MDC EMT Study Guide - Quiz 3 PDF

MDC EMT STUDY GUIDE – QUIZ 3 Chapter 6 - Human Body Pg 190 Anatomy is a field of study that focuses on the physical structure of the body and its systems. Physiology goes a step further, examining the normal functions and activities of these biologic components. Pathophysiology is th...

MDC EMT STUDY GUIDE – QUIZ 3 Chapter 6 - Human Body Pg 190 Anatomy is a field of study that focuses on the physical structure of the body and its systems. Physiology goes a step further, examining the normal functions and activities of these biologic components. Pathophysiology is the study of functional changes that accompany a particular disease or syndrome. Pg 191 Cells are the foundation of the human body. 206 bones of the skeleton give the body its form, protect the vital organs, and allow the body to move. Cells that share a common function grow close to each other, forming tissues. Groups of tissues that perform similar or interrelated jobs form organs. Organs with similar functions work together to comprise the different body systems discussed in this chapter. The skeletal system serves many functions, but some of the most obvious are to: 1. Provide structural support to bear the body's weight. 2. Establish a framework to attach soft tissues and internal organs. 3. Protect vital organs such as the heart and lungs. Pg 192 A joint is where two bones meet. Fibrous tissues that connect bone to bone, helping to stabilize these joints, are called ligaments. The tissues that attach bone to muscle are called tendons. Pg 193 At the base of the cranium, a large opening called the foramen magnum (Latin for "great opening") serves as the passageway for the spinal cord to connect with the brain and descend into the spinal, or vertebral column. The vertebral column (or spinal column) consists of 33 vertebrae. Cervical spine: The first seven vertebrae (C1 through C7). Thoracic spine: The next 12 vertebrae make up the thoracic spine. Lumbar spine: The next five vertebrae form the lumbar spine. Pg 194 Sacrum: The five sacral vertebrae are fused together to form one bone called the sacrum. Coccyx: The last four vertebrae, also fused together, form the coccyx, or tailbone.  The thorax (chest) contains the heart, lungs, esophagus, and great vessels (the aorta and the superior and inferior venae cavae). It is formed by the 12 thoracic vertebrae (T1 through T12) and their 12 pairs of ribs. Midline on the anterior surface of the chest is the sternum (breastbone). Pg 195 The inferior tip of the sternum is formed by a narrow, cartilaginous structure called the xiphoid process. Pg 197 Skeletal muscle is often referred to as striated muscle. It is also known as voluntary muscle because its movements are under our conscious control. The activities of smooth muscle and cardiac muscle do not require conscious thought. You do not, for example, need to "make" your heart beat. For this reason, smooth and cardiac muscle are recognized as involuntary muscle. Smooth muscle is found within blood vessels and the intestines. Cardiac muscle is unique from other muscle types in that it can generate its own electrical impulses. Pg 198 There are more than 600 muscles in the musculoskeletal system. The musculoskeletal system has several functions. One of these is the production of heat. When a person is cold, shivering begins. This involuntary shaking of the muscles generates heat, thereby maintaining homeostasis (the body's self-regulating process for preserving internal balance, or equilibrium, in order to survive). The respiratory system is the set of organs responsible for breathing, or respiration, and the exchange of oxygen and carbon dioxide that occurs within the lungs. The musculoskeletal system plays a synergistic role in voluntary movements, such as walking, raising your hand, and nodding your head. Pg 200 The nose and mouth lead to the oropharynx. The pharynx is composed of the nasopharynx, oropharynx, and the laryngopharynx. The nostrils lead to the nasopharynx (above the roof of the mouth and soft palate), and the mouth leads to the oropharynx. The nasal passages and nasopharynx warm, filter, and humidify air as you breathe. Air enters through the mouth more rapidly and directly. As a result, it is less moist than air that enters through the nose. Food, liquids, and air all can travel through the oropharynx, but on reaching the laryngopharynx, they must diverge, with food/liquids continuing posteriorly into the esophagus, while air proceeds to the anteriorly positioned larynx (voice box) and trachea (windpipe). The larynx does not tolerate any solid or liquid material, and any contact will result in a violent episode of coughing and spasm of the vocal cords. To help keep food and liquid out of the trachea while permitting air to pass, a thin, leaf-shaped flap (the epiglottis) covers the larynx during swallowing and then lifts open to allow for air passage during breathing. Pg 201 The thyroid cartilage (Adam’s apple), which tends to be more visible in men, is in the anterior midline portion of the neck. This cartilage is the anterior part of the larynx.  