DMACC EMT Chapter 14

1. PREHOSPITALPREHOSPITAL
EMERGENCY CAREEMERGENCY CARE
CHAPTER
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Prehospital Emergency Care, 10th
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TENTH EDITION
Pharmacology and
Medication
Administration
14

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Learning ReadinessLearning Readiness
• EMS Education Standards, text p. 396

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Learning ReadinessLearning Readiness
ObjectivesObjectives
• Please refer to page 396 of your text to
view the objectives for this chapter.

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Learning ReadinessLearning Readiness
Key TermsKey Terms
• Please refer to page 396 of your text to
view the key terms for this chapter.

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Setting the StageSetting the Stage
• Overview of Lesson Topics
 Administering Medications
 Medications Commonly Administered by
the EMT
 Medication Names
 Routes of Administration
 Medication Forms
continued on next slide

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Setting the StageSetting the Stage
• Overview of Lesson Topics
 Essential Medication Information
 Key Steps in Administering Medications
 Reassessment Following Administration
 Sources of Medication Information

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Case Study IntroductionCase Study Introduction
As EMT Nate Quick approaches the
patient, he sees that the patient, who is
sitting on the ground, leaning forward to
support himself with his hands, is in
respiratory distress. The patient, a
teenage boy, does not acknowledge his
presence, and appears pale and sweaty.
continued on next slide

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Case Study IntroductionCase Study Introduction
"Hurry!" exclaims the woman kneeling
next to the boy. "He is allergic to bees.
He was stung by a wasp! I don't know
how to use his epinephrine injector."

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Case StudyCase Study
• What is your initial impression of how
serious the patient's condition is?
• How is epinephrine beneficial to a
patient with a serious allergic reaction?
• What would you need to know about
epinephrine before administering it?

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IntroductionIntroduction
• EMTs administer or assist in the
administration of medications.
• You must be completely familiar with
medications and the proper procedures
for giving them.
• Medications are administered under
medical direction.

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Administering MedicationsAdministering Medications
• A drug, or medication, is a chemical
that is used to treat or prevent a
disease or condition.
• The study of drugs is called
pharmacology.
continued on next slide

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Administering MedicationsAdministering Medications
• Medications have specific effects on the
body.
• When administered correctly, the
patient's condition may improve
significantly.
• When administered inappropriately,
drugs can cause serious side effects.
continued on next slide

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Administering MedicationsAdministering Medications
• EMTs only administer or assist with
drugs listed in their protocols with
medical direction approval.

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Medications Administered by EMTsMedications Administered by EMTs
• Drugs that may be carried on the
ambulance
 Oxygen
 Oral glucose
 Activated charcoal
 Aspirin
continued on next slide

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Medications Administered by EMTsMedications Administered by EMTs
• Oxygen
 A medical gas that is indicated when:
• You suspect hypoxia, hypoxemia.
• The patient complains of dyspnea or is in
respiratory distress.
• The patient has signs of shock or poor
perfusion.
• The SpO2 is less than 94%.
continued on next slide

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Medications Administered by EMTsMedications Administered by EMTs
• Supplemental oxygen increases the
amount of oxygen available to bind to
hemoglobin in the patient's blood.
continued on next slide

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Medications Administered by EMTsMedications Administered by EMTs
• Oral glucose
 Brain cells require an uninterrupted
supply of glucose.
 Oral glucose may be administered to
diabetics with low blood glucose levels.
continued on next slide

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Medications Administered by EMTsMedications Administered by EMTs
• Activated charcoal
 A fine black powder
 May be administered in some cases of
ingested poisoning to adsorb the poison
and prevent its absorption into the body
continued on next slide

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Medications Administered by EMTsMedications Administered by EMTs
• Aspirin
 Administered to patients with chest
discomfort or pain related to a lack of
oxygen supplied to the heart
 May prevent complete blockage of
coronary arteries by interfering with
platelet function
continued on next slide

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Medications Administered by EMTsMedications Administered by EMTs
• EMTs may give or assist with giving
some medications that are not carried
on the ambulance, but which are
prescribed to the patient.
continued on next slide

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Medications Administered by EMTsMedications Administered by EMTs
• Medications prescribed to patients
 Inhaled bronchodilators
 Nitroglycerin
 Epinephrine
continued on next slide

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Medications Administered by EMTsMedications Administered by EMTs
• Inhaled bronchodilators
 Prescribed to patients with chronic
respiratory disease
 Given by metered-dose inhaler or small-
volume nebulizer
 EMTs may only administer medications
that are beta2 agonists, designed to
dilate the bronchioles.
 Drugs include albuterol and levalbuterol.
continued on next slide

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Medications Administered by EMTsMedications Administered by EMTs
• Nitroglycerin
 Used by cardiac patients
 Dilates blood vessels to reduce workload
of the heart and allow increased blood
flow to the heart muscle
 Hypotension is a major side effect.
 Must not be given to patients who have
recently taken drugs for erectile
dysfunction
continued on next slide

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Medications Administered by EMTsMedications Administered by EMTs
• Epinephrine
 Used to treat severe allergic reactions
(anaphylaxis)
 Reverses vasodilation,
bronchoconstriction, and increased
capillary permeability through actions on
the sympathetic nervous system
 Patients with severe allergies may carry
an epinephrine autoinjector.

