Everything you need to be successful on the NREMT and in your EMS career.
Wednesday, June 12, 2013
Monday, June 10, 2013
Nitroglycerin (Nitrostat, Tridil) Drug Profile
Mechanism of Action
Nitroglycerin is a vasodilator. Nitroglycerine is a smooth muscle relaxant that acts on vascular, bronchial, uterine, and intestinal smooth muscle. It dilates, or expands the passageway, of arterioles and veins in the periphery, reduces the preload and afterload of the heart. This decreases the work load that the heart is under which also reduces the myocardial oxygen demand.
Indications and Contrindications
Nitroglycerin is indicated for patients with acute angina pectoris, ischemic chest pain, hypertension, cardiac heart failure and pulmonary edema. It should not be used for patients with hypotension, hypovolemia, intracranial bleeding, head injuries, previous administration of Viagra, Revatio, Levitra, Cialis, or other similar agents within the last 24 to 36 hours.
Nitroglycerin Side Effects
Headache, hypotension, syncope, reflex tachycardia, flushing, nausea, vomiting, diaphoresis, and muscle twitching are possible adverse reactions to nitroglycerin. The active ingredient may also cause a stinging sensation when administered. Make sure that you let your patient know this ahead of time so they do not freak out. Let them know that it is normal.
This medication has additive effects if used in combination with any other vasodilators and is incompatible with other drugs intravenously. Nitroglycerin is a class C drug, and should be very closely monitored if needed for a pregnant patient. Geriatric patients are also more likely to experience hypotension after vasodilator administration.
How is it Supplied?
Nitroglycerin tablets come in different strengths; 0.15 mg (1/400 grain), 0.3 mg (1/200 grain), 0.4 mg (1/150 grain), and 0.6 mg (1/100 grain). Nitroglycerin spray comes in 0.4 to 0.8 mg per spray. There is also a nitroglycerin IV available called Nitrostat. The tablets and spray are placed under the tongue (SL) for rapid absorption.
Dosage and Administration
Tablets should be given in 0.3 to 0.4 mg doses and can be repeated in 3 to 5 minutes for a maximum of 3 doses. Nitroglycerin spray should be given in 0.4 mg doses under the tongue, 1 to 2 sprays. If giving Tridil via IV infusion, begin at 10 to 20 ug/min and gradually increase by 5 to 10 ug/min every 5 minutes until you see the desired effect.
Typical onset for nitroglycerin is quick at 1 to 3 minutes. It's peak effect can be seen after 5 to 10 minutes will last for 20 to 30 minutes for the tablet and spray. In the case of IV administration, the duration of action will last 1 to 10 minutes after the infusion is discontinued.
Nitroglycerin is a vasodilator. Nitroglycerine is a smooth muscle relaxant that acts on vascular, bronchial, uterine, and intestinal smooth muscle. It dilates, or expands the passageway, of arterioles and veins in the periphery, reduces the preload and afterload of the heart. This decreases the work load that the heart is under which also reduces the myocardial oxygen demand.
Indications and Contrindications
Nitroglycerin is indicated for patients with acute angina pectoris, ischemic chest pain, hypertension, cardiac heart failure and pulmonary edema. It should not be used for patients with hypotension, hypovolemia, intracranial bleeding, head injuries, previous administration of Viagra, Revatio, Levitra, Cialis, or other similar agents within the last 24 to 36 hours.
Nitroglycerin Side Effects
Headache, hypotension, syncope, reflex tachycardia, flushing, nausea, vomiting, diaphoresis, and muscle twitching are possible adverse reactions to nitroglycerin. The active ingredient may also cause a stinging sensation when administered. Make sure that you let your patient know this ahead of time so they do not freak out. Let them know that it is normal.
This medication has additive effects if used in combination with any other vasodilators and is incompatible with other drugs intravenously. Nitroglycerin is a class C drug, and should be very closely monitored if needed for a pregnant patient. Geriatric patients are also more likely to experience hypotension after vasodilator administration.
Nitroglycerin tablets come in different strengths; 0.15 mg (1/400 grain), 0.3 mg (1/200 grain), 0.4 mg (1/150 grain), and 0.6 mg (1/100 grain). Nitroglycerin spray comes in 0.4 to 0.8 mg per spray. There is also a nitroglycerin IV available called Nitrostat. The tablets and spray are placed under the tongue (SL) for rapid absorption.
Dosage and Administration
Tablets should be given in 0.3 to 0.4 mg doses and can be repeated in 3 to 5 minutes for a maximum of 3 doses. Nitroglycerin spray should be given in 0.4 mg doses under the tongue, 1 to 2 sprays. If giving Tridil via IV infusion, begin at 10 to 20 ug/min and gradually increase by 5 to 10 ug/min every 5 minutes until you see the desired effect.
Typical onset for nitroglycerin is quick at 1 to 3 minutes. It's peak effect can be seen after 5 to 10 minutes will last for 20 to 30 minutes for the tablet and spray. In the case of IV administration, the duration of action will last 1 to 10 minutes after the infusion is discontinued.
How to Write a Patient Care Report (PCR) Narative
One of the most difficult things about EMS documentation is the narrative of the patient care report or PCR. The general idea it to tell the story about what happened, how it happened and what you did about it. Below are some of the general categories to consider when writing your narrative.