The right lung has three lobes: upper, middle, and lower. The left lung has two: an upper lobe and a lower lobe. Each lobe is divided further into segments. The lungs are supplied air by the right and left main stem bronchi, which are two tubes that branch from the trachea at a structure called the carina. Bronchioles end in about 700 million tiny, grapelike clusters of air sacs called alveoli. It is within these alveolar sacs that oxygen and carbon dioxide are exchanged between the lungs and the bloodstream. Immediately below the thyroid cartilage is the palpable cricoid cartilage. Between the thyroid and cricoid cartilage lies the cricothyroid membrane, which can be felt as a depression in the midline of the neck just inferior to the thyroid cartilage. The trachea is approximately 5 inches (13 cm) long and is a semirigid, enclosed air tube made up of rings of cartilage that are open in the back. The rings of cartilage keep the trachea from collapsing when air moves into and out of the lungs. For air to flow in and out of the lungs, the lungs must be able to expand and relax. Pg 202 Covering each lung is a layer of smooth, glistening tissue called pleura. The two layers are called visceral pleura (covering the lungs) and parietal pleura (lining the chest wall). Between these two layers is a small amount of fluid that permits smooth gliding of the tissues. Between the parietal pleura and the visceral pleura is the pleural space, called a potential space because under normal conditions, the space does not exist. These two layers are usually sealed tightly to one another by a thin film of fluid. When blood or air leaks into the pleural space, however, the surfaces separate. The diaphragm is unique because it has characteristics of voluntary (skeletal) and involuntary (smooth) muscles. It is a dome-shaped muscle that divides the thorax from the abdomen and is pierced by the great vessels and the esophagus. The primary muscle of breathing is the diaphragm. Pg 203 When the concentration of carbon dioxide becomes too high, automatic regulation of breathing resumes. When the diaphragm contracts, it moves down slightly, enlarging the thoracic cage from top to bottom. When the intercostal muscles contract, they move the ribs up and out. Ventilation is simply the movement of air between the lungs and the environment. You are providing artificial ventilation when you assist a patient who is not breathing with a bag-mask device, a large bag filled with air that, when squeezed, pushes air out one end. Respiration is the process of gas exchange. Respiration provides the much-needed oxygen to cells and removes the waste product carbon dioxide. This exchange of gases also helps to control the pH of the blood. Pg 204 Carbon dioxide and cell wastes are transported in the reverse, leaving the cells, crossing the capillary walls, and entering the bloodstream.  Oxygen and carbon dioxide pass rapidly across these thin tissue layers by diffusion. Diffusion is a passive process in which molecules move from an area with a higher concentration of molecules (oxygen in the air) to an area of lower concentration (oxygen in the bloodstream). There are more oxygen molecules in the alveoli than in the blood. Therefore, the oxygen molecules move from the alveoli into the blood. Because there are more carbon dioxide molecules in the blood than in the inhaled air, carbon dioxide moves from the blood into the alveoli. Exhaled air contains 16% oxygen and 3% to 5% carbon dioxide; the rest is nitrogen. The brain, specifically the brainstem, controls breathing. Nerves in this area act as sensors for the level of carbon dioxide in the blood and subsequently the spinal fluid. The brain automatically controls breathing if the level of carbon dioxide or oxygen in the arterial blood is too high or too low. In fact, adjustments can be made in just one breath. Pg 205 Breathing occurs as the result of a buildup of carbon dioxide, which causes the pH to decrease in the cerebrospinal fluid (CSF). CSF is a colorless fluid in and around the brain and spinal cord that cushions these structures and filters out impurities and toxins. The cells are constantly working to eliminate carbon dioxide to regulate the acid-alkaline balance of the body. The body also has a