, if improperly used, a cau e of the patient's current problem. For example, a patient who i taking antihypertensive and antidiabetics might
also be taking or misusing other medications that can contribute to an altered mental statusperhap Dilantin to control seizures, codeine for pain, or lnderal for a heart rhythm disorder.
Some medications that may be prescribed to a patient for daily use in managing a respiratory
condition (one example would be beclomethasone, another would be Advair [Figure 16-9])
should not be used to reverse an acute attack or to alleviate breathing difficulty.
51) It is a good idea to have a resource from which you can find out additional information
about a patient's medications en route to the hospital. Many ambulances carry a Physician's
Desk Reference, or PDR, for this purpose. Most EMT carry with them, or have easily available access to, a pocket guide that contains useful information such as commonly used drug
abbreviations. These pocket guides u ually list the most commonly prescribed medications
along with the general category of that medication to help you understand what the medication may be u ed for. A high-tech ver ion of this guide is available that can be carried on
a smartphone. This high-tech version is often more comprehensive than the paper version
and more easily updated over the Internet. Several programs are available, orne of them at
52) very little or no cost. However, remember that your main purpo e in finding out what medications the patient is taking is not to make a fie ld diagnosi but to report this information
to medica l direction and hospital personnel.
Table 16-1lists the seven most common categories of medications you will find in the field
that are relevant to patient care, with a few examples of medications in each category. Table
16-2 lists some common herbal agents patients sometimes take. A sizable number of people
u e the e preparations, but they do not always think of them as medications that they should
tell you about when you ask them what medications they take. Some of these agents have
powerful effects, both intended and unintended, and hould be recorded on the prehospital
care report. Many also have interactions with prescription or over-the-counter medications.
There are many other drugs and drug categories in addition to tho e listed in the tables.
Advair is
a medication that may be
prescribed to a patient for daily
management of a respiratory
disease. It should not be used
for emergency treatment of
an acute attack or breathing
difficulty.
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53)
TABLE 16-1
nalbuphine (Nubain)
codeine
oxycodone (OxyContin)
naproxen (Naprosyn)
indomethacin (lndocin)
disopyramide (Norpace)
propranolol (lnderal)
carvedilol (Coreg)
lamotrigine (Lamictal)
phenytoin (Dilantin)
topiramate (Topamax)
primidone (Mysoline)
ethosuximide (Zarontin)
gabapentin (Neurontin)
levetiracetam (Keppra)
clonidine (Catapres)
methyldopa (Aidomet)
guanabenz (Wytensin)
prazosin (Minipress)
BRONCHODILATORS: DRUGS THAT RELAX THE SMOOTH MUSCLES OF THE BRONCHIAL TUBES. THESE MEDICATIONS
PROVIDE RELIEF OF BRONCHIAL ASTHMA AND ALLERGIES AFFECTING THE RESPIRATORY SYSTEM
albuterol (Proventil, Ventolin, Volmax)
salmeterol (Serevent)
albuterol/ipratropium (Combivent, DuoNeb)
montelukast (Singulair)
ipratropium (Atrovent)
levalbuterol (Xopenex)
zafirlukast (Accolate)
ANTIDIABETIC AGENTS: DRUGS PRESCRIBED TO DIABETIC PATIENTS TO CONTROL HYPERGLYCEMIA (HIGH BLOOD SUGAR)
glipizide (Giucotrol)
metformin (Giucophage)
glimepiride (Amaryl)
ANTIDEPRESSANT AGENTS: DRUGS PRESCRIBED TO HELP REGULATE THE EMOTIONAL ACTIVITY OF THE PATIENT TO MINIMIZE
THE PEAKS AND VALLEYS IN THEIR PSYCHOLOGICAL AND EMOTIONAL STATES
amitriptyline (Eiavil)
nefazodone (Serzone)
amoxapine
bupropion (Wellbutrin)
paroxetine (Paxil)
clomipramine (Anafranil)
protriptyline (Vivactil)
venlafaxine (Effexor)
sertraline (Zoloft)
escitalopram (Lexapro)
trimipramine (Surmontil)
fluoxetine (Prozac)
citalopram (Celexa)
imipramine (Tofranil)
NOTE: Generic names are lowercase. Trade names are capitalized.