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Case StudyCase Study
Kneeling next to the patient, Nate can
hear stridor and wheezing, and he
detects a weak, rapid radial pulse. The
patient is unable to speak. With the
history of bee sting allergy, a witnessed
bee sting, and signs of severe distress
associated with anaphylaxis, Nate knows
he must act quickly. Following protocol,
Nate prepares to administer the
epinephrine autoinjector. continued on next slide

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Case StudyCase Study
• What is the medication form that Nate
is about to administer?
• By what route will Nate administer the
medication?
• What are the steps that Nate must
follow in administering the medication?

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Medication NamesMedication Names
• Drugs have the following categories of
names:
 Chemical
 Generic
 Trade
 Official
continued on next slide

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Medication NamesMedication Names
• Example:
 Chemical Name: 1,2,3-propanetriol
trinitrate
 Generic Name: nitroglycerin tablets
 Official Name: nitroglycerin tablets,
U.S.P.
 Trade Name: Nitrostat

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Routes of AdministrationRoutes of Administration
• The route is how the medication is
given to or taken by the patient.
• The route affects how fast the
medication is absorbed by the body and
its effect.
continued on next slide

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Routes of AdministrationRoutes of Administration
• EMTs commonly give medications by
these routes:
 Sublingual
 Oral
 Inhalation
 Intramuscular injection
continued on next slide

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Routes of AdministrationRoutes of Administration
• Sublingual
 Medication is placed beneath the
patient's tongue, where it is dissolved
and absorbed.
 Used only in alert patients
 Used to administer nitroglycerin tablets
and spray
continued on next slide

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Routes of AdministrationRoutes of Administration
• Oral
 The drug is swallowed for absorption
through the gastrointestinal tract
(activated charcoal is not absorbed).
 Used only in alert patients
 Used to administer aspirin, oral glucose,
activated charcoal
continued on next slide

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Routes of AdministrationRoutes of Administration
• Inhalation
 Used for gases and aerosols
 Medication is inhaled into the lungs for
absorption.
 Used to administer oxygen and
medications given by metered-dose
inhaler or small-volume nebulizer
continued on next slide

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Routes of AdministrationRoutes of Administration
• Intramuscular injection
 Drug is injected into a muscle mass for
absorption.
 Requires use of a needle
 Some discomfort to patient
 Used to administer epinephrine by
autoinjector

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Medication FormsMedication Forms
• The form usually limits administration
to one specific route.
• Common forms include:
 Compressed powder or tablet
continued on next slide

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Aspirin, in pill form, may be administered for chest pain when a heart attack is suspected.
continued on next slide

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Medication FormsMedication Forms
• Common forms include:
 Liquid for injection
continued on next slide

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The epinephrine auto-injector may be prescribed for patients with a history of severe allergic or anaphylactic
reaction. The EpiPen is a brand of epinephrine auto-injector.
continued on next slide

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Medication FormsMedication Forms
• Common forms include:
 Gel
continued on next slide

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Oral glucose is a viscous gel used in acute diabetic emergencies. It is carried on the EMS unit.
continued on next slide

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Medication FormsMedication Forms
• Common forms include:
 Suspension
continued on next slide

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Activated charcoal is administered in suspension form and is carried on some EMS units. It may be used in
poisoning and overdose emergencies.
continued on next slide

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Medication FormsMedication Forms
• Common forms include:
 Fine powder for inhalation
continued on next slide

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A metered-dose inhaler or a metered-dose inhaler with a spacer may be prescribed for respiratory conditions.
continued on next slide

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Medication FormsMedication Forms
• Common forms include:
 Small-volume nebulizer
continued on next slide

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Nebulized medications may be administered by a small-volume nebulizer, through either a mouthpiece or a face
mask. (© Carl Leet, YSU)
continued on next slide

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Medication FormsMedication Forms
• Common forms include:
 Gas
continued on next slide

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The gas oxygen is considered a medication. It is the most commonly used medication in EMS and is carried on
the EMS unit.
continued on next slide

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Medication FormsMedication Forms
• Common forms include:
 Spray
continued on next slide

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The EMT may assist the patient with administration of nitroglycerin prescribed for chest pain. Two common forms
are tablet and spray.