backup system to control respiration called the hypoxic drive. When the oxygen level falls, this system will also stimulate breathing. Pg 206 Expiratory reserve volume is the maximum amount of air that you can forcibly breathe out after a normal breath. Gas remains in the lungs after exhalation simply to keep the lungs open. This is the residual volume. A loss of residual volume occurs when a person is hit in the chest and has the "wind knocked out" of them. Dead space is the portion of the respiratory system that has no alveoli, and therefore, little or no exchange of gas between air and blood occurs. Minute volume is another measure used to assess ventilation; it is the amount of air that moves in and out of the lungs in one minute. Minute Volume = Respiratory Rate x Tidal Volume. An adult man has a total lung capacity of 6,000 mL (equivalent to three 2-liter bottles of soda). An adult woman has about one-third less total capacity because the lung size is smaller. Tidal volume is the amount of air that is moved into or out of the lungs during a single breath, generally 500 mL in an adult. Inspiratory reserve volume is the deepest breath you can take after a normal breath. Pg 207 Normal breathing has the following characteristics: o A normal rate and depth (tidal volume). o A regular rhythm or pattern of inhalation and exhalation. o Clear, audible breath sounds on both sides of the chest. o Regular rise and fall movement on both sides of the chest.  o Movement of the abdomen. A patient in cardiac arrest may appear to be breathing. These occasional, gasping breaths are called agonal gasps and occur when the respiratory center in the brain continues to send signals to the breathing muscles. However, these gasps are inadequate because they come at a slow rate and are generally shallow. Patients with agonal gasps need artificial ventilations and, most likely, chest compressions. g 208 The circulatory system is entirely closed, with capillaries connecting arterioles and venules. There are two circuits in the body: the systemic circulation in the body and the pulmonary circulation in the lungs. The systemic circulation, the circuit in the body, carries oxygen-rich blood from the left ventricle through the body and back to the right atrium. In the systemic circulation, as blood passes through the tissues and organs, it gives up oxygen and nutrients and absorbs cellular wastes and carbon dioxide. The heart is a hollow muscular organ approximately the size of a clenched fist. It is made of a specialized muscle tissue called cardiac muscle or myocardium. Pg 209 The heart works as two paired pumps; the left side is more muscular. A wall called the septum divides the heart down the middle into right and left sides. Each side of the heart is divided again into an upper chamber (atrium) and a lower chamber (ventricle). The left side of the heart, which pumps blood to the body, is a high-pressure pump; the right side supplies blood to the lungs and is a low-pressure pump. Valves prevent the backflow of blood and keep it moving through the circulatory system in the proper direction. Chordae tendineae are thin bands of fibrous tissue that attach to the valves in the heart and prevent them from inverting. When a valve controlling the filling of a heart chamber is open, the other valve allowing it to empty is shut, and vice versa. Normally, blood moves in only one direction through the entire system. In the normal adult, the resting heartbeat may range from 60 to 100 beats/min. At each beat, 70 to 80 mL of blood is ejected from the adult heart. The amount of blood moved in one beat is called the stroke volume (SV). In 1 minute, the entire blood volume of 5 to 6 L is circulated through all the vessels. The amount of blood moved in 1 minute is called the cardiac output (CO). Cardiac output is equal to heart rate times stroke volume. Mathematically, cardiac output can be expressed as follows: CO = HR x SV. For example: 70 beats/min X 75 mL/beat = 5,250 mL/min or 5.25 L/min. The heart muscle’s blood supply comes from the aorta. The aorta has two branches at its base that form the left and right coronary arteries. These arteries supply the heart muscle with oxygenated blood. The right side of the heart receives blood from the veins of the body. Blood enters from the superior and inferior venae cavae into the right atrium and then passes through the tricuspid valve to fill the right ventricle. After the right ventricle is filled, the tricuspid valve closes to prevent backflow as the right ventricular muscle contracts. Contraction of the right ventricle causes blood to flow through the pulmonic valve into the pulmonary artery and the pulmonary circulation. Each