EMT Lecture - General Pharmacology

Pharmacology for EMTs: Understanding Medications

Introduction to EMT Pharmacology

• EMTs will encounter various medications during patient care, but there is limited time in training to cover all types.

• The focus of this lecture is on the specific medications that EMTs in New York State are permitted to carry and administer.

Medication Administration Guidelines

• When responding to a call, family members may inquire about missed medications; however, EMTs should generally advise against administering them without proper knowledge.

• There are exceptions where EMTs can assist patients with their own medications or use those carried in their kits.

Key Pharmacological Concepts

• Pharmacodynamics: Refers to how a medication acts on the body; key terms include agonist (stimulates) and antagonist (blocks).

• Example: A sympathetic agonist stimulates the sympathetic nervous system, while an antagonist blocks its effects.

Indications and Contraindications

• Indication: The reason for using a medication or treatment; it justifies its administration.

• Contraindication: A condition that serves as a reason not to use a particular treatment even if indications are met. This concept applies equally to medications as it does to other medical interventions like traction splints.

Understanding Drug Names

• Every medication typically has at least two names: a trade name (e.g., Tylenol) and a generic name (e.g., acetaminophen). Trade names are proprietary and cannot be used by others without permission from the owning company.

• Generic drugs often provide the same efficacy at lower costs compared to brand-name versions, which is important for cost-effective patient care decisions. For example, purchasing acetaminophen generically can save money compared to buying Tylenol directly from retailers like Rite Aid or Costco.

Over-the-Counter vs Prescription Medications

Understanding Drug Administration Methods

Forms of Medications

• Medications can be categorized into different forms: solids, liquids, and gases. The discussion will cover these forms in more detail later.

Routes of Drug Administration

• Two primary routes for drug administration are identified: enteral (through the digestive tract) and parenteral (bypassing the digestive tract).

• EMTs are permitted to use specific methods for delivering drugs, including oral (PO) and sublingual (under the tongue), both marked with a star indicating EMT approval.

Parenteral Methods

• Other parenteral methods include intravenous (IV), intraosseous (IO), intranasal, intramuscular, subcutaneous (sub-Q), and transdermal. However, EMTs cannot administer inhalation or transdermal medications.

• Subcutaneous injections typically involve insulin administered by patients using very short needles.

Pulse Oximetry: A New Tool for EMTs

Introduction to Pulse Oximetry

• Pulse oximeters have recently become available for EMT use; they provide critical information about oxygen saturation levels in patients.

Importance of Proper Use

• While pulse oximeters can be valuable tools when used correctly, improper usage can lead to significant errors in patient assessment.

Understanding Readings from Pulse Oximeters

• Pulse oximetry provides two key readings: SpO2 (oxygen saturation level in hemoglobin) and heart rate. However, it does not indicate whether the heart rate is regular or irregular.

Limitations of Pulse Oximetry

• The accuracy of pulse oximeter readings can be compromised if users do not understand how they function. For instance, an average heart rate reading may not reflect true cardiac rhythm.

Key Considerations Regarding Oxygen Saturation

Interpreting SpO2 Levels

Understanding Pulse Oximetry and Its Limitations

The Basics of Pulse Oximetry

• Pulse oximeters measure hemoglobin levels in arterial blood, but their effectiveness can be compromised by various factors.

• Cold temperatures can affect blood flow to extremities, leading to inaccurate readings when using a pulse oximeter.

• External factors like nail polish (e.g., red nail polish) can interfere with the device's ability to read hemoglobin saturation accurately.

Clinical Implications of Readings

• In emergency situations, low SpO2 readings (e.g., 76%) indicate hypoxia and necessitate immediate medical intervention.

• Asthmatic patients may show misleadingly high SpO2 levels despite experiencing severe respiratory distress due to difficulty in air exchange.

Interpreting Data vs. Patient Condition

• A pulse oximeter provides a numerical value that should not be solely relied upon; it does not reflect overall respiratory function or ventilation status.

• Vital signs must be interpreted in conjunction with patient presentation; for instance, a patient appearing critically ill should not be dismissed based on an artificially high SpO2 reading.

Monitoring Techniques and Equipment Evolution

• Modern pulse oximeters have become more affordable and compact over time, enhancing accessibility for medical professionals.

• It is crucial for medics to prioritize treating the patient rather than focusing exclusively on monitor readings; real-life observations take precedence.

Recognizing Hypoxia and Treatment Protocol

• Conditions such as cyanide poisoning can yield misleadingly high SpO2 values, emphasizing the need for comprehensive assessment beyond just numbers.

Understanding Mucous Membranes and Oxygen Delivery

Overview of Mucous Membranes

• The term "mucous membranes" refers to wet tissues found in areas like the eyelids and mouth, which can indicate health issues such as hypoxia.