Chapter 16
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54)
TABLE 16-2
Used For
Herbal Agent
Depression
Echinacea
Garlic
High cholesterol
Ginger root
Saw palmetto
Swollen prostate
Heart failure
Premenstrual syndrome
Feverfew leaf
Migraine prevention
Kava kava
Anxiety
Valerian root
Insomnia
After any medication i given to a pa tient, it i important that yo u rea e s the patient to
ee how the drug has affected him . Obtain another set of vital sign , and compare them to
the vital signs that you took before administering the medication. Ongoing patient as essme nt should include an eva luation of the changes in the patient's condition and vital igns
after administration of medication . Be sure to docume nt th e patie nt's response to each drug
inte rve ntion , for example, ' The patient's re piratory distress decreased after five minutes of
high-concentration oxygen by nonre breathe r mas k."
Assisting in IV Therapy
CORE CONCEPT
How the EMT may assist
in IV therapy
56) What are the two ways fluids and medications may
be administered into the vein:
through a heparin or saline lock: Catheter is placed
into the skin. This lock contains a port through which you
can administer medication. There is no IV bag attached to
a saline lock. used in cases where fluid isn't likely to
be administered but the administration of medication and/
or the need for IV access later on is likely.
through the traditional IV bag, hangs above the patient
and constantly flows fluids and medication into the
patient.
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FIGURE 16-10
A saline
2. The flow regulator i located below the drip chamber. It is a device that can be pushed
up or down to start, stop, or control the rate of flow.
3. The drug or needle port is below the flow regulator. The Paramedic can inject medication into this opening.
58)
An ex tension set includes an extra length of tubing, which can make it easier to
carry or di robe the patient without accidentally pulling out the IV. Extension sets are
sometimes not used with the macro drip set because lengthening tubing reduces the
flow rate.
In mo t ca es a Paramedic or AEMT will insert the IV into the patient's vein. However,
you may be enlisted to help set up the IV administration set. If so, you will need to do the
following tep :
59)
1.
Setting up the
IV administration set:
Take out and inspect the fluid bag (Figure 16-11). The bags come in a protective wrapping to keep them clean. If you are setting up the IV, you must remove the wrapper then
inspect the bag to be sure it contains the fluid that has been ordered. Check the expiration date to make sure the fluid is usable, and look to see that the fluid is clear and free
FIGURE 16- 11
Inspect the IV
Chapter 16
I General Pharmacology
45 7
of pa rticles. Squeeze the bag to check for leaks. Occasionally the fluid comes in a bottle.
If so, be sure it i free of cracks. If a nything is wrong, repo rt the proble m and inspect
anothe r bag or bottle.
2. Select the prope r administra tion e t. Uncoil the tubing, a nd do not le t the end touch
the ground (Figure 16-12).
3. Connect the extension set to the administration set, if an exte n ion set is to be used.
4. Make ure the flow regulator is closed.To do this, roll the stopcock away from the fluid bag.
5. Remove the protective cove ring from the po rt of the fluid bag and the protective covering from the spiked e nd o f the tubing. Insert the spiked e nd of the tubing into the fluid
bag with a quick twist (Figure 16-13). Do this ca refull y. Maintain ste rility. If these parts
touch the ground , they must not be used . Introducing ge rms or dirt directly into a
patie nt's bloodstrea m ca n be extre mely serious and possibly fatal.
6. H old the fluid bag highe r th an the drip chamber. Squeeze the drip cha mber a time or
two to sta rt the fl ow. Fill the chambe r to the marker line (a pproxima tely one-third full).
7. Ope n th e fl ow r gulato r a nd a llow the fluid to flu sh a ll th e air from th e tubin g
(Figure 16-14). You may need to loose n th e ca p a t th e lowe r e nd to g t the fluid to
FIGURE 16- 13
Insert the
spiked end of the tubing into the
fluid bag.
