Medication Administration

Medications

Epinephrine (Epi-Pen)

Albuterol (MDI)

Atropine/2-PAM (Mark-1 Kit)

Oral Glucose

Oxygen

6 Rights of Med Aministration

Right Patient

Right Medication

Right Dose

Right Route

Right Time

Right Documentation

Epinephrine

Epi-Pen - single or dual dose

Adult - 1:1,000 solution, 0.3 mL(0.3 mg)

Peds - 1:2,000 solution, 0.3 mL(0.15 mg)

Onset : Seconds

Peak : Minutes

Duration : Several Minutes

What is it?

Non-selective Adrenergic Agonists (ɑ and β)

“Turns on” sympathetic nervous system

Increased HR and contractility

Increased RR

vasoconstrictor or vasodilator

bronchodilator

When to use it?

Allergic Reaction

Asthma

Cardiac Arrest

Allergic Reaction

Mild

itching, rash/hives, watery, red eyes, tingling in mouth

Moderate

anxiety, throat tightness, trouble breathing or swallowing, wheezing, rash/hives, abd pain/cramp, NV

Allergic Reaction

Severe

feeling of impending doom, respiratory distress, hives, decreased LOC, low BP, tachycardia

Anaphylactic shock

like severe accompanied by shock

SBP < 90, HR> 110, life threatening

Management

ABCDs

Oxygen

ID and remove allergen if possible

Monitor condition for worsening

Arrange transport

Epinephrine administration

Epi-Pen Administration

6 Rights of Medications

Remove safety cap

Grasp injector- don’t put thumb over end

Place over outer thigh muscle and push until needle deploys.

Hold in place 10 seconds

Massage sight

Side Effects

Tachycardia

Anxiety

Increased BP

Angina?

AlbuterolProventil, Ventolin, Xoponex

Metered Dose Inhaler (MDI or “Puffer”)

May have spacer

Onset: 5-15 minutes

Peak: .5 - 2 hours

Duration: 3-4 hours

What is it?

Selective β Adrenergic Agonists (β2 > β1)

Relaxes bronchial smooth muscle

other smooth muscle too - vascular, uterine etc.

Increased HR

When to use it?

Bronchospasm

Asthma

Allergic Reaction

Asthma

Mild

mild SOB, may have some wheezing

Moderate

increased SOB, pronounced wheeze, may have prolonged expiration, anxiety

Severe

respiratory distress, may have silent breath sounds, severe anxiety

Management

ABCDs

Oxygen

MDI

Monitor and/or transport

Epi-Pen, in extremis, if available

MDI AdministrationRemove Cap

Shake

Have patient exhale

Have patient place lips around mouthpiece

Have patient breathe in slowly

Depress top as they breathe in

Hold breathe for at least 10 seconds

Repeat every 30 - 60 sec as needed

Side Effects

Dysrythmia, tachycardia

Tremors, anxiety

Nausea, vomiting

Hyperglycemia

Rare paradoxical bronchospasm

Atropine/2 PAM

Mark 1 Kit (autoinjectors)

Atropine: 2 mg in 0.7cc

Pralidoxime (2 PAM) 600 mg in 2 cc

Onset : 1 minute

Peak : 2-5 minutes

Duration : 2 hours

What is it?

Atropine: Competitive antagonist of acetylcholine

2 PAM: Cholinesterase re-activator

Both act to turn off parasympathetic nervous system

When to use it?

Anticholinesterase exposre

Nerve Gas/WMD

Organophosphate (insecticide)

Atropine has other uses - including cardiac arrest, symptomatic bradycardia etc

Parasympathetic Nervous System

AnticholinesteraseExposure

Turns on Parasympathetic nervous system

S - salivation

L - lacrimation

U - urination

D - defecation

G - GI distress

E - Eye constriction

AnticholinesteraseExposure

Turns on Parasympathetic nervous system

D - defecation

U - urination

M - miosis (pupil constriction)

B - bronchorhea, bradycardia

E - emesis

L - lacrimation

S - salivation

AnticholinesteraseExposure

Respiratory Arrest

Seizure

Coma

Death

Management

Do not expose yourself

ABCDs/Oxygen

Decontamination

Atropine

2 PAM

Arrange transport

Atropine/2 PAM Administration

6 Rights of Medications

Remove safety cap

Grasp injector- don’t put thumb over end

Place over outer thigh muscle and push until needle deploys.

Hold in place 10 seconds

Massage sight

Atropine/2 PAM Administration

Give atropine first

Mild

Atropine q5 minutes until effect

2 PAM q15 minutes times three

Severe

Give 3 doses each in rapid succession

Can give atropine q5 with no limit

Grasp injector- don’t put thumb over end

Place over outer thigh muscle and push until needle deploys.

Hold in place 10 seconds

Massage sight

Side Effects

Dry mouth, thirst

Hot, dry, flushed skin

Fever, palpitations, restlessnes

Delerium

Oral Glucose

Adult - 15-45 G PO

Peds - 5-45 G PO

Onset : 10 minutes

Duration : uncertain

When to use it?

Symptomatic Hypoglycemia

SymptomaticHypoglycemia

Typically patients on DM medication

Mild/Moderate

funny feeling, anxiety, sweatiness, shaky

Severe

altered mental status, decreased LOC, seizure

Patients typically can tell

Management

ABCDs

Check glucometer if possible

Administer PO glucose if patient can handle secretions

Give other food PO once recovered

Patients on oral hypoglycemic meds should be transferred due to long half-life

Side Effects

Hyperglycemia

Oxygen

Used liberally in pre-hospital setting

Air is ~20% oxygen

2LNC ~24%

10L FM ~57%

10L NRB ~68%

Oxygen

Generally safe

Oxygen toxicity from prolonged exposure to high partial pressures

COPD pts may have blunted respiratory response

In ski patrol setting there should be no contra-indication