mechanical contraction of the heart is associated with two electrical processes. The first is depolarization, during which the electrical charges on the surface of the muscle cell change from positive  to negative. The second is repolarization, during which the heart returns to its resting state and the positive charge is restored to the surface. The left side receives oxygenated blood from the lungs through the pulmonary veins into the left atrium, where the blood passes through the mitral valve into the left ventricle. Contraction of this most muscular of the pumping chambers pumps the blood through the aortic valve into the aorta and then to the arteries of the body. The flow of blood through the four heart chambers is governed by one-way valves. Pg 211 The arteries carry blood from the heart to all body tissues. They branch into smaller arteries and then into arterioles. The arterioles, in turn, branch into the vast network of capillaries. The aorta is the main artery leaving the back left side of the heart; it carries freshly oxygenated blood to the body. This blood vessel is found just in front of the spine in the chest and abdominal cavities. The coronary arteries supply the heart; the carotid arteries supply the head; the hepatic arteries supply the liver; the renal arteries supply the kidneys; and the mesenteric arteries supply the digestive system. The aorta divides at the level of the umbilicus into the two common iliac arteries that lead to the lower extremities. The pulmonary artery begins at the right side of the heart and carries oxygen-depleted blood to the lungs. It divides into finer and finer branches until it meets with the pulmonary capillary system located in the thin walls of the alveoli. These arteries are the only ones in the body that carry oxygen-depleted blood. Many of the abnormal cardiac rhythms associated with cardiac arrest can be effectively treated with defibrillation. Therefore, any patient in cardiac arrest should have an AED applied as soon as possible. Arterioles are the smallest branches of an artery leading to the vast network of capillaries. Pg 213 The pulse, which is palpated most easily at the neck, wrist, or groin, is created by the forceful pumping of blood out of the left ventricle and into the major arteries. Capillary vessels are fragile divisions of the arterial system that allow contact between the blood and the cells of the tissues. Oxygen and other nutrients pass from blood cells and plasma in the capillaries to the individual tissue cells through the thin wall of the capillary. Carbon dioxide and other metabolic waste products pass in a reverse direction from the tissue cells to the blood to be carried away. Blood in arteries is characteristically bright red because its hemoglobin is rich in oxygen. Blood in the veins is dark blue-red because it has passed through a capillary bed and given up its oxygen to the cells. Capillaries connect directly at one end with the flow-regulating arterioles and at the other with the venules. Once oxygen-depleted blood passes through the network of capillaries, it moves to the venules, which are the smallest branches of the veins. The blood returns to the heart via a network of larger and larger veins. The veins become larger and ultimately form two major vessels, called the superior and inferior venae cavae. The superior vena cava carries blood returning from the head, neck, shoulders, and upper extremities. Blood from the abdomen, pelvis, and lower extremities passes through the inferior vena cava. The superior and inferior venae cavae join at the right atrium of the heart.  Blood is composed of plasma, red blood cells, white blood cells, platelets, and protein molecules. Red blood cells, or erythrocytes, contain hemoglobin, a protein responsible for carrying oxygen. Most carbon dioxide is carried in the form of bicarbonate dissolved in the plasma, while a tiny amount of carbon dioxide is carried by hemoglobin. White blood cells, or leukocytes, play an important role in the body's immune defense against infection. Platelets are tiny, disc-shaped elements that are essential in the initial formation of a blood clot, the mechanism that stops bleeding. Plasma is the liquid portion of the blood that carries the blood cells, hormones, and nutrients. Pg 215 The average adult has approximately 6 L of blood. Children have 2 to 3 L, depending on age and size. Infants have about 300 mL. Thus, while the loss of a relatively small amount of blood might be insignificant for an adult, an equal amount of blood loss in an infant could be fatal. Perfusion is the circulation of blood in an organ or tissue. When perfusion is adequate, the cells' metabolic