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Essential Medication InformationEssential Medication Information
• For each medication, you must
understand the following information:
 Indications
 Contraindications
 Dose
 Administration
 Actions
 Side effects
continued on next slide

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Essential Medication InformationEssential Medication Information
• Indications
 The most common uses of the drug in
treating a specific condition
 Geared toward relief of signs,
symptoms, or specific conditions
continued on next slide

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Essential Medication InformationEssential Medication Information
• Contraindications
 Situations in which the drug should not
be administered because of the harm it
could cause
continued on next slide

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Essential Medication InformationEssential Medication Information
• Dose
 The amount of the drug that is given to
the patient
continued on next slide

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Essential Medication InformationEssential Medication Information
• Administration
 The route by which the medication is
given to the patient
continued on next slide

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Essential Medication InformationEssential Medication Information
• Actions
 The effect the drug has on the body
• The therapeutic effect is the intended
positive response by the body.
• The mechanism of action is how the drug
works to create its effect on the body.
continued on next slide

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Essential Medication InformationEssential Medication Information
• Side effects
 Actions that are not desired and that
occur in addition to the desired
therapeutic effects
 May be predictable or unpredictable

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Click on the term that is used to describe reasonsClick on the term that is used to describe reasons
why a medication must not be given to a patient.why a medication must not be given to a patient.
A. Side effects
B. Indications
D. Contraindications
C. Actions

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Steps in Medication AdministrationSteps in Medication Administration
• Follow these steps in administering
medication:
 Obtain an order from medical direction.
 Select the proper medication.
 Verify the patient's prescription.
 Check the expiration date.
continued on next slide

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Steps in Medication AdministrationSteps in Medication Administration
• Follow these steps in administering
medication:
 Check for discoloration or impurities.
 Verify the form, route, and dose.
 Check the Five Rights of medication
administration.
 Document medication administration.
continued on next slide

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Steps in Medication AdministrationSteps in Medication Administration
• Obtain an order from medical direction.
 Every medication EMTs administer or
assist with requires an order from
medical direction.
 The order may be obtained on-line or
off-line.
 Verify an on-line order by restating it.
continued on next slide

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Steps in Medication AdministrationSteps in Medication Administration
• Select the proper medication.
 Read the label carefully.
continued on next slide

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Steps in Medication AdministrationSteps in Medication Administration
• Verify the patient's prescription.
 When assisting with the patient's
medication, verify that the medication to
be given is prescribed to him.
continued on next slide

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Steps in Medication AdministrationSteps in Medication Administration
• Check the expiration date.
 Do not administer expired medications.
continued on next slide

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Steps in Medication AdministrationSteps in Medication Administration
• Check for discoloration or impurities.
 Inspect for discoloration and cloudiness.
 Do not give discolored or cloudy
medications.
continued on next slide

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Steps in Medication AdministrationSteps in Medication Administration
• Verify the form, route, and dose.
 Use the proper form for the route
selected.
 Make sure the label matches the order
from medical direction.
continued on next slide

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Steps in Medication AdministrationSteps in Medication Administration
• Check the Five Rights of Medication
Administration.
 Right patient
 Right medication
 Right route
 Right dose
 Right time
continued on next slide

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Steps in Medication AdministrationSteps in Medication Administration
• Documentation
 Drug
 Dose
 Route
 Time
 Changes in patient's condition

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ReassessmentReassessment
• You must reassess the patient after
medication administration.
 Mental status
 Airway
 Respirations
 Pulse
 Skin
 Blood pressure
continued on next slide

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ReassessmentReassessment
• You must reassess the patient after
medication administration.
 SpO2
 Change in complaints/relief of signs and
symptoms
 Medication side effects
 Change in patient's condition

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Sources of Medication InformationSources of Medication Information
• American Hospital Formulary Service
• AMA Drug Evaluation
• Physicians' Desk Reference (PDR)
• Package inserts
• Poison control centers
• EMS pocket drug reference guide
• ePocrates

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Case Study ConclusionCase Study Conclusion
As Nate's partner assists the patient's
ventilations, Nate mentally reviews the
protocol for anaphylaxis, which allows
him to administer a patient's epinephrine
pen in such circumstances. He confirms
that the medication belongs to the
patient, and checks the name, dosage,
and expiration date.
continued on next slide

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Case Study ConclusionCase Study Conclusion
He administers the drug by the
intramuscular route, and prepares to
repeat the primary assessment and
perform a secondary assessment.
Fortunately, the epinephrine begins
working quickly, but Nate knows that its
effects are short-lived, and that they
must work quickly to get the patient to
the hospital.

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Lesson SummaryLesson Summary
• Medication administration is a
considerable responsibility.
• EMTs give medications only under
medical direction.
• You must understand the indications,
contraindications, dose, administration
route and form, actions, and side
effects.
continued on next slide

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Lesson SummaryLesson Summary
• The Five Rights of Medication
Administration are:
 Right patient
 Right medication
 Right route
 Right dose
 Right time