BLS EMS Only - Pharmacology .pdf

BLS Pharmacology – ACETAMINOPHEN 10.1 TRADE NAMES: Tylenol® a) Indications Pati...

BLS Pharmacology – ACETAMINOPHEN 10.1 TRADE NAMES: Tylenol® a) Indications Patients 3 months of age and older with: (1) Mild to moderate discomfort (e.g., 1–5 on FACES scale) or (2) Fever (EMS-documented temperature greater than or equal to 100.4 F / 38 C) b) Adverse Effects Not clinically significant c) Precautions (1) Administration of acetaminophen for mild to moderate pain does not eliminate the need for transport of the patient to an appropriate facility capable of conduct- ing a comprehensive evaluation of the cause of the pain and appropriate definitive treatment. (2) A 3 mL, 5 mL, or 6 mL syringe must be used to measure doses of acetaminophen. BLS Pharmacology: ACETAMINOPHEN 10.1 d) Contraindications (1) Head Injury (2) Hypotension (3) Administration of acetaminophen or medications containing acetaminophen within the previous 4 hours. Many common cold preparations contain acetaminophen. (4) Inability to swallow or take medications by mouth (5) Respiratory distress (6) Persistent vomiting (7) Known or suspected liver disease (including patients suspected of current alcohol ingestion) (8) Allergy to acetaminophen (9) Patients less than 3 months of age e) Preparations Use Unit Dose Only (DO NOT USE MULTIDOSE BOTTLE OF LIQUID) Unit dose 160 mg/5 mL liquid Unit dose 325 mg pill or tablet f) Dosage (1) Less than 3 months of age: Not indicated (2) 3 months to 2 years of age: Age Under 3 months 3 months 4-11 months 12-23 months Liquid 160 mg/ Not indicated 1.25 mL 2.5 mL 3.75 mL 5 mL (3) 2–4 years: Unit dose 160 mg/5 mL (4) 5–12 years: TWO unit doses of 160 mg/5 mL each for a total of 320 mg/10 mL (5) 13 years and above: FOUR unit doses of 160 mg/5 mL each for a total of 640 mg/ 20 mL OR in a form of 325 mg pill or tablet x2 for a total of 650 mg with sips of water as tolerated by the patient. www.miemss.org 1067177 of 2175 Release Date July 1, 2023 Back to Contents  BLS Pharmacology – 10.2 ACTIVATED CHARCOAL (WITHOUT SORBITOL) TRADE NAMES: Not Applicable a) Indications Poisoning by mouth b) Adverse Effects May indirectly induce vomiting and cause nausea c) Precautions Does not adsorb all drugs and toxic substances BLS Pharmacology: ACTIVATED CHARCOAL (WITHOUT SORBITOL) 10.2 d) Contraindications (1) Altered mental status (2) Patients who have received an emetic e) Preparations (1) 25 grams/125 mL bottle (2) 50 grams/250 mL bottle f) Dosage (1) Adult: Administer 1 gram/kg PO (2) Pediatric: Administer 1 gram/kg PO POISON INFORMATION CENTER RECOMMENDATIONS SHOULD BE SOLICITED IN CONJUNCTION WITH MEDICAL CONSULTATION, BUT MEDICATION ORDERS CAN ONLY BE ACCEPTED FROM AN APPROVED BASE STATION OR CONSULTATION CENTER. Release Date July 1, 2023 1068178 of 2175 www.miemss.org Back to Contents  BLS Pharmacology – ALBUTEROL 10.3 TRADE NAMES: PROVENTIL®, VENTOLIN® a) Indications (1) Signs and symptoms of respiratory distress (2) Bronchospasm/wheezing associated with: (a) Asthma (b) COPD/emphysema (c) Allergic reactions (anaphylaxis) b) Adverse Effects (1) Tachycardia/palpitations (2) Hypertension (3) Angina (4) Nervousness/anxiety (5) Tremors (6) Dizziness (7) Headache BLS Pharmacology: ALBUTEROL 10.3 (8) Sweating (9) Nausea/vomiting (10) Sore throat c) Precautions May cause severe bronchospasm from repeated excessive use. d) Contraindications Known hypersensitivity e) Preparations (1) Hand-held (unit dose) aerosol inhaler (2) Ampule for nebulizer f) Dosage Inhaler (1) Adult: Patient may receive a maximum of 2 doses (4 puffs) over a 30-minute period (2) Pediatric: Patient may receive a maximum of 2 doses (4 puffs) over a 30-minute period Nebulizer (1) Adult: 2.5 mg by nebulized aerosol connected to 6–8 lpm of oxygen; may repeat one time (2) Pediatric: May repeat one time; connect to 6–8 lpm of oxygen (a) Age 2 or older: 2.5 mg by nebulized aerosol (b) Age less than 2 years: 1.25 mg by nebulized aerosol (3) Additional doses may be administered with medical consultation. www.miemss.org 1069179 of 2175 Release Date July 1, 2023 Back to Contents  BLS Pharmacology – 10.4 ASPIRIN TRADE NAMES: Not Applicable a) Pharmacology (1) Platelet inhibitor (2) Anti-inflammatory b) Pharmacokinetics Blocks platelet aggregation c) Indications Suspected Acute Coronary Syndrome and/or ST Elevation MI (STEMI) d) Contraindications (1) Known hypersensitivity. (2) Patients who receive a full dose (324 mg) of aspirin prior to EMS arrival. e) Adverse Effects (1) Heartburn BLS Pharmacology: ASPIRIN 10.4 (2) Nausea and vomiting (3) Wheezing f) Precautions GI bleeding and upset g) Dosage (1) Adult: 324 mg or 325 mg chewed (2) Pediatric: Not indicated Release Date July 1, 2023 1070180 of 2175 www.miemss.org Back to Contents  BLS Pharmacology – EPINEPHRINE (1 mg/mL) 10.5 TRADE NAMES: Not Applicable Optional Supplemental Protocol: BLS manual draw-up epinephrine from vial or preloaded syringe (non-auto injector) a) Indications (1) Moderate to severe allergic reaction with respiratory distress or mild allergic reaction with history of life-threatening allergic reaction (2) Patients with severe asthma b) Adverse Effects (1) Tachycardia/palpitations (2) Angina (3) Headache (4) Nausea/vomiting BLS Pharmacology: EPINEPHRINE (1 mg/mL) 10.5 (5) Dizziness (6) Hypertension (7) Nervousness/Anxiety (8) Tremors c) Precautions Medical consultation must be obtained before administering the EMS service’s manual epinephrine or EMS service’s auto-injector to asthma patients with pregnancy or cardiac history. However, medical consultation is not required for any patients who have severe allergic reactions with respiratory distress. d) Contraindications None in the presence of anaphylaxis e) Preparations Epinephrine (Patient prescribed or EMS supplied) (1) Vial: 1 mg in 1 mL (2) Preloaded Syringe (a) Adult: 0.5 mg in 0.5 mL (b) Pediatric: 0.15 mg in 0.15 mL f) Dosage (1) Patients 5 years of age or greater: Adult: 0.5 mg in 0.5 mL IM in lateral thigh (2) Patients less than 5 years of age: Pediatric: 0.15 mg in 0.15 mL IM in lateral thigh (3) Additional doses may be administered with medical consultation. www.miemss.org 1071181 of 2175 Release Date July 1, 2023 Back to Contents  BLS Pharmacology – 10.6 EPINEPHRINE AUTO-INJECTOR TRADE NAMES: Not Applicable a) Indications (1) Moderate to severe allergic reaction with respiratory distress or mild allergic reaction with history of life-threatening allergic reaction (2) Patients with severe asthma b) Adverse Effects (1) Tachycardia/palpitations (2) Angina (3) Headache (4) Nausea/vomiting (5) Dizziness (6) Hypertension BLS Pharmacology: EPINEPHRINE AUTO-INJECTOR 10.6 (7) Nervousness/anxiety (8) Tremors c) Precautions Medical consultation must be obtained before administering the EMS service’s manual epinephrine or EMS service’s auto-injector to asthma patients with pregnancy or cardiac history. However, medical consultation is not required for any patients