CHAPTER 10 General Pharmacology I. How Medications Work A.

Pharmacology is the science of drugs, including their ingredients, preparation, uses, and actions on the body. B. The dose is the amount of the medication that is given. 1. It depends on the patients weight or age; adults and children will get different amounts of the same medication. C. The action is the desired therapeutic effect on the body. D. Indications are the reasons or conditions for which a particular medication is given. 1. Situations where medications should not be given are known as contraindications. E. Side effects are the actions of a medication that are not desired. F. Medication Names 1. The generic name is the name of a medication that is given by the original manufacturer. 2. A trade name is the brand name that the manufacturer gives to a medication. 3. Some medications are prescribed, where others are OTC. G. Routes of Administration 1. Absorption is the process in which medications travel through the body tissues until they reach the bloodstream. 2. Common routes of medication administration include: intravenous injection, oral (per os), sublingual, intramuscular, intraosseous, subcutaneous injection, transcutaneous, inhalation, and per rectum. Medication Forms A. The form of medication usually dictates the route of administration. B. The 7 forms of medications include tablets and capsules, solutions and suspensions, MDIs, topical medications, transcutaneous medications, gels, and gases for inhalation. Medications Carried on the EMS Unit A. The five medications that may be carried on the EMS unit are oxygen, oral glucose, activated charcoal, aspirin, and epinephrine. B. Oxygen 1. Oxygen is generally given via a NRB at 10 to 15 L/min in the prehospital setting. C. Activated Charcoal 1. Adsorption is the binding or sticking to a surface, while absorption is the process by which medications travel until they reach the blood stream. 2. Activated charcoal is ground into very fine powder to provide the greatest possible surface area for binding. D. Oral Glucose 1. When the level of glucose in the blood gets to low (hypoglycemia), a person can lose consciousness, have seizures, and ultimately die.. 2. Oral glucose should not be administered to an unconscious patient or to one who is unable to swallow or protect the airway. E. Aspirin 1. Aspirin is an antipyretic (reduces fever), analgesic (reduces pain), and anti inflammatory (reduces inflammation), and inhibits platelet aggregation (clumping). 2. Aspirin can be lifesaving during a potential heart attack. F. Epinephrine 1. Since epinephrine is secreted by the adrenal glands, it is also known as adrenaline.

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2. Epinephrine can increase heart rate and BP and dilate passages in the lungs, so it is used to ease breathing problems caused by bronchial spasms and allergic reactions. 3. Epinephrine can be injected by either SC or IM injections. Patient Assisted Medications A. Epinephrine B. MDI Medications 1. Sometimes, when epinephrine is not necessary for respiratory conditions, MDIs may be used. 2. In order to properly assist a patient in administering the medication, patients must aim properly and spray just as they start to inhale, however, most of the medications tends to end up on the roof of the patients mouth. a. To prevent this, a device known as a spacer can be used. C. Nitroglycerin 1. Many patients with cardiac conditions carry nitroglycerin to relieve the pain of angina. 2. The purpose of nitroglycerin is to increase blood flow by relieving the spasms or causing arteries to dilate. 3. It also relaxes the veins throughout the body, so less blood is returned to the heart BP is decreased. 4. If the systolic BP is less than 100 mm Hg, the nitroglycerin may have harmful effects of lowring the blood flow to the hearts own blood vessels, therefore it should not be administered. 5. Nitroglycerin: relaxes the muscular walls of coronary arteries and veins, often causes mild headache after administration. 6. Nitroglycerin can be administered either by tablet (sublingually) or by a MDI. General Steps in Administering Medication A. As an EMT-B, you must be familiar with the general steps of administering any medication to a patient: 1. Obtain an order from medical control 2. Verify the proper medication and prescription 3. Verify the form, dose, and route of the medication 4. Check the expiration date and condition of the medication 5. Reassess vitals 6. Document Patient Medications A. Part of the patient assessment is to find out what medications the patient is taking. 1. For example, the patient may be taking OTC drugs, or herbal medications which should also be documented. 2. When in doubt, ask if the patient is taking illegal drugs as well.