needs are met. Blood pressure (BP) is the force of circulating blood against the walls of the arteries. This pressure wave keeps the blood moving through the body. When the left ventricle of the heart contracts, it pumps blood into the aorta. This phase in the cardiac cycle is called systole. The pressure inside the arteries during this time is referred to as the systolic blood pressure. The time between contractions when the ventricle is relaxed and refilling with blood is called diastole. The resting pressure in the arteries during this phase is the diastolic blood pressure. When multiple systems are affected (i.e., systemic), the terms shock and hypoperfusion may be used interchangeably. However, hypoperfusion can also be limited to a specific region of the body, such as an arm, perhaps from an arterial occlusion (blockage). By contrast, shock is always systemic. In short, shock is a state of systemic hypoperfusion. Pg 216 As the blood pressure falls, the pulse increases to keep the cardiac output constant at 5 to 6 L per minute. If the loss of blood is too great, the adjustment fails. Pg 217 Nutrients move from the capillaries into the interstitial space (space between the cells) and into the intracellular space (within the cell). Wastes move from the cells through the interstitial space and into the capillaries. Pg 219 The sympathetic nervous system sends commands to the adrenal glands (which sit atop the kidneys), where two hormones, epinephrine (also known as adrenaline) and norepinephrine (also known as noradrenaline), are secreted to stimulate the heart and blood vessels. The release of epinephrine and norepinephrine affects receptors within the heart and blood vessels and improves the ability to cope with stress, known as the fight-or-flight reaction. The heart and blood vessels have alpha-adrenergic receptors and beta-adrenergic receptors within them. Adrenergic simply means related to the adrenal gland, where epinephrine and norepinephrine are made. The alpha-adrenergic receptors are found in the blood vessels. When stimulated, the blood vessels constrict, thereby increasing blood pressure. The beta-adrenergic receptors are found in the heart and lungs. When beta-1 receptors are stimulated, they cause the heart to increase its rate and also squeeze harder with each contraction. This increases cardiac output. When beta-2 receptors are stimulated, the bronchi in the lungs dilate. This allows more air to be inhaled and exhaled; therefore, more oxygen is  available to the cells of the body. Together, the alpha- and beta-adrenergic receptors prepare the body for fight or flight. The parasympathetic nervous system also has effects on the cardiovascular system. When stimulated, this system causes the heart to slow and beat more weakly. Pg 220 The nervous system is divided into two main portions: the central nervous system (CNS) (the brain and spinal cord) and the peripheral nervous system (PNS) (the nerves outside of the brain and spinal cord that link the CNS to various organs throughout the body). The peripheral nervous system can be further divided into the somatic and autonomic nervous systems. The somatic nervous system regulates activities over which we have voluntary control, such as walking, talking, and writing. The autonomic nervous system controls those functions that occur autonomously (i.e., automatically), including digestion, dilation and constriction of blood vessels, sweating, and other involuntary actions. The nervous system is perhaps the most complex organ system within the human body. It comprises the brain, spinal cord, and thousands of nerves spread throughout the body. The brain controls all functions of the body, and it assembles and interprets the information received through the body's various senses. Pg 221 The cerebellum is a structure that controls balance, muscle coordination, and posture. Without the cerebellum, highly specialized muscular activities such as writing would be impossible. Deep within the cranium, the well-protected brainstem acts as a relay center connecting the cerebrum and cerebellum to the spinal cord. It is the most primitive part of the CNS, controlling virtually all involuntary, life-sustaining functions, such as heart rate, breathing, temperature regulation, digestion, vomiting, swallowing, coughing, and the wake/sleep cycle. The brainstem comprises the midbrain, the pons, and the medulla oblongata. Three major subdivisions of the brain are the cerebrum, the cerebellum, and the brainstem. The cerebrum accounts for the largest portion of the brain (about three-fourths). Its surface, the cortex, is made up of neurons (nerve cell bodies), which give it a gray-brown color (thus the reason why the cerebrum is sometimes called the gray matter). Pg 223 The PNS is divided into the somatic nervous system and the autonomic nervous system. The autonomic nervous system, in turn, is divided between the sympathetic and parasympathetic nervous systems. The sympathetic nervous system is responsible for the fight-or-flight reaction that enables us to respond under stress. The parasympathetic nervous system tends to slow the body's activities or return the body to its resting state. Effects include pupil constriction, promotion of digestive system activities, constriction of airway passages, and reduction of heart rate and force of contraction. Pg 226 The digestive system, also called the gastrointestinal system, is composed of the gastrointestinal tract (stomach and intestines), mouth, salivary glands, pharynx, esophagus, liver, gallbladder, pancreas, rectum, and anus. The function of this system is digestion: the processing of food that nourishes the individual cells of the body. Most of the organs of this system are found within the abdomen. Chapter 12 - Pharmacology Pg 495 Pharmacology is the science of drugs, including their ingredients, preparation, uses, and actions on the body. In general terms, a medication is a substance that is used to treat or prevent disease or relieve pain. Pharmacodynamics is the process by which a medication works on the body. Different types of receptors are located throughout the body. Receptors are sites on cells where medications or chemicals produced in the body can bind and produce an effect. Pg 496 When administering a medication or treating an overdose, you should also consider how the body absorbs, distributes, changes, or eliminates a particular substance. These actions refer to the pharmacokinetics of a medication, or actions of the body upon the medication (or chemical). A medication that causes stimulation of receptors is called an agonist. A medication that binds to a receptor and blocks other medications or chemicals from attaching is called an antagonist, or blocker. The dose is the amount of the medication that is given. It often depends on the patient's weight or age. The dose also depends on the desired action of the medication. The action is the intended therapeutic effect that a medication is expected to have on the body. The therapeutic effect is also referred to as the desired or intended effect. Pg 497 Indications are the reasons or conditions for which a particular medication is given. Medications usually have two names. The generic name (such as ibuprofen) is a simple, clear, nonproprietary name. The generic name is not capitalized. Sometimes a medication is called by its generic name more often than by any of its trade names. There are times when you should not give a medication, even if it usually is indicated for that person’s condition. Such situations are called contraindications. A medication is contraindicated when it would harm the patient or have no positive effect on the patient’s condition. A trade name is the brand name that a manufacturer gives to a medication, such as Tylenol (acetaminophen). Adverse effects are any actions of a medication other than the desired ones. Adverse effects can occur even when medications are administered correctly. There are two types of adverse effects: o Unintended effects: Undesirable but pose little risk to the patient, such as a slight headache after taking nitroglycerin. o Untoward effects: Harmful to the patient, such as hypotension after taking nitroglycerin. Medications may be prescription medications or over-the-counter (OTC) medications. Prescription medications are distributed to patients only by pharmacists according to a physician’s order. OTC medications may be purchased directly, without a prescription. Pg 498 Enteral medications enter the body through the digestive system. Typically, the form of the medication will be a pill or a liquid such as cough medicine. Medications administered via this route tend to absorb slowly. Most emergency medications are not administered orally because the delayed absorption would limit their efficacy when time is crucial. Parenteral medications enter the body by a route other than the digestive tract, the skin, or the mucous membranes. Parenteral medications are often in a liquid form and are generally administered using syringes and needles. These medications are absorbed much more quickly and offer a more predictable and measurable response. Oral: Many medications are taken by mouth, or per os (PO), and enter the bloodstream through the digestive system. This process often takes as long as 1 hour but may be surprisingly rapid, depending on the substance or form