TRANSITION SERIES
Topics for the Advanced EMT
CHAPTER
12
EMS Pharmacology
Objectives
• Look at the frequency with which
certain medical emergencies occur that
often require drug therapy.
• Discuss the ways drugs can affect
cellular metabolism.
• Review select pharmacological agents
and the medical emergencies that
warrant them.
Introduction
• The scope of practice for Advanced
EMTs regarding drug therapy continues
to expand.
• Understanding how a drug works is
integral to using it correctly.
• It is the responsibility of the Advanced
EMT to also understand the medical
problems that warrant prehospital drug
therapy.
Introduction (cont’d)
• The National EMS Education Standards
and the Scope of Practice provide a
framework in which the Advanced EMT
can function.
• There will be a variation from state to
state on which medications can be
administered by the Advanced EMT.
Preventing Medication Errors
• Key points to reducing medication
errors
– Be familiar with all the medications you
carry
– Ensure you have the right medication
– Repeat orders received from medical
control
Preventing Medication Errors
(cont’d)
• Key points to reducing medication
errors
– Verify amount and concentration
– Work as a team to monitor the patient
– Do not practice while fatigued
– Immediately report errors that do occur
Epidemiology
• Use of oxygen is constant.
• Hypoglycemia occurs in 1:1,000 people.
• 7-8 million people a year seek medical
attention for chest pain.
• 41 million people have severe allergies.
• Over 35,000 overdose deaths occur per
year.
• 600 million MDIs are sold per year.
Pathophysiology
• Signs and symptoms seen in patients
are directly due to cellular dysfunction.
• Drugs act to alter cellular activity in the
hopes of returning them to a more
normal state, and preventing death.
– Agonist medications
– Antagonist medications
Some Medications Commonly Used by AEMTs
Some Medications Commonly Used by AEMTs (continued)
Some Medications Commonly Used by AEMTs (continued)
Oxygen gas is considered a medication. It is the most commonly used
medication in EMS and is carried on the EMS unit.
Oral glucose is a viscous gel used in acute diabetic emergencies. It is carried
on the EMS unit.
Aspirin, in pill form, may be administered for chest pain when a heart attack
is suspected.
Nitroglycerin tablets are one common form of nitroglycerin. Nitroglycerin
spray is another form.
An epinephrine auto-injector, such as the EpiPen, may be prescribed for
patients with a history of severe allergic or anaphylactic reactions.
Activated charcoal is administered in suspension form and is carried on some
EMS units. It may be used in poisoning and overdose emergencies.
A metered-dose inhaler or a metered-dose inhaler with a spacer may be
prescribed for respiratory conditions.
Nebulized medications may be administered by a small-volume nebulizer,
through either a mouthpiece or a face mask. (© Carl Leet, YSU)
Assessment Findings
• When the cellular activity changes due
to illness or disease, signs and
symptoms present.
• The Advanced EMT must interpret the
findings back to the body system
causing the disturbance.
• Drug therapy can then be guided by
the failing body system.
Drugs to Be Used in Medical Emergencies
Drugs to Be Used in Medical Emergencies (continued)
Drugs to Be Used in Medical Emergencies (continued)
Emergency Medical Care
• General Treatment Guidelines
– Ensure open airway
– Provide oxygen
– Position patient as appropriate
– Administer medication based on
indications
– Arrange for Paramedic backup or
intercept
– Provide transport to the Emergency
Department
The “Rights” of Drug
Administration
•
•
•
•
•
Right
Right
Right
Right
Right
patient – prescribed to patient
medication – patient condition
route – patient condition
dose – prescribed to patient
time – within expiration date
Case Study
• You are doing a standby at the local
high school for a track meet. A young
woman rushes to your ambulance and
says “My boyfriend passed out in the
bathroom…. I think he forgot to take
his medication!”
Case Study (cont’d)
• Scene Size-Up
– There is only one patient.
– BSI precautions are taken.
– Male patient, early 20s, 160 lbs.
– He is lying on the floor, not in a stall.
– NOI is unresponsive, but you cannot
rule out trauma yet.
Case Study (cont’d)
• What are at least five differentials that
could be causing the loss of
consciousness?
• What are three important questions you
would want to ask his girlfriend?
Case Study (cont’d)
• Primary Assessment Findings
– Patient has nonpurposeful motion to
pain.
– Airway patent, slight sonorous sounds.
– Normal rate and depth of breathing.
– Respiratory rate is 18/min.
– Peripheral pulse is present, skin cool
and clammy, no signs of trauma.
Case Study (cont’d)
• Is this patient a high or low priority?
Why?
• What care should be provided
immediately?
Case Study (cont’d)
• Medical History
– Girlfriend is not sure of name, but said
he's had it since he was a kid.
• Medications
– She states he takes one, once or twice
daily.
• Allergies
– Girlfriend does not know.
Case Study (cont’d)
• Pertinent Secondary Assessment
Findings
– Pupils reactive to light, airway now
patent with manual airway technique
applied.
– Breath sounds present bilaterally.
– Peripheral perfusion is intact.
Case Study (cont’d)
• Pertinent Secondary Assessment
Findings
– Diffuse ecchymotic areas to the
abdomen.
– Physical exam reveals no sign of other
trauma.
– Skin is cool and diaphoretic.
– B/P 100/78, Pulse 108, Respirations 18.
Case Study (cont’d)
• Which medical diagnostic test would
you like to obtain at this time?
– AED analysis
– Pulse oximetry
– Blood sugar level
– End tidal capnography
• Defend your above answer.
Case Study (cont’d)
• Care provided:
– Spinal precautions taken
– Oxygen maintained via NRB mask
– Pulse ox 99%, BGL 24 mg/dL.
– Initiate intravenous access and
administer dextrose.
– Patient packaged and transported by
ambulance.
Case Study (cont’d)
• Explain how the following interventions
may help improve the patient's
condition.
– Oxygen administration?
– Dextrose administration?
– What is the dose of dextrose?
Summary
• Pharmacology administration is a
common skill the Advanced EMT must
provide.
• Understanding how a drug works on the
body will make it easier to determine
when it would be necessary.
• With any drug therapy, ensure you
have proper medical direction prior to
administration.