Chapter 11
Emergency
Medications
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11-1
Objectives
11-2
Administered Medications
11-3
Administered Medications
•
•
•
•
Activated charcoal
Aspirin
Oral glucose
Oxygen
11-4
Activated Charcoal
11-5
Activated Charcoal
• Generic name
– activated charcoal
• Trade names
– Liqui-Char, Actidose, InstaChar,
SuperChar, and others
• Activated charcoal can only bind a drug
that is not yet absorbed from the
gastrointestinal tract
11-6
Activated Charcoal
Action
• Acts as an adsorbent
• Binds with many (but not all chemicals)
• Slows down or blocks absorption of the
chemical
11-7
Activated Charcoal
Indications
• Some ingested poisons
11-8
Activated Charcoal
Contraindications
• Patient has an altered mental status
• Patient is unable to swallow
• Medical direction does not give
authorization
• Patient has ingested acids or alkalis
11-9
Activated Charcoal
Adverse Effects
• Abdominal cramping
• Constipation
• Black stools
• Nausea, vomiting
11-10
Activated Charcoal
Dosage
• Dosage
– 1 gram of activated charcoal per kilogram
of body weight
– Usual adult dose: 25 to 50 grams
– Usual infant/child dose: 12.5 to 25 grams
11-11
Activated Charcoal
• Before giving activated charcoal, you must
determine if your patient can follow
directions and swallow safely.
• Activated charcoal looks like tar, stains any
material with which it comes in contact, and
doesn’t taste good.
– Be prepared for the patient to spit out the
medication.
11-12
Giving Activated Charcoal
11-13
Giving Activated Charcoal
11-14
Giving Activated Charcoal
11-15
Giving Activated Charcoal
11-16
Aspirin
11-17
Aspirin
• Generic name
– Acetylsalicylic acid
• Trade names
– Bayer, Ecotrin, Empirin, and others
• Nonnarcotic pain reliever
• Fever reducer
• Anti-inflammatory medication
11-18
Aspirin
Action
• Inhibits platelet clumping, thus interfering
with blood clotting
11-19
Aspirin
Indications
• Chest pain or other signs/symptoms
suspected to be of cardiac origin
– (Unless hypersensitive to aspirin)
• If ordered by medical direction, aspirin
should be given as soon as possible after the
patient’s onset of chest discomfort.
11-20
Aspirin
Contraindications
• Known allergy or sensitivity to aspirin
• Bleeding ulcer or bleeding disorders
• Children and adolescents
11-21
Aspirin
Adverse Effects
•
•
•
•
•
Rapid pulse
Flushing
Wheezing
Nausea, vomiting
Gastrointestinal
bleeding
• Diarrhea
• Heartburn
• Loss of appetite
• Ringing in the ears
(tinnitus)
• Rash
• Hives
• Bruising
11-22
Aspirin
Dosage
• Adult
– Two to four 81-mg tablets (baby aspirin),
chewed and swallowed
11-23
Aspirin
Special Considerations
• Use with caution in a patient who has any of
the following:
– Asthma
– Nasal polyps
– Nasal allergies
11-24
Aspirin
Administration
• Open the container
• Pour the correct number into
the inside cap of the container
• Transfer the tablets by
pouring them into the
patient’s hand
– Do not to contaminate the
inside cap of the container
• Carefully recap the container
11-25
Oral Glucose
11-26
Oral Glucose
Action
• When administered, oral glucose increases
the amount of sugar available for use as
energy by the body.
