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Pharm Chapter23
Emergency Drugs and Equipment
| Question | Answer |
|---|---|
| PABCD | Positioning, Airway,Breathing,Circulation (pulse), Definitive Tx |
| BLS | Basic Life Support |
| CPR | Cariopulmonary Rescucitation |
| Routes of Drug Administration | Endotracheal, Intravenous, Intranasal, Sublingual or intralingual, Intramuscular |
| Intramuscular(IM) Administration | (2)Outer thigh, (1)mid-deltoid, gluteal region; pediatric 1st choice-outer thigh; onset 10min. |
| Critical (Essential) Emergency Drugs | epinephrine, Histamine blockers, oxygen, vasodilator, bronchodilator, antihypoglycemic, antiplatelet |
| Critical Emergency Equipment | oxygen delivery system, automatic external defibrillator (AED), syringes, suction and suction tips, tourniquets, Magill intubation forceps |
| Secondary(Noncritical)injectable emergency drugs: | anticonvulsant,analgesic,vasopressor,antihypoglycemic,corticosteroid,antihypertensive,anticholinergic |
| Secondary Noninjectable Drugs: | Respiratory stimulants, Antihypertensives |
| Secondary Emergency Equipment | Scalpel or cricothyrotomy needle,artificial airways,laryngoscope and endotracheal tubes,laryngeal mask airway |
| Epinephrine (Adrenalin) | (TwinJet) Most important emergency drug. Drug of choice for acute(life-threatening)allergic rxn. |
| Signs/Symptoms of Anaphylaxis | Laryngeal edema, severe Hypotension |
| Histamine Blockers (antihistamine) | diphenhydramine (Benadryl) and chlorpheniramine (ChlorTrimeton) |
| Primary Injectable Epinephrine Indications | Acute allergic rxn, acute asthmatic attack(bronchospasm), cardiac arrest. Only drug that can maintain coronary artery blood flow while CPR is in progress. |
| Side effects of epiniphrine | nervousness, shaking,tachycardia,anxiety, headache |
| Actions of epinephrine | rapid onset, hypertensive response, vascular constriction, relaxation of bronchial smooth muscle |
| Primary Injectable: Histamine Blockers Indications | diphenhydramine(benadryl)OR chlorpheniramine(ChlorTrimeton)-IV or IM. For mngmt of Type IV allergic rxns.definitive mngmt of acute allergic rxn. local anesthetic when pt has history of alleged allergy to local anesthesia. |
| Side effects of Histamine Blockers | CNS depression,Decreased BP,thickening of bronchial secretions. Contra in mngmt of acute asthmatic episodes |
| Primary Noninjectable: Oxygen | Most useful drug in emergency kit. Min size required is "E" sized cylinder (provides O2 for 30 minutes). Color of oxygen tank is green. |
| Indications for Oxygen | Any emergency where respiratory distress is evident. Administering pure O2 to pts w/ depressed respiratory center could be dangerous. May remove remaining stimulus for respiration. |
| Supplemental Oxygen | When breathing is weak, shallow or labored, supplemental oxygen is used. Started at 4-6L/minute. |
| Primary Noninjectable: Vasodilator Indications | Used for chest pain (angina pectoris), acute MI, acute hypertensive episodes. Causes contraction of smooth muscle of blood vessels. |
| Vasodilator: Nitroglycerin tablet | onset 1-2 minutes, place sublingually (bitter taste and sting), short shelf-life once exposed to air(12 wks), if Not bitter then it is ineffective |
| Vasodilator: Nitroglycerin spray | onset 1-2 minutes, Do NOT shake,hold upright,1-2 sprays every 5 min. in mouth, no more than 3 sprays in 15 min.;longer shelf-life;recomm for emergency kits |
| Vasodilator: Amyl Nitrate inhalant | onset 10 sec.;crush btwn fingers and hold under victims nose; duration of action shorter than nitroglycerin; shelf-life is longer |
| Side effects of nitroglycerin | transient, pulsating headache, facial flushing, and degree of hypotension |
| Side effects of amyl nitrate | facial flushing,pounding pulse,dizziness,intense headache,and hypotension. Do NOT administer while pt is upright. |
| Primary Noninjectable:Bronchodilator indications | ProAir (Proventel,Ventolin);MetaproterenolUsed for bronchospasm(acute asthmatic episodes) and allergic rxn with bronchospasm |
| Bronchodilator Use | Shake well, pt breathes out all air, closes lips around inhalar,depress top of canister and breathe in slowly, hold breath as long as possible, wait 1 min and repeat starting with shaking again |