who have severe allergic reactions with respiratory distress. d) Contraindications None in the presence of anaphylaxis e) Preparations Epinephrine Auto-injector (single or multi-dose) only (Patient prescribed or EMS supplied) (1) Adult: 0.3 mg (2) Pediatric: 0.15 mg f) Dosage (1) Less than 5 years of age: 0.15 mg IM in the lateral thigh via epinephrine auto-injector. (2) 5 years and greater: administer 0.3 mg IM in the lateral thigh via epinephrine auto-injector. (3) Additional doses may be administered with medical consultation. Release Date July 1, 2023 1072182 of 2175 www.miemss.org Back to Contents  BLS Pharmacology – NALOXONE PUBLIC SAFETY AND EMR 10.7 TRADE NAMES: Narcan® a) Pharmacology Reverses all effects due to opioid (morphine-like) agents. This drug will reverse the respiratory depression and all central and peripheral nervous system effects. b) Pharmacokinetics (1) Onset of action is within a few minutes with intranasal (IN) administration. (2) Patients responding to naloxone may require additional doses and transportation to the hospital since most opioids/narcotics last longer than naloxone. (3) Has no effect in the absence of opioid/narcotic. c) Indications To reverse respiratory depression induced by opioid/narcotic agent. BLS Pharmacology: NALOXONE PUBLIC SAFETY AND EMR 10.7 d) Contraindications Patients under 28 days of age e) Adverse Effects Opioid withdrawal f) Precautions (1) Naloxone may induce opiate withdrawal in patients who are physically dependent on opioids. (2) Certain drugs may require much higher doses of naloxone for reversal than are cur- rently used. (3) Should be administered and titrated so respiratory efforts return, but not intended to restore full consciousness. (4) Intranasal naloxone must be administered via nasal atomizer. (5) Naloxone has a duration of action of 40 minutes; the effect of the opioid/narcotic may last longer than naloxone and patients should be encouraged to be transported. g) Dosage (1) Adult: Administer 2 mg IN, dividing administration of the dose equally between the nares to a maximum of 1 mL per nare, OR administer 4 mg/0.1 mL IN in one nare. (2) Pediatric (child aged 28 days to adult): Administer 2 mg IN, dividing administration of the dose equally between the nares to a maximum of 1 mL per nare, OR administer 4 mg/0.1 mL IN in one nare. (3) Repeat as necessary to maintain respiratory activity. CLINICIANS MUST OBTAIN MEDICAL CONSULTATION WITH A BASE STATION PHYSICIAN FOR PATIENTS WISHING TO REFUSE TRANSPORT AFTER BLS ADMINISTRATION OF NALOXONE. www.miemss.org 1073183 of 2175 Release Date July 1, 2023 Back to Contents  BLS Pharmacology – 10.8 NITROGLYCERIN TRADE NAMES: Not Applicable (Patient Prescribed, Patient Assisted) a) Indications Chest pain b) Adverse Effects (1) Hypotension (2) Headache (3) Dizziness (4) Tachycardia c) Precautions (1) BLS clinician may only administer patient prescribed sublingual nitroglycerin. (2) Reassess blood pressure before and after administration. BLS Pharmacology: NITROGLYCERIN 10.8 (3) If systolic blood pressure drops more than 20 mmHg per dose of nitroglycer- in given, obtain medical consultation before further administration. d) Contraindications (1) Blood pressure below 90 mmHg systolic (2) Heart rate less than 60 or greater than 150 bpm (3) Medication not prescribed for the patient (4) Pediatric patient under age 13 (5) Any patient having taken medication for Pulmonary Artery Hypertension (e.g., Adcirca® or Revatio®) or erectile