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Mechanism of Action for Oxygen
Rapidly diffuses across alveolar walls
Binds to hemoglobin in RBC
Reverses effects of hypoxemia in brain, heart, other body tissues
Increases arterial oxygen tension
Necessary for breakdown of glucose into ATP
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Indications and field use of Oxygen:
Systemic or local hypoxemia is present
Dyspnea, respiratory arrest, chest pain, shock, cardiopulmonary arrest, unconsciousness, submersion, toxic inhallations, stroke, head injury, seizures, critical patient
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Contraindications of Oxygen:
None in prehospital
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Adverse reactions of Oxygen:
None in prehospital
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Incompatibilities / Drug Interactions of Oxygen:
None in prehospital
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Adult and Pediatric Dosage of Oxygen:
- Nasal Cannula - 1-6 (LPM)
- Simple Face Mask - 8-10
- Non-Rebreather 10-15
- Bag Valve Mask 15
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Routes of Administration of Oxygen:
- Nasal Cannula
- Simple Face Mask
- Non-Rebreather
- Bag Valve Mask
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Onset of Action of Oxygen:
Variable
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Peak Effects of Oxygen:
Variable
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Duration of Action of Oxygen:
Variable
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Dosage Forms / Packaging of Oxygen:
Steel or aluminum gree canisters with pressure of 2,000-2,200psi.
High pressure is reduced with a regulator
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Special Notes on Oxygen:
COPD - may experience respiratory depression with high flow because their systems are regulated with hypoxic drive. If already on a low flow upon arrive, mirror that amount, or provide 2LPM.
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Generic name for Aspirin:
Acetylsalicylic Acid, Aspirin
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Brand names for Aspirin:
Aspirin, Bayer, Bufferin, Anacin, Children's flavored chewable aspirin
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Class for Aspirin:
- Analgesic
- Anti-Thrombotic
- Anti-Pyretic
- Anti-Inflamatory
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What is the class of Oxygen:
Natural gas
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What is the mechanism of Action for Aspirin:
- Blocks Thromoxane 2
- Decreased platelet aggregation and thrombus formation
- Use in management of MI
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Indications and Field Use of Aspirin:
- Chest pain
- Signs/Symptoms or MI
- ECG suggestive of MI
- Unstable angina
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Contraindications of Aspirin:
- Bleeding ulcer
- Hemorrhagic state
- Hemophilia
- Known allergies to salicylates
- Childern or adolescents
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Adverse Reations to Aspirin:
- Caution with history of asthma
- Anaphylactic reactions in sensitive patients
- Rare - gastrointestinal irritation and bleeding
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Incompatibilities / Drug Interactions with Aspirin:
Not applicable with single dose
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Adult Dosage with Aspirin:
Cardiac: 325 (4 x 81mg pediatric chewable tabs), chew or swallow
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Pediatric Dosage for Aspirin:
Not indicated for prehospital
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Routes of Administration for Aspirin:
Oral
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Onset of Action for Aspirin:
20-30 minutes
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Peak Effects of Aspirin:
2-3 hours
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Duration of Action of Aspirin:
4-6 hours
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Dosage Forms / Packaging of Aspirin:
81 - 325 mg individually packaged
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AZ Drug Box Supply Range for Aspirin:
Paramedic - 50-100 tablets
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Special Notes for Aspirin:
- Baby aspirin is heat and light sensitive
- Odor like vinegar is degredation
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What is the generic name of Morphine?
Morphine Sulfate
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Brand name of morphine?
Morphine
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Mechanism of Action of Morphine
- Binds to opiate receptors in CNS
- Alters perception and response to pain
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- Causes CNS depression
- Respiratory depression
- Vasomotor center depression
- Vasodilation
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- Releases histamine
- Vasoldilation
- Itching/hives
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Indications and field use of Morphine
- Analgesia
- Chest pain of probable cardiac origin
- Major burns
- Isolated muscosceletal injury
- Kidney stones
Why - Binds to opiate receptors in CNS altering perspective of pain
CHF with pulmonary edema (per agency)
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Dosage of Morphine?
Via slow IV push or IM
- Adult:
- Chest pain or isolated muscoskeletal injury -
- MS 2-4mg slow IV push q 5 minutes if BP >100, max 10mg
- Major burns -
- MS 2-4mg slow IV push q 5 minutes if BP >100, max 20mg
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Contraindications of Morphine?
- Known hypersensitivity
- Hypotension
- Decreased level of consciousness
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Drug Interactions with Morphine?
- Potentiated by other CNS depressants
- Overdose/side effects reversed by Narcan
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Side effects of Morphine?
- True allergic reaction (Patch with Medical Control)
- Itching/hives (due to histamine release, not allergy, patch with Medical Control)
- Hypotension
- CNS depression
- Bradycardia
- Nausea/Vomiting
- Anxiety
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Onset of Action of Morphine?
Seconds
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AZ Drug Box Supply of Morphine?
2 x 10mg in 1cc sealed prefilled Tubex syringe or ampule
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Special note for Morphine?
Schedule II controlled substance, requires documentation and DEA tracking
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What is the Generic name for Nitro?
Nitroglycerin
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What is the brand name for Nitro?
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What is the class for Nitro?
Nitrate
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What is the Mechanism of Action for Nitro?
- Nitrates release nitric oxide which relaxes smooth muscle
- Dilation of vascular smooth muscle
- Reduces preload
- Reduces afterload
- Dilation of coronary arteries
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Indications and field use of Nitro?
- Chest pain of probable cardiac origin - Why?
- Reduced preload and afterload decreasing myocardial workload
- Dilation of coronary arteries increases blood flow to myocardium
- Congestive heart failure with pulmonary edema - Why?
- Reduced preload reduces amount of blood sent to the lungs
- Reduced afterload allows left ventricle to move blood out of the lungs
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Dosage of Nitro?
Dosage is via SL tablet or spray
- Adult:
- Chest pain
- - NTG 0.4mg SL tablet or spray q 5 minutes if BP >100, max 3 times
- CHF with pulmonary edema
- - NTG 0.4mg SL tablet or spray q 5 minutes if BP >100, no max
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Contraindications of Nitro?
- Right ventricle MI
- Known hypersensitivity or allergy
- Hypotension BP >100 systolic
- Head injury / CVA
- Erectile dysfunction drugs - Viagra, Cialis, Levitra
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Drug Interactions with Nitro?
- Potentiated by anti-hypertensives
- Alcohol
- Beta-blockers
- Calcium-channel blockers
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Side effects of Nitro?
- Headache
- Bitter taste / Burning feeling in mouth
- Hypotension - consider starting IV prior to NTG administration
- Syncope - do not have patient walk after NTG admin
- Tachycardia
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Onset of Action of Nitro?
1-5 minutes
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AZ Drug box supply of Nitro?
- Dark glass bottle with 25 0.4mg tablets
- Red spray bottle with 200 metered 0.4 sprays
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Special Notes for Nitro?
- NTG is heat, light and air sensitive, so keep in dark closed container
- NTG infusion must be done with glass IV bottle
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