| Side effects of Bronchdilator | Cardiovascular(tachycardia and ventricular disrythmias) |
| Primary Noninjectable: Antihypoglycemic | Orange juice/fruit juices/soft drink(nondiet)/Glucose tablets |
| Antihypoglycemic Indication | Hypoglycemic states secondary to diabetes mellitus or fasting hyplglycemia in the conscious pt. |
| Decorative Icing/Insta-Glucose | Management of unconscious hypoglycemic pts. apply to buccal mucosa in max and mand vestibules and rub in. onset 20-30min. |
| Primary Noninjectable: Antiplatelet | Aspirin; 4 baby aspirin= 1 adult aspirin(325 mg); management of pts with suspected MI or unstable angina |
| Oxygen Delivery System: Positive Pressure | Positive Pressure/demand valve; reservoir bag on many inhalation sedation units |
| Oxygen delivery system: Bag-valve-mask device | Ambu-bag(more than 21% but less than 100% oxygen);source of positive-pressure oxygen, ambient air, or enriched oxygen attached to an oxygen delivery tube should be available |
| Oxygen delivery System: Pocket mask | Rescuer applies exhaled air into inlet on top of mask to ventilate victim; available w/supplemental oxygen port for enriched oxygen; invert mask for pediatric pt. |
| Automatic External Defibrillator | Comp recognize 2 cardiac dysrhythmias, ventricular fibrillation and pulseless ventricular tachycardia. verbally advises rescuer if shock is needed. Only the button activates shock. |
| Secondary Injectable: Anticonvulsant | midozolam(Versed)/diazepam(Valium); for prolonged seizures, local anesthetic-induced seizures, hyperventilation, and thyroid storm;onset 10-15min (IM). |
| Side Effects of Anticonvulsant | Respiratory Depression or arrest |
| Secondary Injectable: Analgesic | morphine sulfate/meperidine(Demerol); used for intense, prolonged pain or anxiety, acute MI, CHF; use IV if suspect MI |
| Side effects of Analgesic | Central nervous and respiratory depression; schedule II drug-must be kept secured; for MI pain: n2o and o2 decreases pain,sedates pt,and provides oxygen |
| Secondary Injectable: Vasopressor | methoxamine(Vasoxyl)/phenylephrine(Neo-Synephrine); for hypotension when cardiovascular status is unknown and want to raise BP w/o undue cardiac stimulation(ie syncope,drug overdose,postseizure,allergy,acute adrenal insufficiency) |
| Side effects of Vasopressor | Parenteral admin of most vasopressors is contra in pts with high BP or ventricular tachycardia. Persistent and pronounced bradycardia |
| Secondary Injectable: Antihypoglycemic | dextrose,50%solution/glucagon;for hypoglycemia,diagnostic aid in unconsciousness or unknown seizures |
| Use of Antihypoglycemic | for unconscious pt: 50% dextrose solution (IV), glucagon (IM). As soon as pt is conscious CHO should be administered. |
| Secondary Injectable: Corticosteroid | hydrocortisone sodium succinate (Solu-Cortef); used for definitive mngmt of acute allergy and in acute adrenal insufficiency; slow onset-up to 60 min (IV); 2nd line drugs bc of slow onset |
| Secondary Injectable: Antihypertensive | esmolol(Brevibloc)/propranolol(Inderal); used for acute hypertensive episodes, |
| Esmolol | antidysrhythmic agent in pt with paraxysmol supraventricular tachycardia (PSVT)and for mngmnt of intraoperative and postop tachycardia and hypertension |
| Secondary Injectable: Anticholinergic | Atropine;parasympathetic blocking agent; used for bradycardia and hemodynamically significant bradydysrhythmias(sig heart block and asystole) |
| Secondary Noninjectable: Respiratory Stimulant | Aromatic ammonia; used for respiratory depression not induced by opioid analgesics;vasodepressor syncope |
| Aromatic ammonia Use | crush silver-grey vaporole and place under breathing victim's nose until respiratory stimulation; possible movement of arms and legs in response to ammonia |
| Side effects of Ammonia | Bronchospasm may occur in pts with COPD or asthma; *2nd most commonly used drug in emergency kit. |
| Secondary Noninjectable: Antihypertensive | nifedipine(Procardia)/nitroglycerin; used for hypertension, acute anginal pain |
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