Prehospital Emergency Pharmacology

DR. BRYAN BLEDSOE   Dr. Bryan Bledsoe is an emergency physician with a special interest in prehospital care. He received his B.S. degree from the University of Texas at Arlington and his medical degree from the University of North Texas Health Sciences Center/Texas College of Osteopathic Medicine. He completed his internship at Texas Tech University and residency training at Scott and White Memorial Hospital/Texas A&M College of Medicine. Dr. Bledsoe is board certified in emergency medicine. Prior to attending medical school, Dr. Bledsoe worked as an EMT, a paramedic, and a paramedic instructor. He completed EMT training in 1974 and paramedic training in 1976 and worked for 6 years as a field paramedic in Fort Worth, Texas. In 1979, he joined the faculty of the University of North Texas Health Sciences Center and served as coordinator of EMT and paramedic education programs at the university. Dr. Bledsoe is active in emergency medicine and EMS research. He is a popular speaker at state, national, and international seminars and writes regularly for numerous EMS journals. Dr. Bledsoe is on the faculty of the University of Nevada, Las Vegas. He is active in educational endeavors with the United States Special Operations Command (USSOCOM) and co-chairs their Certification and Evaluation Board (CEB). Dr. Bledsoe has authored several EMS books published by Brady, including Paramedic Care: Principles & Practice, Essentials of Paramedic Care, Intermediate Emergency Care: Principles & Practice, Critical Care Paramedic, Anatomy & Physiology for Emergency Care, Prehospital Emergency Pharmacology, and Pocket Reference for ALS Providers. He is married to Emma Bledsoe. They have two children, Bryan and Andrea,and a grandson, Andrew, and live on a ranch south of Dallas, Texas. He enjoys saltwaterfishing and warm latitudes.

Preface

Acknowledgments

About the Authors

Notices

Precautions on Bloodborne Pathogens and Infectious Diseases

1. General Information

Objectives
Introduction
Drug Research and Bringing a Drug to Market
FDA Classification of Newly Approved Drugs
New Drug Development
Unlabeled Uses of Drugs
Medical Oversight
Components of a Drug Profile
Important Pharmacological Terminology
Summary

2. Pharmacokinetics and Pharmacodynamics

Objectives
Introduction
Pharmacology
Pharmacokinetics
Review of Physiology of Transport
Pharmacodynamics
Summary

3. Administration of Drugs

Objectives
Introduction
Patient Care Using Medications
The Medication Order
Six Rights of Medication Administration
General Administration Routes
Drug Administration and Preparation
Medical Direction
Medical Asepsis
Disposal of Contaminated Equipment and Sharps
Medication Routes Used in Emergency Medicine
Pediatric Administration Techniques
Summary

4. Drug Dosage Calculations

Objectives
Introduction
Section 1: The Metric System
Section 2: Find the Ordered Dose
Section 3: Find the Units per Kilogram
Section 4: Concentration Problems
Section 5: Calculate an IV Drip
Section 6: Calculate an IV Drip Based on Patient Weight
Section 7: Milliliters per Hour to Drops per Minute
Practice Problems

5. Fluids, Electrolytes, and Intravenous Therapy

Objectives
Introduction
Fluids
Electrolytes
Cell Physiology
Blood
IV Therapy
Insertion of Indwelling IV Catheter
Collection of Blood Samples for Laboratory Analysis
Blood Transfusions
Summary

6. The Autonomic Nervous System

Objectives
Introduction
The Autonomic Nervous System
Summary

7. Drugs Used in the Treatment of Cardiovascular Emergencies

Objectives
Introduction
Oxygen
Sympathomimetics
Sympathetic Blockers
Antidysrhythmics
Parasympatholytics
Cardiac Glycosides
Anticoagulants
Fibrinolytics
Alkalinizing Agents
Cardiac Pain Management (Analgesics)
Diuretics
Natriuretic Peptides
Antianginal Agents
Antihypertensives
Other Cardiovascular Drugs
Summary

8. Drugs Used in the Treatment of Respiratory Emergencies

Objectives
Introduction
Oxygen
Asthma
Neuromuscular Blockers
Induction Agents
Rapid-Sequence Induction
Pharmacologically-Assisted Intubation
Summary

9. Drugs Used in the Treatment of Metabolic-Endocrine Emergencies

Objectives
Introduction
Diabetes Mellitus
Types of Diabetes
Diabetic Ketoacidosis (Diabetic Coma)
Hypoglycemia (Insulin Shock)
Insulin
Glucagon
Thiamine
Summary

10. Drugs Used in the Treatment of Neurological Emergencies

Objectives
Introduction
Neurological Trauma
Nontraumatic Neurological Emergencies
Summary

11. Drugs Used in the Treatment of Obstetrical and Gynecological Emergencies

Objectives
Introduction
Severe Vaginal Bleeding
Hypertensive Disorders of Pregnancy
Preterm Labor
Summary

12. Toxicological Emergencies in Prehospital Care

Objectives
Introduction
Regional Poison Centers
Patient History
General Approach to the Poisoned Patient
Toxidromes
Specific Toxic Agents Encountered in Prehospital Care
Summary

13. Drugs Used in the Treatment of Behavioral Emergencies

Objectives
Introduction
Understanding Behavioral Emergencies
Summary

14. Drugs Used in the Treatment of Gastrointestinal Emergencies

Objectives
Gastrointestinal Medications
Summary

15. Drugs Used in Pain Management

Objectives
Introduction
Analgesics
Summary

16. Weapons of Mass Destruction

Objectives
Introduction
Personal Protection
NBC Agents Overview
Summary

Appendix A Glossary of Street Drug Names

Appendix B Emergency Intravenous Fluids Quick

Reference Guide

Appendix C Quick Drug Reference

Appendix D Adult Advanced Cardiac Life Support Algorithms

Appendix E Common Home Prescription Drug Information

Appendix F Pediatric Drug Dosages

Appendix G Pediatric Advanced Cardiac Life Support Treatment Algorithm

Appendix H Drug Administration Skills

Appendix I A Guide to Herbal Supplements

Appendix J Practice Problems Answer Key

Index