Medication Administration Medications Epinephrine EpiPen Albuterol MDI Atropine2
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 m. L(0. 3 mg) Peds - 1: 2, 000 solution, 0. 3 m. L(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?
Albuterol Proventil, 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 (β 2 > β 1) 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 Administration Remove 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. 7 cc 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
Anticholinesterase Exposure Turns on Parasympathetic nervous system S - salivation L - lacrimation U - urination D - defecation G - GI distress E - Eye constriction
Anticholinesterase Exposure Turns on Parasympathetic nervous system D - defecation U - urination M - miosis (pupil constriction) B - bronchorhea, bradycardia E - emesis L - lacrimation S - salivation
Anticholinesterase Exposure 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 Mild Administration Give atropine first Atropine q 5 minutes until effect 2 PAM q 15 minutes times three Severe Give 3 doses each in rapid succession Can give atropine q 5 with no limit Grasp injector- don’t put thumb over end Place over outer thigh muscle and push until
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
Symptomatic Typically patients on DM medication Hypoglycemia 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 2 LNC ~24% 10 L FM ~57% 10 L 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 contraindication
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