dysfunction (e.g., Viagra®, Levitra®, or Cialis®) within the past 48 hours. Medical consultation is required to override this contraindication. e) Preparations Spray or tablet f) Dosage (1) Adult: 0.4 mg sublingually (one tablet or one spray) (a) Repeat in 3 to 5 minutes if chest pain persists. (b) Maximum of three doses (a combination of patient-administered and EMT- administered) of nitroglycerin (2) Pediatric: (nitroglycerin contraindicated for children under age 13) (3) Additional doses may be administered with medical consultation. Release Date July 1, 2023 1074184 of 2175 www.miemss.org Back to Contents  BLS Pharmacology – ORAL GLUCOSE 10.9 TRADE NAMES: Not Applicable a) Indications (1) Altered mental status with known diabetic history (2) Unconscious for an unknown reason (3) Measured blood glucose less than 70 mg/dL b) Adverse Effects Not clinically significant c) Precautions Patient without gag reflex may aspirate. d) Contraindications Not clinically significant e) Preparations BLS Pharmacology: ORAL GLUCOSE 10.9 10–15 grams of glucose (contained in 24, 30, or 37.5 gram tube) f) Dosage (1) Adult: Administer 10–15 grams of oral glucose between the gum and cheek. Consider single additional dose of oral glucose if not improved after 10 minutes. (2) Pediatric: Administer 10–15 grams of oral glucose between the gum and cheek; this may be accomplished through several small administrations. Consider single additional dose of oral glucose if not improved after 10 minutes. www.miemss.org 1075185 of 2175 Release Date July 1, 2023 Back to Contents  BLS Pharmacology – 10.10 OXYGEN TRADE NAMES: Not Applicable a) Pharmacology (1) Increases oxygen content of the blood (2) Improves tissue oxygenation (3) Decreases energy expended for respirations b) Pharmacokinetics Changing the percentage of inspired oxygen results in an increased blood and tissue level equilibration within 5–20 minutes. c) Indications (1) If evidence of hypoxia (Less than 94% SpO2) (2) Respiratory distress (3) Cardiopulmonary arrest (4) Trauma (5) Suspected CO exposure (6) Dyspnea d) Contraindications BLS Pharmacology: OXYGEN 10.10 Not clinically significant e) Adverse Effects High concentrations of oxygen will reduce the respiratory drive in some COPD patients; these patients should be carefully monitored. f) Precautions (1) Never withhold oxygen from those who need it. (2) Oxygen should be given with caution to patients with COPD. (3) Simple or partial rebreather face masks must be supplied with a minimum 6 lpm. (4) Non-breather (NRB) face masks must be supplied with a minimum 12 lpm. g) Dosage (1) Adult: Administer 12–15 lpm via NRB mask or 2–6 lpm via nasal cannula, as needed. CO exposure: Administer 100% oxygen via NRB mask. Maintain SpO2 at 100% (2) Pediatric: Administer 12–15 lpm via NRB mask or 2-6 lpm via nasal cannula, as needed. CO exposure: Administer 100% oxygen via NRB mask. Maintain SpO2 at 100% Percent O2 Saturation Ranges General Patient Care 94–100% Normal Give oxygen as necessary 91–93% Mild Hypoxia Give oxygen as necessary Moderate Give 100% oxygen 86–90% Hypoxia Assisting Ventilations if necessary less than Give 100% oxygen or equal to Severe Hypoxia Assist Ventilations 85% If indicated, Intubate INACCURATE OR MISLEADING SpO2 READINGS MAY OCCUR IN THE FOLLOWING PATIENTS: HYPOTHERMIC, HYPOPERFUSION (SHOCK), CO POISONING, HEMOGLOBIN ABNORMALITY, ANEMIA, AND VASOCONSTRICTION. Release Date July 1, 2023 1076186 of 2175 www.miemss.org Back to Contents