Advanced EMT A Clinical-Reasoning Approach 2nd Edition

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Advanced EMT
A Clinical-Reasoning Approach, 2nd Edition
Chapter 13
Medications

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• Applies fundamental knowledge of medications in
the Advanced EMT scope of practice to patient
assessment and management.
Advanced EMT
Education Standard

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1. Define key terms introduced in this chapter.
2. Describe the drug profiles for each of the following
medications:
– Acetaminophen
– Activated charcoal
– Aspirin
– Dextrose 50 percent, 25 percent, and 10 percent for treating
hypoglycemia, and 5 percent in water for intravenous infusion
– Epinephrine 1:1,000
– Glucagon
– Ibuprofen
Objectives (1 of 2)

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2. Describe the drug profiles for each of the following
medications:
– Inhaled beta2 agonists
– Lactated Ringer’s solution for intravenous infusion
– Naloxone
– Nitroglycerin tablets and spray
– Nitrous oxide
– Oral glucose
– Other isotonic intravenous solutions as allowed by medical
direction
– Oxygen
– Sodium chloride solution 0.9 percent for intravenous infusion
Objectives (2 of 2)

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• AEMTs administer limited number of medications
• Must know key information about each drug
(drug profile)
• Call medical direction for guidance when needed
Introduction

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• What are some initial hypotheses about causes of
the patient’s condition?
• What additional information would assist David
and Christy in determining the cause of the
patient’s condition?
• What treatments should David and Christy
implement as they continue their assessment?
Think About It

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• Medications are part of supplies and equipment
– Inventoried at beginning of each shift
 Account for each medication
 Proper quantity
 Not expired
Medications in Patient Care (1 of 2)

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• You must know
– Indications/contraindications
– Mechanism of action
– Correct dose
– Expected effects
– Side effects
– Special considerations
Medications in Patient Care (2 of 2)

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• Intravenous fluids are medications that have
indications, contraindications, and side effects.
• Indications
– Replace lost circulatory volume from blood loss, burns,
and dehydration
– Establish route for medication administration
IV Solutions (1 of 4)

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• Normal saline crystalloid solution: water and
electrolytes (sometimes dextrose)
– May be hypotonic, isotonic, hypertonic
• Common IV fluids used in EMS
– Normal saline (0.9% sodium chloride solution)
– Dextrose, 5% in water
– Lactated Ringer’s solution
IV Solutions (2 of 4)

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• Normal saline
– Rehydration
– Vascular volume replacement
– Diluting medications for intravenous infusion
• Dextrose solutions (D5W)
– Patient benefits from intravenous carbohydrates
– Keep open IV in patients prone to fluid overload
IV Solutions (3 of 4)

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• Lactated Ringer’s (LR) solution
– Patients with acidosis (hypovolemic shock or diabetic
ketoacidosis)
– Patients with hypokalemia
IV Solutions (4 of 4)

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• Normal Saline (0.9% Sodium Chloride Solution)
for IV Infusions
– Class
– Description
– Mechanism of action
– Indication
– Contraindication
IV Fluids (1 of 3)
– Precautions
– Side effects
– Dosage
– Route
– How supplied

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• 5% Dextrose in Water for Intravenous Infusion
– Class
– Description
– Mechanism of action
– Indication
– Contraindication
IV Fluids (2 of 3)
– Precautions
– Side effects
– Dosage
– Route
– How supplied

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• Lactated Ringer’s Solution
– Class
– Description
– Mechanism of action
– Indication
– Contraindication
IV Fluids (3 of 3)
– Precautions
– Side effects
– Dosage
– Route
– How supplied

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• Inhaled bronchodilator
– Class
– Description
– Mechanism of action
– Indication
– Contraindication
Medications—Albuterol Sulfate
– Precautions
– Side effects
– Interactions
– Dosage
– Route
– How supplied

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• Important in the treatment of acute myocardial
infarction; inhibits platelet aggregation to reduce
additional blood clotting
– Class
– Description
– Mechanism of action
– Indication
– Contraindication
Medications—Aspirin
– Precautions
– Side effects
– Interactions
– Dosage
– Route
– How supplied

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• Used to supply sugar to patients with acute
hypoglycemia with decreased LOC
– Class
– Description
– Mechanism of action
– Indication
– Contraindication
Medications—50% Dextrose
– Precautions
– Side effects
– Interactions
– Dosage
– Route
– How supplied

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• Used in patients with anaphylaxis either with
autoinjector or drawing up in a syringe and
administering
– Class
– Description
– Mechanism of action
– Indication
– Contraindication
Medications—Epinephrine 1:1,000
– Precautions
– Side effects
– Interactions
– Dosage
– Route
– How supplied

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• Promotes the breakdown of glycogen in the liver
into glucose to increase blood glucose levels
– Class
– Description
– Mechanism of action
– Indication
– Contraindication
Medications—Glucagon (1 of 2)
– Precautions
– Side effects
– Interactions
– Dosage
– Route
– How supplied

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• Administered orally in hypoglycemic patients who
are awake and are not at risk of aspiration
– Class
– Description
– Mechanism of action
– Indication
– Contraindication
Medications—Glucagon (2 of 2)
– Precautions
– Side effects
– Interactions
– Dosage
– Route
– How supplied

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• Used to reverse respiratory depression associated
with narcotic overdose
– Class
– Description
– Mechanism of action
– Indication
– Contraindication
Medications—Naloxone
– Precautions
– Side effects
– Interactions
– Dosage
– Route
– How supplied

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• Causes vascular smooth muscle relaxation,
resulting in dilation of the coronary arteries and
systemic vasculature to increase myocardial
perfusion and reduce myocardial workload
– Class
– Description
– Mechanism of action
– Indication
– Contraindication
Medications—Nitroglycerin: Sublingual
Tablets and Spray
– Precautions
– Side effects
– Interactions
– Dosage
– Route
– How supplied

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• Inhaled anesthetic or analgesic in the presence of
severe pain from musculoskeletal injury or acute
myocardial infarction
– Class
– Description
– Mechanism of action
– Indication
– Contraindication
Medications—Nitrous Oxide
– Precautions
– Side effects
– Interactions
– Dosage
– Route
– How supplied

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• A compressed gas necessary for cellular energy
production
– Class
– Description
– Mechanism of action
– Indication
– Contraindication
Medications—Oxygen
– Precautions
– Side effects
– Interactions
– Dosage
– Route
– How supplied

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• Adsorbent for ingested toxins
– Class
– Description
– Mechanism of action
– Indication
– Contraindication
Medications—Activated Charcoal
– Precautions
– Side effects
– Interactions
– Dosage
– Route
– How supplied

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• Nonprescription analgesic and antipyretic
– Class
– Description
– Mechanism of action
– Indication
– Contraindication
Medications—Acetaminophen
– Precautions
– Side effects
– Interactions
– Dosage
– Route
– How supplied

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• Nonsteroidal anti-inflammatory (NSAID)
– Class
– Description
– Mechanism of action
– Indication
– Contraindication
Medications—Ibuprofen
– Precautions
– Side effects
– Interactions
– Dosage
– Route
– How supplied

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• Nerve agent antidote kits
– Homeland security precautions
– Prefilled injectors of atropine (2 mg);
pralidoxime chloride (600 mg)
– Antidotes for organophosphate nerve agents
(tabun, sarin, VX)
Medications

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Chapter Summary
• As an AEMT, you will be responsible for not only
knowing which medication is indicated for use but
also what medication will do to, and for, the
patient.
• Maintain working knowledge of medications.