1. Medication Administration

2. Medications Epinephrine (Epi-Pen) Albuterol (MDI) Atropine/2-PAM (Mark-1 Kit) Oral Glucose Oxygen

3. 6 Rights of Med Aministration Right Patient Right Medication Right Dose Right Route Right Time Right Documentation

4. Epinephrine Epi-Pen - single or dual dose Adult - 1:1,000 solution, 0.3 mL(0.3 mg) Peds - 1:2,000 solution, 0.3 mL(0.15 mg) Onset : Seconds Peak : Minutes Duration : Several Minutes

5. What is it? Non-selective Adrenergic Agonists ( ɑ and β) “Turns on” sympathetic nervous system Increased HR and contractility Increased RR vasoconstrictor or vasodilator bronchodilator

6. When to use it? Allergic Reaction Asthma Cardiac Arrest

7. Allergic Reaction Mild itching, rash/hives, watery, red eyes, tingling in mouth Moderate anxiety, throat tightness, trouble breathing or swallowing, wheezing, rash/hives, abd pain/cramp, NV

8. Allergic Reaction Severe feeling of impending doom, respiratory distress, hives, decreased LOC, low BP, tachycardia Anaphylactic shock like severe accompanied by shock SBP 110, life threatening

9. Management ABCDs Oxygen ID and remove allergen if possible Monitor condition for worsening Arrange transport Epinephrine administration

10. Epi-Pen Administration 6 Rights of Medications Remove safety cap Grasp injector- don’t put thumb over end Place over outer thigh muscle and push until needle deploys. Hold in place 10 seconds Massage sight

11. Side Effects Tachycardia Anxiety Increased BP Angina?

12. Albuterol Proventil, Ventolin, Xoponex Metered Dose Inhaler (MDI or “Puffer”) May have spacer Onset: 5-15 minutes Peak:.5 - 2 hours Duration: 3-4 hours

13. What is it? Selective β Adrenergic Agonists (β2 > β1) Relaxes bronchial smooth muscle other smooth muscle too - vascular, uterine etc. Increased HR

14. When to use it? Bronchospasm Asthma Allergic Reaction

15. Asthma Mild mild SOB, may have some wheezing Moderate increased SOB, pronounced wheeze, may have prolonged expiration, anxiety Severe respiratory distress, may have silent breath sounds, severe anxiety

16. Management ABCDs Oxygen MDI Monitor and/or transport Epi-Pen, in extremis, if available

17. MDI Administration Remove Cap Shake Have patient exhale Have patient place lips around mouthpiece Have patient breathe in slowly Depress top as they breathe in Hold breathe for at least 10 seconds Repeat every 30 - 60 sec as needed

18. Side Effects Dysrythmia, tachycardia Tremors, anxiety Nausea, vomiting Hyperglycemia Rare paradoxical bronchospasm

19. Atropine/2 PAM Mark 1 Kit (autoinjectors) Atropine: 2 mg in 0.7cc Pralidoxime (2 PAM) 600 mg in 2 cc Onset : 1 minute Peak : 2-5 minutes Duration : 2 hours

20. What is it? Atropine: Competitive antagonist of acetylcholine 2 PAM: Cholinesterase re-activator Both act to turn off parasympathetic nervous system

21. When to use it? Anticholinesterase exposre Nerve Gas/WMD Organophosphate (insecticide) Atropine has other uses - including cardiac arrest, symptomatic bradycardia etc

22. Parasympathetic Nervous System

23. Anticholinesterase Exposure Turns on Parasympathetic nervous system S - salivation L - lacrimation U - urination D - defecation G - GI distress E - Eye constriction

24. Anticholinesterase Exposure Turns on Parasympathetic nervous system D - defecation U - urination M - miosis (pupil constriction) B - bronchorhea, bradycardia E - emesis L - lacrimation S - salivation

25. Anticholinesterase Exposure Respiratory Arrest Seizure Coma Death

26. Management Do not expose yourself ABCDs/Oxygen Decontamination Atropine 2 PAM Arrange transport

27. Atropine/2 PAM Administration 6 Rights of Medications Remove safety cap Grasp injector- don’t put thumb over end Place over outer thigh muscle and push until needle deploys. Hold in place 10 seconds Massage sight

28. Atropine/2 PAM Administration Give atropine first Mild Atropine q5 minutes until effect 2 PAM q15 minutes times three Severe Give 3 doses each in rapid succession Can give atropine q5 with no limit Grasp injector- don’t put thumb over end Place over outer thigh muscle and push until needle deploys. Hold in place 10 seconds Massage sight

29. Side Effects Dry mouth, thirst Hot, dry, flushed skin Fever, palpitations, restlessnes Delerium

30. Oral Glucose Adult - 15-45 G PO Peds - 5-45 G PO Onset : 10 minutes Duration : uncertain

31. When to use it? Symptomatic Hypoglycemia

32. Typically patients on DM medication Mild/Moderate funny feeling, anxiety, sweatiness, shaky Severe altered mental status, decreased LOC, seizure Patients typically can tell

33. Management ABCDs Check glucometer if possible Administer PO glucose if patient can handle secretions Give other food PO once recovered Patients on oral hypoglycemic meds should be transferred due to long half-life

34. Side Effects Hyperglycemia

35. Oxygen Used liberally in pre-hospital setting Air is ~20% oxygen 2LNC ~24% 10L FM ~57% 10L NRB ~68%

36. Oxygen Generally safe Oxygen toxicity from prolonged exposure to high partial pressures COPD pts may have blunted respiratory response In ski patrol setting there should be no contra- indication