11-27
Oral Glucose
Indications
• Patients with an altered mental status who
have a known history of diabetes controlled
by medication and can swallow
11-28
•
•
•
•
Oral Glucose
Contraindications
Medical direction does not give
permission
Unresponsive
Unable to swallow
Known allergy to the glucose
preparation
11-29
Oral Glucose
Adverse Effects
• Nausea
• May be aspirated by the patient
without a gag reflex
11-30
Oral Glucose
Dosage
• One tube
11-31
Oral Glucose
Special Considerations
• Ensure signs and symptoms of altered
mental status with a known history of
diabetes
• Make sure the patient is responsive, can
swallow, and can protect his airway
• Obtain order from medical direction
• Use appropriate personal protective
equipment
• Practice the six rights of drug administration
11-32
Giving Oral Glucose
11-33
Giving Oral Glucose
11-34
Giving Oral Glucose
11-35
Giving Oral Glucose
11-36
Oxygen
11-37
Oxygen
Action
• Giving oxygen increases the amount
available in the bloodstream for use by the
body’s cells
11-38
Oxygen
Indications
• Cardiac or respiratory arrest
• Suspected low oxygen levels from any
• Any suspected cardiopulmonary emergency,
especially complaints of shortness of breath
or chest pain
11-39
Oxygen
Adverse Effects
• May reduce the respiratory drive in some
patients with chronic obstructive pulmonary
disease
• Drying of the mucous membranes
11-40
Oxygen
Dose
• Nasal cannula
– 1 to 6 L/min
• Nonrebreather mask
– 15 L/min
• Cardiac or
respiratory arrest:
positive-pressure
ventilation with
100% oxygen
11-41
Assisted Medications
11-42
Assisted Medications
• An EMT can assist a patient in taking the
following physician-prescribed medications
when authorized by medical direction:
– Epinephrine auto-injector
– Inhaled bronchodilators
– Nitroglycerin
11-43
Epinephrine
11-44
Epinephrine
• Generic name
– epinephrine
• Trade name
– Adrenalin
11-45
Epinephrine
Actions
• Relaxes the bronchial passages of
the airway
• Constricts blood vessels
11-46
Epinephrine
Indications
• All of the following criteria must be
met:
– Patient shows signs and symptoms of
a severe allergic reaction
– Epinephrine is prescribed for patient or
EMS system authorizes you to carry it
– Medical direction authorizes use for
the patient
11-47
Epinephrine
Contraindications
• There are no contraindications when an
epinephrine auto-injector is used in a
life-threatening situation
11-48
Epinephrine
Adverse Effects
• Rapid heart rate
• Anxiety
• Excitability
• Nausea, vomiting
• Chest pain or
discomfort
• Headache
• Dizziness
11-49
Epinephrine
Dosage
• Adult
– One adult auto-injector (0.3 mg)
• Infant and child
– One infant/child auto-injector (0.15 mg)
11-50
Epinephrine
Special Considerations
• Use appropriate personal protective
equipment
• Practice the six rights of medication
administration.
• Use a pulse oximeter
• Give oxygen by nonrebreather mask
• Assess lung sounds
11-51
Epinephrine
Special Considerations
11-52
Epinephrine Auto-Injector
Procedure
11-53
Epinephrine Auto-Injector
Procedure
11-54
Epinephrine Auto-Injector
Procedure
11-55
Epinephrine Auto-Injector
Procedure
11-56
Epinephrine Auto-Injector
Procedure
11-57
Epinephrine Auto-Injector
Procedure
11-58
Inhaled Bronchodilators
11-59
Prescribed Metered-dose Inhaler
11-60
Inhaled Bronchodilators
Action
• Generic (trade) names
– albuterol (Proventil, Ventolin)
– isoetharine (Bronkosol)
– metaproterenol (Alupent, Metaprel)
• Dilate bronchioles, reducing airway
resistance
11-61
Inhaled Bronchodilators
Indications
• An EMT can assist a patient in taking a
prescribed inhaler if all of the following
criteria are met:
– Patient has signs and symptoms of a
respiratory emergency
– Patient has a physician prescribed
handheld inhaler
– No contraindications to giving the
medication
– Specific authorization by medical direction
11-62
Inhaled Bronchodilators
Contraindications
• The patient is unable to use the device.
• The inhaler is not prescribed for the patient.
• Permission is not received from medical
direction.
• The patient has already met the maximum
prescribed dose before your arrival.