CHAPTER 11 Respiratory Emergencies I. Lung Structure and Function A. Adequate Breathing 1. Normal rate and depth, regular pattern of inhalation and exhalation, good audible bilateral breath sounds, regular rise and fall movement on both sides of the chest. B. Inadequate Breathing 1. Rate that is slower than 12 breaths/min. or faster than 20 breaths/min., unequal chest expansion, decreased breath sounds, muscle retractions, pale or cyanotic skin, cool/damp skin, pursed lips, and nasal flaring. C. The failure of the respiratory center of the brain to respond normally to a rise in levels of CO2. 1. Primary respiratory drive- when CO2 increases in the body, the brain stem sends signals to the diaphragm and intercostal muscles to contract forcing air to enter. 2. Hypoxic drive- secondary stimulus that operates on low oxygen levels D. In most lung disorders, one of the following situations exists: 1. The pulmonary veins and arteries are actually obstructed from absorbing oxygen or releasing carbon dioxide 2. The alveoli are damaged and cannot transport gases properly across their own walls. 3. The air passages are obstructed. 4. Blood flow to the lungs is obstructed. 5. The pleural space is filled with excess air or fluid. Causes of Dyspnea A. Dyspnea is a shortness of breath or difficulty breathing. B. Upper or Lower Airway Infection 1. The problem is some form of obstruction, either to the flow of air in the major passages (colds, diphtheria, epiglottis, and croup) or to the exchange of gases between the alveoli and the capillaries (pneumonia). C. Acute Pulmonary Edema 1. In some cases, the left side of the heart can not remove blood from the lung as fast as the right side delivers it. 2. Hence, the accumulation of fluid buildup in the space between the alveoli and the pulmonary capillaries is called pulmonary edema and can develop after a major heart attack. 3. In most of the severe cases, you will see a pink frothy sputum. D. Chronic Obstructive Pulmonary Disease 1. COPD is the end of a slow process which results over several results in the disruption of the airways, the alveoli, and the pulmonary blood vessels. 2. Chronic bronchitis is the ongoing irritation of the trachea and bronchi in which excess mucus is constantly produced. 3. Emphysema is a loss of the elastic material around the air spaces as a result of the chronic stretching of the alveoli when inflamed airways obstruct easy expulsion of the gases.

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4. Patients with COPD present with abnormal breath sounds such as rales, crackles, rhonchi, and wheezes. E. Asthma 1. Asthma is the acute spasm of the smaller air passages called bronchioles, associated with excessive mucus production and the swelling of the mucus lining in the reparatory passages. F. Spontaneous Pneumothorax 1. The accumulation of air in the pleural space. 2. A patient with spontaneous pneumothorax becomes dyspnea and can complain of pleuritic chest pain, a sharp, stabbing pain on one side that is worse during inspiration and expiration, or with certain movements of the chest wall. G. Anaphylactic Reactions H. Hay Fever I. Pleural Effusions 1. A pleural effusion is a collection of fluid outside the lung on one or both sides of the chest; in compressing the lung or lungs, it causes dyspnea. 2. When listening to lung sounds for a patient with dyspnea resulting from pleural effusions, you will hear decreased breath sounds over the region of the chest where the fluid has moved the lung away from the chest wall. J. Mechanical Obstruction of the Airway K. Pulmonary Embolism 1. An embolus is anything in the circulatory system that moves from its point of origin to a distant site and loges there, blocking subsequent blood flow in that area. 2. A pulmonary embolism is the passage of a blood clot formed in a vein that breaks off and circulates through the venous system and eventually becomes lodged in the pulmonary artery, significantly decreasing or even blocking the blood flow. 3. Signs and symptoms include: dyspnea, acute chest pain, hemoptysis (coughing up blood), cyanosis, tachypnea, and varying degrees of hypoxia. L. Hyperventilation Syndrome 1. Hyperventilation is defined as overbreathing to the point that the level of arterial carbon dioxide falls below normal. 2. Alkalosis is the cause of many of the symptoms associated with hyperventialtion syndrome, including anxiety, dizziness, numbness, tingling of the hands and feet, and even a sense fof dyspnea despite the rapid breathing. 3. Hyperventilation syndrome and hyperventilation are different. 4. The respirations of someone experiencing hyperventilation syndrome may be as high as 40 shallow breaths/min. or as low as only 20 very deep breaths/min. 5. All patients who are hyperventilating should be given supplemental oxygen and transported to the hospital. Assessment of the Patient in Respiratory Distress A. Scene Size Up B. Initial Assesment 1. If the patient is alert or responding to verbal stimuli, the brain is still receiving oxygen. If the patient is responsive to painful stimuli or unresponsive, the brain may not be adequately oxygenated and the potential for an airway or breathing problem is likely. C. Focused History and Physical Exam

1. The number of questions should be limited because a patient in respiratory distress does not need to be wasing more air. 2. While listening to breath sounds, you should look for crackles, which are crackling rattling sounds that are usually associated with fluid in the lungs but here are related to chronic scarring of small airways; rhonchi which are coarse gravelly sounds caused by mucus in the upper airways; and wheezing which is a high pitched whistling sound most often heard on exhalation, but sometimes heard on both exhalation and inhalation, or inhalation only. D. Interventions for respiratory problems include: 1. Oxygen via a NRB at 15 L/min 2. Positive pressure ventilations using a BVM, pocket mask, or a flow restricted oxygen powered ventilation device. `