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Administering Medications :

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• EMTs administer or assist in the administration of medications. • Medications are administered under medical direction. • A drug, or medication, is a chemical that is used to treat or prevent a disease or condition. • 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. • EMTs only administer or assist with drugs listed in their protocols with medical direction approval.

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Pharmacology

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is the study of drugs.

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Drugs that may be carried on the ambulance:

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Oxygen, Oral glucose, Activated charcoal, Aspirin.

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Oxygen

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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%. Supplemental oxygen increases the amount of oxygen available to bind to hemoglobin in the patient's blood.

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Oral glucose

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Brain cells require an uninterrupted supply of glucose. Oral glucose may be administered to diabetics with low blood glucose levels.

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Activated charcoal

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A fine black powder. May be administered in some cases of ingested poisoning to adsorb the poison and prevent its absorption into the body.

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Aspirin

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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.

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Medications Administered by EMTs.

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EMTs may give or assist with giving some medications that are not carried on the ambulance, but which are prescribed to the patient.

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Medications prescribed to patients -

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Inhaled bronchodilators, Nitroglycerin, Epinephrine. These are the only medications EMTs can assist or give to a patient.

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Inhaled bronchodilators

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Prescribed to patients with chronic respiratory disease. Given by metered-dose inhaler or smallvolume nebulizer. EMTs may only administer medications that are beta2 agonists, designed to dilate the bronchioles. Drugs include albuterol and levalbuterol.

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Nitroglycerin

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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.

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Epinephrine

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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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Anaphylaxis

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an acute allergic reaction to an antigen (e.g., a bee sting) to which the body has become hypersensitive.

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Anaphylactic Reaction

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a reactive release of chemical mediators that produce bronchoconstriction, vasodilation, capillary permeability, and increased mucus production leading to airway and respiratory compromise and hypoperfusion.

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Drugs have the following categories of names:

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Chemical, Generic, Trade, Official.

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Medication Names Example:

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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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Chemical Name Example:

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1,2,3-propanetriol trinitrate.

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Generic Name Example:

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nitroglycerin tablets.

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Official Name Example:

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nitroglycerin tablets, U.S.P.

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Trade Name Example:

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nitrostat.

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Routes of Administration

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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.

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EMTs commonly give medications by these routes:

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Sublingual, Oral, Inhalation, Intramuscular injection

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Sublingual

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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.

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Oral

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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

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Inhalation

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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.

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Intramuscular injection

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Drug is injected into a muscle mass for absorption. Requires use of a needle. Some discomfort to patient.

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Medication Forms

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The form usually limits administration to one specific route. Common forms include: Compressed powder or tablet, Liquid for injection, Gel, Suspension, Liquid for injection, Small-volume nebulizer, Gas, Spray.

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Compressed powder or tablet -

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

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Liquid for injection -

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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.

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Gel -

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

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Suspension -

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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.

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Fine powder for inhalation -

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

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Small-volume nebulizer -

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Nebulized medications may be administered by a small-volume nebulizer, through either a mouthpiece or a face mask.

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Gas -

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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.

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Spray -

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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 Information

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For each medication, you must understand the following information: Indications, Contraindications, Dose, Administration, Actions, Side effects.

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Indications

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The most common uses of the drug in treating a specific condition. Geared toward relief of signs, symptoms, or specific conditions.

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Contraindications

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Situations in which the drug should not be administered because of the harm it could cause.

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Dose

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The amount of the drug that is given to the patient.

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Administration

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The route by which the medication is given to the patient

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Actions

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The effect the drug has on the body. Two types: the therapeutic effect and the mechanism of action.

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The therapeutic effect

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is the intended positive response by the body.

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The mechanism of action

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is how the drug works to create its effect on the body.

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Side effects

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Actions that are not desired and that occur in addition to the desired therapeutic effects. May be predictable or unpredictable

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Steps in Medication Administration

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Obtain an order from medical direction. Select the proper medication. Verify the patient's prescription. Check the expiration date. Check for discoloration or impurities. Verify the form, route, and dose. Check the Five Rights of medication administration. Document medication administration.

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Obtain an order from medical direction.

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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.

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Select the proper medication.

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Read the label carefully.

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Verify the patient's prescription.

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When assisting with the patient's medication, verify that the medication to be given is prescribed to him.

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Check the expiration date.

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Do not administer expired medications.

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Check for discoloration or impurities.

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Inspect for discoloration and cloudiness. Do not give discolored or cloudy medications.

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Verify the form, route, and dose.

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Use the proper form for the route selected. Make sure the label matches the order from medical direction.

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Check the Five Rights of Medication Administration.

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Right patient, Right medication, Right route, Right dose, Right time.

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Documentation of medication administration includes:

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Drug, Dose, Route, Time, Changes in patient's condition.

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Reassessment of the patient after medication administration -

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You MUST reassess the patient. When reassess check; Mental status, Airway, Respirations, Pulse, Skin, Blood pressure, SpO2, Change in complaints/relief of signs and symptoms, Medication side effects, Change in patient's condition.

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Sources of Medication Information:

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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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Five Rights of Medication Administration:

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Right patient, Right medication, Right route, Right dose, Right time.

EMT Chapter 14 Pharmacology and Medication Administration – Notes – Flashcards

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