11-63
Inhaled Bronchodilators
Adverse Effects
• Increased heart rate
• Nausea
• Shaking or tremors
• Headache
• Restlessness
• Dizziness
• Nervousness
11-64
Inhaled Bronchodilators
Dosage
• Number of inhalations based on medical
direction’s order or physician’s order based
upon consultation with the patient
11-65
Inhaled Bronchodilators
Special Considerations
• Use appropriate personal protective
equipment.
• Practice the six rights of medication
administration.
• Assist the patient in finding his MDI if it is
not readily available.
• Assess lung sounds
• Reassess vital signs and patient’s degree of
breathing difficulty.
11-66
Inhaled Bronchodilators
11-67
Inhaled Bronchodilators
11-68
Inhaled Bronchodilators
11-69
Inhaled Bronchodilators
11-70
Inhaled Bronchodilators
11-71
Inhaled Bronchodilators
11-72
Nitroglycerin
11-73
Nitroglycerin
• Generic name
– nitroglycerin
• Trade names
– Nitrostat, Nitrobid, Nitrolingual,
Nitroglycerin Spray
• Action
– Relaxes (dilates) the smooth muscle of
blood vessel walls
– Decreases the workload of the heart
11-74
Nitroglycerin
Indications
• An EMT can assist a patient in taking
nitroglycerin if all of the following criteria are
met:
– Patient has signs and symptoms of chest
discomfort suspected to be of cardiac
origin
– Patient has physician prescribed
sublingual tablets or spray
– No contraindications
– Specific authorization by medical direction
11-75
Nitroglycerin
Contraindications
•
•
•
•
•
•
•
•
Medical direction does not give permission
Medication is not prescribed for the patient
Patient has taken maximum prescribed dose
Blood pressure below 100 mm Hg systolic
Heart rate <50 beats/min or >100 beats/min
Head injury (recent) or stroke (recent)
Infants and children
Erectile dysfunction drug within last 24-48
hours
11-76
Nitroglycerin
Adverse Effects
• Hypotension
• Headache
• Tachycardia
• Palpitations
• Bradycardia
• Fainting
11-77
Nitroglycerin
Dosage
• One tablet or one spray under the tongue
• Dose may be repeated in 3 to 5 minutes
(maximum of three doses) if:
– Patient experiences no relief,
– Patient’s systolic blood pressure remains
above 100 mm Hg systolic
– Patient’s heart rate remains between 50
and 100 beats/minute
– No other contraindications
– Medical direction okays another dose
11-78
Nitroglycerin
Special Considerations
• Recheck the patient’s vital signs within two
minutes.
• Reassess the patient’s degree of discomfort.
11-79
Assisting with Prescribed Nitroglycerin
11-80
Assisting with Prescribed Nitroglycerin
11-81
Assisting with Prescribed Nitroglycerin
11-82
Assisting with Prescribed Nitroglycerin
11-83
Assisting with Prescribed Nitroglycerin
11-84
Assisting with Prescribed Nitroglycerin
11-85
Assisting with Prescribed Nitroglycerin
11-86
Assisting with Prescribed Nitroglycerin
11-87
Special Situations
11-88
Nerve Agents
• Chemical weapons
• Interrupt nerve signals causing a loss of
consciousness within seconds and death
within minutes of exposure
11-89
Antidote
• An antidote is a substance that neutralizes a
poison.