of preparation. One of the advantages of using this route is that it is noninvasive. Patients are often much happier to take a pill than to have a needle stuck in them. Absorption is the process by which medications travel through body tissues until they reach the bloodstream. Pg 499 Intramuscular (IM) injection: Intramuscular means into the muscle. Usually, medications that are administered by IM injection are absorbed quickly because muscles have a lot of blood vessels. However, not all medications can be administered by the IM route. Possible problems with IM injections include damage to muscle tissue and uneven, unreliable absorption, especially in people with decreased tissue perfusion or who are in shock. Intravenous (IV) injection: Intravenous means into the vein. Medications that need to enter the bloodstream immediately may be injected directly into a vein. This is the fastest way to deliver a chemical substance, but the IV route cannot be used for all chemicals. Intraosseous (IO) injection: Intraosseous means into the bone. Medications that are given by this route reach the bloodstream through the bone marrow. Giving a medication by the IO route, into the marrow, requires drilling a needle into the outer layer of the bone. Because this is painful, the IO route is used most often in patients who are unconscious as a result of cardiac arrest or extreme shock. Inhalation: Some medications are inhaled into the lungs so that they can be absorbed into the bloodstream more quickly. Others are inhaled because they work in the lungs. Generally, inhalation helps minimize the effects of the medication in other body tissues. Such medications come in the form of aerosols, fine powders, and sprays. Sublingual (SL): Sublingual means under the tongue. Medications given by the SL route, such as nitroglycerin tablets, enter through the oral mucosa under the tongue and are absorbed into the bloodstream within minutes. This route is faster than the oral route, and it protects medications from chemicals in the digestive system, such as acids that can weaken or inactivate them. Pg 500 Intranasal (IN): In the intranasal route of medication administration, a liquid medication is pushed through a specialized device called a mucosal atomizer device (MAD). The liquid medication is aerosolized and is administered into a nostril. The mucous membranes lining the sinuses and passageways within the head and neck are very vascular; therefore, absorption is rather quick with this route. Pg 502  A metered-dose inhaler (MDI) is a miniature spray canister used to direct such substances through the mouth and into the lungs and is often used by a patient with a respiratory illness such as asthma or emphysema. An MDI delivers the same amount of medication each time it is used. Because an inhaled medication usually is suspended in a propellant, the MDI must be shaken vigorously before the medication is administered. Many patients who use MDI medications also self-administer medications with a nebulizer. Pg 503 As an EMT, you may only administer medications for which you have an order from medical control. Medical control may be provided online or offline based on local protocol. You must be familiar with the general steps of administering any medication to a patient. These steps are the rights of medication administration: o Right patient o Right medication and indication o Right dose o Right route o Right time o Right education o Right to refuse o Right response and evaluation o Right documentation Pg 506 The following is a list of medications that, depending on local protocol, may be administered by EMTs. Keep in mind that this list is ultimately set by the state in which you will be delivering patient care and the medical director of your agency: o Oxygen o Oral glucose o Aspirin o Epinephrine o Inhaled beta agonist/bronchodilator and anticholinergic (albuterol/ipratropium) o MDI medications o Nitroglycerin o Naloxone o Oral OTC analgesics for fever or pain You may administer or help to administer medications only under the following conditions: o Medical control gives you a direct order to administer a medication and/or the local medical protocols under which you are working permit you to administer that medication.  