That's a...cute cardiogenic pulmonary edema...NOT!
First used to manage angina, classified as a nitrate and a vasodilator.
Nitroglycerin
Percentage of deaths in Canada are caused by this condition. List both:
9%, Congestive Heart Failure.
Lung disease characterized by obstruction of airflow; emphysema, bronchitis, asthma
Characterized by progressive, irreversible airway obstruction
COPD
- Short acting, Beta 2 adrenergic receptor agonist.
- Used for relief of brocho spasm
- Brochodilator
- Anti-asthmatic
Salbutamol
What did it make you do and what can stop this by blocking their signalling pathways.
Vomit! - Anti-emetics.
Acute Cardiogenic Pulmonary Edema is an accumulation of...
extra fluid in the lungs.
Not too much fluid, just in the wrong place. CPAP forces air into the lungs, forcing fluid out.
Euvolemic
Signs and symptoms of COPD (5 of them)
- Dyspnea
- Wheezing
- Chest tightness
- Productive cough/sputum
- Fatigue/insomnia
Symptoms of bronchoconstriction include:
- W
- C
- D
- D
- S
- Wheezing
- Coughing
- Dyspnea
- Decreased air entry
- Silent chest
Side effects of anti-emetics:
- C
- H
- F
- M
- D
- B
- D
- P
- Constipation or diarrhea
- Headache
- Fatigue
- Malaise
- Dizziness
- Blurred vision
- Dry mouth
- Photosensitivity
Signs & symptoms of heart failure include: dyspnea/orthopnes, hypertension, crackles, rarely wheezing, anxiety, confusion, restlessness, tachypnea and four others:
Tachycardia, diaphoresis/cyanosis, paroxysmal nocturnal dyspnea, persistent cough.
Preserves speech and swallowing, allowing patient to communicate with family and staff. This would be one of the CPAP ___________.
advantages
Goal of Prehospital CPAP are:
- Provides effective way to treat CHF/COPD
- Distends alveoli, preventing collapse on expiration and providing a greater surface area, therefore improving gas exchange.
Name one more:
Increases functional residual capacity; volume of gas remaining in lungs at end-expiration.
If patient is unable to cooperate with MDI administration, what would you consider as a form of administration and up to how many doses?
Nebulized; max 3 doses.
- Drug interaction
- Head trauma
- Taking anticholinergics
- 73 years old
What medication would you select for this situation?
Ondansetron
Initial 12 or 15 lead acquisition is not required for nitroglycerin administration in this directive because.....
RVI's generally do not present with acute pulmonary edema.
CPAD Disadvantages include:
- Discomfort and pressure sores
- Gastric distention
- Pulmonary barotrauma (rate of 0.5%)
Name the four remaining:
- Reduced cardiac output
- Hypoventilation
- Claustrophobic and noisy
- Requires coaching and support
CPAP Medical Directive:
Indications: (2)
Conditions: (4)
Indications: Severe respiratory distress
AND
Signs/symptoms of acute pulmonary edema or COPD
Conditions:
- >18 years old
- Tachypnea
- Normotension
- Sp02 <90% OR accessory muscle use
Bronchoconstriction Medical Directive:
Dexamethasone:
Indication =
Conditions =
Contraindications =
Indication = Respiratory distress AND suspected bronchoconstriction.
Conditions = Hx of asthmas OR COPD OR 20 pack-year hx of smoking.
Contraindications = Allergy/sensitivy to steriods, currently on PO or parenteral steriods.
Nausea/Vomiting Medical Directive:
Indication: Nausea OR vomiting
Condition: >25kg, unaltered
Contraindications: Allergy, prolonged QT syndrome (known to patient), Apomorphine use
This is referring to this drug:
Ondansetron
A patient has an SBP >140mmHg with not history of nitroglycerin use. Outline the treatment.
Route: SL
Dose: 0.3mg or 0.4mg
Max single dose: 04.mg
Dosing interval: 5 mins
Max # of doses: 6
These are signs and symptoms of heart failure. Name the remaining 7:
- Dyspnea
- Crackles, rarely breathing
- Fatigued, generalized weakness
- Diaphoresis
- Cyanosis (late)
- Hypertension
- Anxiety, confusion, restlessness
- Tachypnea, Tachycardia
- Persistent cough
CPA contraindications include:
- Asthma exacerbation
- Suspected pneumothorax
- Inability to cooperate
Name four more:
- Unprotected or unstable airway
- Major trauma or burns to head or torso
- Tracheostomy
- Inability to sit upright
Bronchoconstriction Medical Directive:
Treatment: Consider _______________
Weight: >25kg
Route: NEB
Dose: 5mg
Max single dose: 5mg
Dosing interval: 5-15min PRN
Max # of doses: 3
Salbutamol.
Consider this drug if:
- <65 years old
- >50kg
- Route: IV/IM
- Dose: 50mg
- Max single dose: 50mg
- Max # of doses: 1
Dimenhydrinate