• Cyanosis is a visible sign of oxygen deprivation, particularly noticeable in darker-skinned individuals where it manifests as a bluish tint.

Oxygen as a Medical Intervention

• Oxygen is considered a drug; its administration is crucial even if the patient has hypoxic conditions. It’s important to treat all patients consistently regardless of their condition.

• A metered dose inhaler (MDI) is introduced as both an at-home medication for patients and one that medical professionals may carry.

Usage of Metered Dose Inhalers

• MDIs are commonly used by asthmatic patients; they should be administered correctly to avoid misuse or accidents during assistance.

• Patients may have their inhalers readily available at home, making it quicker to use their own device rather than setting up professional equipment.

Administration Techniques

• When assisting with an MDI, ensure the six rights of medication administration are followed. The specific name on the inhaler does not limit its use if it's indicated for respiratory issues.

• Spacers can enhance delivery effectiveness for children who struggle with using MDIs properly. They help ensure medication reaches the lungs instead of being wasted.

Important Considerations for EMTs

• While spacers are typically used for younger children, older children usually do not require them.

Understanding Dosage and Administration of Medications

Introduction to Medication Dosage

• Each packet contains one dose; the specific dosage for the New York City Medical Examiner's is 0.0834.

• The importance of checking expiration dates on medication vials is emphasized, particularly for "our butyl."

Administration Techniques

• Proper technique involves breaking the seal and squeezing the entire vial into a nebulizer connected to oxygen.

• Understanding that "our butyl" acts as a bronchodilator is crucial; it helps alleviate bronchospasms during an asthma attack.

Mechanism of Action

• Bronchodilation allows more oxygen to enter the lungs, which is vital during an asthma attack when alveoli constrict.

• Wheezing typically occurs during exhalation due to difficulty expelling air through constricted passages.

Introduction to Glucometers in Emergency Medical Services

Usage and Procedure

• EMTs are now permitted to use glucometers, which require a small drop of blood from a fingertip for testing.

• It's essential to clean and dry the finger before testing; failure to do so can lead to inaccurate readings.

Testing Process

• A full drop of capillary blood is needed for accurate glucose level readings, with results available within seconds.

• The setup includes disposable components: pricking device, test strip, and non-disposable machine.

Blood Glucose Level Insights

• Normal blood glucose levels have shifted; anything above 60 mg/dL is now considered acceptable in New York City due to shortages in dextrose supplies.

• The previous standard was based on remembering blood pressure norms (120/80), simplifying learning for EMT students.

Conclusion on Equipment Use

Understanding Changes in EMT Protocols

Overview of Previous and Current Roles

• The speaker discusses the evolution of EMT protocols, highlighting that previously, if a patient was known to be diabetic and conscious, glucose administration was straightforward.

• Now, EMTs are instructed to check blood glucose levels before administering glucose, particularly if levels are below 60 or between 60 to 80 with hypoglycemic symptoms.

Importance of Blood Glucose Monitoring

• The speaker emphasizes the critical difference between low blood sugar (hypoglycemia) and high blood sugar (hyperglycemia), noting that while hypoglycemia can lead to immediate danger, hyperglycemia typically does not result in acute death.

• A sliding scale is introduced where zero represents death and 60 represents the lowest normal level; this illustrates how small changes in glucose can have significant implications for patient safety.

Clinical Judgment vs. Machine Reliance

• The speaker argues against over-reliance on glucometers, advocating for clinical judgment based on observable symptoms rather than solely machine readings.

• While acknowledging that machines provide accurate data, the speaker stresses the importance of using clinical experience alongside technology.

Administering Glucose Safely

• Guidelines for administering glucose are provided: it should only be given to conscious patients; if a patient becomes unconscious during administration, EMTs must stop immediately.

• Practical tips include mixing glucose with juice for easier consumption by conscious patients and ensuring they can hold the cup themselves.

Emergency Situations Without Resources

• In scenarios lacking resources like juice or cups, EMTs should administer glucose directly into the cheek but avoid using fingers due to potential complications.

Aspirin and Epinephrine in EMS

Understanding Aspirin Administration

• The type of aspirin used in EMS is 81 mg chewable aspirin, which should not be given with water.

• New York State allows a maximum total dose of 324 mg (four 81 mg tablets) for patients suspected of having cardiac events.

• Chewable baby aspirin is administered to patients experiencing potential myocardial infarction; it must be chewed, not swallowed.

• Regular 325 mg aspirin taken with water takes approximately 45 minutes to an hour to work, while chewable aspirin acts much faster in emergencies.

• Aspirin functions as an anticoagulant that prevents the formation of larger clots but does not dissolve existing clots.

