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Pharm Chapter23

Emergency Drugs and Equipment

QuestionAnswer
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
Created by: Hygiene103