• Nerve agent antidotes
11-90
Signs/Symptoms of
Nerve Agent Exposure
Mild
– Tearing
– Unexplained runny nose
11-91
Signs / Symptoms
Moderate
– Drooling
– Excessive sweating
– Nausea and/or vomiting
– Abdominal cramps
– Diarrhea
– Tightness in chest
– Muscle twitching at site of exposure
– Pinpoint pupils resulting in blurred vision
– Difficulty breathing, shortness of breath,
wheezing
11-92
Signs / Symptoms
Severe
• Strange or confused
behavior
• Severe difficulty
breathing or severe
secretions from the
airway
• Muscle twitching,
jerking, staggering
• Drowsiness
• General weakness
• Headache
• Involuntary
urination
• Involuntary
defecation
• Seizures
• Apnea
• Unconsciousness
11-93
Nerve Agent Antidotes
• Atropine sulfate
• Pralidoxime chloride
• Packaged in auto-injectors
– Mark I™ kits
11-94
Nerve Agent Antidotes
• Mark I™ kit
– Contains two separate auto-injectors
• One for atropine
• One for pralidoxime chloride
11-95
Nerve Agent Antidotes
• DuoDote™
– Approved by the FDA in 2007
– Prefilled auto-injector
– Delivers atropine and pralidoxime chloride
in one intramuscular injection
11-96
Atropine
Action
• Reverses some effects of nerve agent
poisoning
– Increases heart rate
– Relaxes bronchioles
– Dries secretions
– Decreases gastric motility
– Dilates pupils
11-97
Atropine
Indications
• An EMT can self-administer or administer an
atropine auto-injector to a peer if all of the
following criteria are met:
– The EMT or a peer has signs and
symptoms consistent with nerve agent
exposure.
– The EMT has specific authorization by
medical direction.
11-98
Atropine
Contraindications
• None – in the face of life-threatening
poisoning by chemical nerve agents
11-99
Atropine
Adverse Effects
• Pain at site of
injection
• Dryness of the
mouth
• Blurred vision
• Confusion
• Headache
• Dizziness
•
•
•
•
Tachycardia
Palpitations
Flushing
Urinary hesitance or
retention
• Constipation
• Nausea, vomiting
11-100
Atropine
Dosage
• Adult
– One auto-injector, which contains about 2
mg of atropine in 0.7 mL
11-101
Atropine
Special Considerations
• More than one dose may be necessary
11-102
Pralidoxime Chloride
Action
• Generic name: pralidoxime chloride
• Trade name: 2-PAM Chloride
• Action
– Reverses some effects of nerve agent
poisoning
• Muscle twitching
• Difficulty breathing
11-103
Pralidoxime Chloride
Indications
• An EMT can self-administer or administer a
2-PAM auto-injector to a peer if all of the
following criteria are met:
– The EMT or a peer has signs and
symptoms consistent with nerve agent
exposure.
– The EMT has specific authorization by
medical direction.
11-104
Pralidoxime Chloride
Contraindications
• None in the face of life-threatening poisoning
by chemical nerve agents
11-105
Pralidoxime Chloride
Adverse Effects
•
•
•
•
•
•
Pain at injection site
Tachycardia
Hypertension
Muscle weakness
Nausea
Blurred or double
vision
• Dizziness
• Loss of
coordination
• Headache
• Drowsiness
11-106
Pralidoxime Chloride
Dosage
• Dosage (adult)
– One auto-injector contains 600 mg
pralidoxime chloride in 2 mL
11-107
Pralidoxime Chloride
Special Considerations
• Three kits used for severe symptoms
11-108
Diazepam (Valium)
• Used to control seizures following severe
exposure to nerve agents (and similar toxins)
• May be carried in a single auto-injector
– Convulsant Antidote for Nerve Agent
(CANA)
11-109
Diazepam (Valium)
Action / Indications
• Action
– Relaxes skeletal muscle and controls
seizures
• Indications
– Seizures that persist after three Mark I (or
DuoDote) kits have been given and the
EMT has specific authorization by
medical direction
11-110
Diazepam (Valium)
Contraindications
• Hypersensitivity to any component of
the product
11-111
Diazepam (Valium)
Adverse Effects
•
•
•
•
•
Pain at injection site
Dizziness
Drowsiness
Confusion
Respiratory depression
11-112
Diazepam (Valium)
Dosage
• One auto-injector contains 10 mg of
diazepam
11-113
Diazepam (Valium)
Special Considerations
• Relatively short-acting drug
– Seizure activity may recur
• Onset of action is about 15 to 30 minutes
• Monitor blood pressure, pulse, and
respiratory rate every 5 minutes.
11-114
Questions?
11-115