Key Points on Epinephrine Use

• Epinephrine serves dual purposes: it acts as a bronchodilator and a vasoconstrictor, useful in cases like anaphylaxis and severe asthma attacks.

• It is particularly effective when other treatments (like albuterol) fail; epinephrine can provide rapid relief by opening airways and constricting blood vessels.

• Administered intramuscularly (IM), epinephrine should be injected into the lateral thigh muscle for optimal absorption.

• Proper administration technique involves holding the injector against the thigh for ten seconds after injection to ensure full delivery of the medication.

Understanding the Use of Narcan in Overdose Situations

Overview of Narcan Administration

• New York City has approved a new dosage protocol for Narcan, increasing from 1 milligram per nostril to 4 milligrams as a one-time use shot.

• An atomizer is essential for administering Narcan; it allows the drug to be delivered through the nostrils effectively.

Atomizer and Drug Packaging

• The atomizer is a small device that EMTs must carry; it fits into the nostril and delivers the medication.

• The packaging includes both the drug vial and an atomizer, which are separate items. The atomizer is disposable and crucial for administration.

• The assembly involves screwing the drug into the atomizer, which then allows for proper dosing.

Mechanism of Action

• When administered correctly, Narcan creates a mist that penetrates the mucosal membrane of the nose, ensuring effective absorption.

• This method was developed after initial IV-only usage; thus, not all components were included in early packaging.

Identifying Opioid Overdoses

• Effective use of Narcan requires recognizing signs of overdose: respiratory distress and constricted pupils are key indicators.

• Common opioids involved include heroin, fentanyl, morphine, oxycodone, and dilaudid. Respiratory issues signal when to administer Narcan.

Responding to Overdose Situations

• Observing patient behavior (e.g., "heroin wobble") can indicate opioid influence but does not always correlate with respiratory distress.

• Initial assessments should focus on airway management (ABC check), especially if encountering someone unresponsive on the street.

Gathering Contextual Information

• Information from bystanders or friends can provide critical context about what occurred before finding an unresponsive individual.

Understanding Narcan and Its Administration

The Importance of Breathing Assessment

• Assessing a patient's breathing is crucial; if they are not breathing, it may indicate severe issues.

• Constricted pupils can signal an overdose situation, necessitating immediate action such as calling emergency services.

Narcan: Usage and Effects

• Narcan (naloxone) has side effects but is generally considered safe; however, its administration can lead to violent reactions in patients recovering from opioid overdoses.

• Patients may react violently upon awakening from an overdose due to the sudden return to consciousness after being in a drug-induced state.

Administration Techniques

• Administering just enough Narcan to restore breathing without fully waking the patient is recommended for safety.

• If a patient is breathing adequately, administering Narcan becomes unnecessary and contraindicated.

Nitroglycerin: Indications and Precautions

Overview of Nitroglycerin

• Nitroglycerin is a potent vasodilator used primarily for cardiac-related chest pain; it comes in pill form that must be placed under the tongue.

• Despite its small size, nitroglycerin pills are extremely powerful and can significantly lower blood pressure.

Guidelines for Administration

• In New York State, EMT personnel cannot assist with nitroglycerin if the patient's systolic blood pressure is below 120 mmHg.

• This medication should only be administered if the patient has prescribed it for angina and meets specific criteria regarding their condition.

Storage and Expiration Considerations

• Nitroglycerin pills have long expiration dates but lose potency when exposed to light or stored improperly.

• Proper storage in dark bottles away from sunlight is essential to maintain effectiveness beyond four months post-opening.

Contraindications for Use

Medication Administration and Protocol Changes

Overview of Medications Used in Emergency Situations

• The discussion begins with the introduction of a second medication, following the metered dose inhaler previously mentioned. The focus is on sublingual administration.

• Simple ipecac and activated charcoal have been removed from all ambulances in New York City, marking a significant change in emergency protocols.

• It is crucial to know that for activated charcoal, medical control must be contacted for guidance on dosage and usage, emphasizing the importance of protocol adherence.

• Ipecac syrup induces vomiting but is no longer used; current practices aim to prevent vomiting during transport by administering medications that suppress it.

• Activated charcoal absorbs poisons from the gastrointestinal tract but poses practical challenges when administered in an ambulance setting due to its messy preparation process.

Current Practices and Protocol Compliance

• The speaker highlights the impracticality of using activated charcoal in moving ambulances, especially given New York City's proximity to hospitals.

• While these medications are not carried by EMTs in NYC, they may still be part of protocols elsewhere in New York State where different regulations apply.

Six Rights of Medication Administration

• Understanding the six rights of medication administration is essential for safe practice: right patient, right medication, right dose, right route (e.g., sublingual), right time (ensuring medications are not expired).