o Local medical protocols, developed by a medical physician under whom you are working, include standing orders for the use of a medication in defined situations. It is imperative that you not give or help patients take any other medications under any other circumstances. Pg 508 TABLE 12-4 EMT Medication Overview Pg 510 Never administer oral medications to an unconscious patient or to a patient who is unable to swallow or protect the airway. Pg 511 Aspirin (acetylsalicylic acid or ASA) is an antipyretic (reduces fever), analgesic (reduces pain), and anti- inflammatory (reduces inflammation) medication that inhibits platelet aggregation (clumping). This last property makes it one of the most used medications today. Research has shown that the aggregation of platelets in the coronary arteries under certain conditions is one of the direct causes of heart attack. Patients at risk for coronary artery disease are often prescribed one or two "baby" (children's) aspirins per day. During a potential heart attack, aspirin may be life-saving. The purpose of nitroglycerin is to increase blood flow by relieving the spasms or causing the arteries to dilate. It does this by relaxing the muscular walls of the coronary arteries and veins. Nitroglycerin also relaxes veins throughout the body, so less blood is returned to the heart and the heart does not have to work as hard each time it contracts. In short, blood pressure is decreased. Because of this, it is important that you always take the patient’s blood pressure before administering nitroglycerin. If the systolic blood pressure is less than 100 mm Hg, the nitroglycerin may have a harmful effect. Pg 512 If a significant decrease in the patient’s blood pressure (15 to 20 mm Hg) occurs and the patient suddenly feels dizzy or sick, have the patient lie down. There are important interactions to consider when administering nitroglycerin. Erectile dysfunction medications, such as sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra), can have potentially fatal interactions with nitroglycerin. When taken together, nitroglycerin and these drugs can cause a dramatic drop in blood pressure. Always ask a patient who has been prescribed nitroglycerin if he or she has used any medication for the treatment of erectile dysfunction within the previous 24 hours. If so, do not administer the nitroglycerin, and report this to medical control. When using nitroglycerin, whether using the tablets or the metered-dose spray, you should wait 5 minutes for a response before repeating the dose. Nitroglycerin has the following effects: o Relaxes the muscular walls of coronary arteries and veins o Results in less blood returning to the heart o Decreases blood pressure o Relaxes arteries throughout the body o Often causes a mild headache and/or burning under the tongue after administration Pg 513  Epinephrine is not indicated for patients who do not show signs of airway obstruction or wheezing due to an allergic reaction. In addition, this medication should not be given to patients with hypertension or hypothermia, or if you believe the patient may be experiencing an MI. Epinephrine has the following characteristics: o Secreted naturally by the adrenal glands o Dilates passages in the lungs o Constricts blood vessels, causing increased blood pressure o Increases heart rate and blood pressure Pg 514 General procedure for administering epinephrine: 1. Grasp unit with the tip pointing downward. 2. Form a fist around the unit. Do not place your thumb over either end of the unit. 3. With the other hand, pull off the activation cap. 4. Hold the tip near the outer part of the patient’s thigh. 5. Insert firmly into the outer thigh so that the unit is perpendicular (at a 90-degree angle) to the thigh. Do not allow the unit to bounce. 6. Hold firmly in the thigh for several seconds. 7. Immediately place the unit in an appropriate sharps container after administration. Epinephrine causes a burning sensation where it is injected, and the patient’s heart rate will increase after the injection, so be prepared for these adverse effects. Some services do not permit EMTs to carry epinephrine but do allow them to assist patients in administering their own epinephrine in life-threatening anaphylactic reactions. Pg 515 The most common technique for naloxone administration is via the intranasal route. Follow these steps to administer a medication intranasally: 1. Obtain medical direction per local protocol. 2. Confirm correct medication and expiration date. 3. Attempt to determine if the patient is allergic to any medications. 4. Prepare the medication and attach the atomizer. Never use a needle. 5. Place the atomizer in one nostril, pointing up and slightly outward. 6. Administer a half-dose (1 mL maximum) into each nostril. 7. Reassess the patient and document appropriately. Pg 519 Antiplatelet medications, such as aspirin and clopidogrel (Plavix), decrease the ability of blood platelets to aggregate (stick together). Anticoagulant medications, such as warfarin (Coumadin), apixaban (Eliquis), and rivaroxaban (Xarelto), interfere with other blood clotting mechanisms in the body.