458
FIGURE 16-14
regulator.
flow. Maintain the sterility of the tubing end and replace the cap when you are finished. Most sets can be flushed without removing the cap. Be sure that all air bubbles
have been flushed from the tubing to avoid introducing a dangerous air embolism into
the patient's vein.
8. Turn off the flow (Figure 16-15).
60)
Make certain that the setup stays clean until the Paramedic removes the needle and
connects the IV tubing to the catheter inside the patient' vein. Occasionally the Paramedic
will draw blood from the vein to obtain samples before inserting the IV. You may be asked
to assist by placing the blood in sample tubes and labeling the tubes with the patient's name
and any other information that your hospital requires. Remember that these tubes are
potential carrier of pathogens. Be sure to take Standard Precautions. Carry the blood tubes
to a safe place where they will not be in danger of breaking.
Do not be surprised if you are asked to hold up the patient' arm for a few minutes during a cardiac arrest. During cardiac arrest, medications can be more effective if the arm i
temporarily raised after a drug is injected into the IV.
FIGURE 16- 15
Turn off
t he flow.
Chapter 16
I General Pharmacology
459
Maintaining an IV
61)
An IV must continue to flow at the proper rate once it has been inserted into the patient's
vein. Howeve r, a number of thi ngs may interrupt the flow. If you are charged with maintai ning an IV, be sure to check for and correct the following problems:
The constricting band used to raise the vein for insertion of the needle may have been
mistakenly left on the patient's arm, perhaps covered by a sleeve.
The flow regulator may be closed.
The clamp may be clo ed on the tubing.
The tubing may kink .
The tubing may get caught under the patient or the backboard.
The position of th e IV or of the patien t's arm also may need to be adju ted. Some IVs
flow on ly when the patie nt's arm or IV site is in a certain posi ti on. Adjusting, or even
splinting the arm may be helpful as long as the splint is not too tight. Since the IV flow
usually depends on gravity, b sure that the bag is held well above the IV site and the
patient's heart.
64)
Insufficient flow can cause blood to clot in the catheter. Thi can be prevented by adjusting the flow to an adequate " keep the vein open," or KYO, rate. Although the KYO rate
varies, it is usually about 30 drops per minute for a micro drip and 10 drop per min ute for
a macro drip set. If the drip chamber is overfi lled, cl amp the tubing, invert the drip chamber,
and pump orne fluid back into the bag.
An IV with a flow rate that is too fa t is called a " runaway IV." It can rapidly overload
the pati ent with fluid and ca use serious problems, especially in an infant or child.
An infiltrated IV i one where the needle has e ither punctured the vein and exited the
other side or ha pu ll ed out of the vei n. In eithe r ca e th e fluid is flowin g into the surrounding tissue instead of into the vein. An unnoticed infiltrated IV ca n be very dangerous. Certain high-concentration medications (such as 50 percent dex trose) can cause the
dea th of the surrounding tissue. In addition to complaining of pain, the patient will show
welling at the site (noticeable in all but some obese pati ents). The person in charge of
maintaining the IV must stop the flow and discontinue the IV according to loca l protocol.
If you are not authorized to do this, report the problem immediately to the Paramedic or
medical direction.
If you learn how to help advanced life support personnel tart an IV, set up an administration set, label blood tub s, and maintain an IV, valuable time ca n be saved at the sce ne
and during transport.
63)
67)
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1. You are treating a patient who has chest pain. He tells you his wife has nitroglycerin. He asks if he should take her pills. What should you tell him?
2. You are treating a patient who is diabetic. She appears very sleepy and responds to
only loud verbal stimulus by briefly opening her eyes. The patient's sister says,
"Give her some sugar!" Should you? Why or why not?
3. Your COPD patient is breathing forty-eight times per minute shallowly. His wife
believes his "lung problems" have been acting up. Would the patient's inhaler
he lp him ?