Standard Precautions
What standard precautions did you use and why?
Scene Safety
Was the scene safe when you arrived? Did you have to make the scene safe? What did you do and why did you do it? Did this cause a delay in patient care? If so, how long?
Mechanism of Action/Nature of Illness
What was the MOI or NOI?
Number of Patients
If you had more than one patient at the scene, record which patient it is and out of how many. "Patient 2 of 3."
Additional Help
If additional help was needed, what kind did you need? When did you call for the extra help and what time did they arrived? Was there any delay in patient care due to this?
Cervical Spine
What cervical spine precautions were taken and why?
Initial General Impression
How did the patient appear when you first arrived on scene?
Level of Consciousness
Be sure to record what the patient's LOC was upon arrival and any changes. The time the change took place should also be recorded. Also, note if no changes occurred.
Chief Complaint
Record and quote any complaints by the patient. This also includes pertinent negatives like a patient who has chest pain but no numbness or tingling.
Life Threats
List all interventions and how the patient responded to them.
ABCs
Document everything you find and any interventions performed. This includes noting that breathing was adequate or pulse normal. Don't just put the things that are wrong with the ABCs.
Oxygen
Was oxygen given? What delivery method was used and how much?
Primary, Secondary, Patient History, or Reassessment
Write the type of assessment done and all findings.
SAMPLE/OPQRSTI
Record all relevant answers.
Vital Signs
Record the times and findings, depending on if your service requires them to be in the narrative as well.
Medical Direction
Quote any orders given to you by medical control and who gave them.
Management of Secondary Injuries/Treat for Shock
Record all interventions, the time, and response by the patient.
Standard Precautions
What standard precautions did you use and why?
Scene Safety
Was the scene safe when you arrived? Did you have to make the scene safe? What did you do and why did you do it? Did this cause a delay in patient care? If so, how long?
Mechanism of Action/Nature of Illness
What was the MOI or NOI?
Number of Patients
If you had more than one patient at the scene, record which patient it is and out of how many. "Patient 2 of 3."
Additional Help
If additional help was needed, what kind did you need? When did you call for the extra help and what time did they arrived? Was there any delay in patient care due to this?
Cervical Spine
What cervical spine precautions were taken and why?
Initial General Impression
How did the patient appear when you first arrived on scene?
Level of Consciousness
Be sure to record what the patient's LOC was upon arrival and any changes. The time the change took place should also be recorded. Also, note if no changes occurred.
Chief Complaint
Record and quote any complaints by the patient. This also includes pertinent negatives like a patient who has chest pain but no numbness or tingling.
Life Threats
List all interventions and how the patient responded to them.
ABCs
Document everything you find and any interventions performed. This includes noting that breathing was adequate or pulse normal. Don't just put the things that are wrong with the ABCs.
Oxygen
Was oxygen given? What delivery method was used and how much?
Primary, Secondary, Patient History, or Reassessment
Write the type of assessment done and all findings.
SAMPLE/OPQRSTI
Record all relevant answers.
Vital Signs
Record the times and findings, depending on if your service requires them to be in the narrative as well.
Medical Direction
Quote any orders given to you by medical control and who gave them.
Management of Secondary Injuries/Treat for Shock
Record all interventions, the time, and response by the patient.
National EMS Scope of Practice Model
| EMR | EMT | AEMT | Paramedic |
|---|---|---|---|
Airway and Breathing Minimum Psychomotor Skill Set | |||
| Oral airway | Humidifiers | Esophageal intubation | BiPAP/CPAP |
| Bag-mask Device | Partial rebreathing mask | Multilumen airways | Needle chest decompression |
| Sellick Maneuver | Venturi mask | Chest tube monitoring | |
| Head tilt-chin lift | Manually triggered ventilators | Percutaneous cricothyrotomy | |
| Jaw Thrust | Automatic transport ventilators | ETCO2/capnography | |
| Modified chin lift | Oral and nasal airways | NG/OG tube | |
| Obstruction, manual | Nasal and oral endotracheal intubation | ||
| Oxygen therapy | Airway obstruction removal by direct laryngoscopy | ||
| Nasal Cannula | Positive end-expiratory pressure | ||
| Nonrebreathing mask | |||
| Upper airway suctioning | |||
| Assesment Minimum Psychomotor Skill Set | |||
| Manual BP | Pulse oximetry | Blood glucose monitoring | ECG interpretation |
| Manual and auto BP | Interpretive 12-lead | ||
| Blood chemistry analysis | |||
Pharmacologic Intervention Minimum Psychomotor Skill Set | |||
| Medication Administration Routes: *Unit dose auto-injector for self or peer care (eg. Mark 1) | Assisted Medications: *Assisting a patient in administering his/her own prescribed medications, including auto-injector | *Peripheral IV insertion * IV fluid infusion *Pediatric IO insertion | *Central line monitoring *IO insertion *Venous blood sampling |
| Medication administration routes: *Buccal *Oral | Medication administration routes: *Subcutaneous (SQ) *Intramuscular (IM) *Nebulized *Sublingual (SL) *Intranasal *IV push or D50 and narcotic antagonist only | Medication administration routes: *Endotracheal *IV (push and infusion) *Nasogastric (NG) *Rectal *Intraosteous (IO) *Topical *Accessing implanted central IV port | |
| Medications to be administered: *Physician-approved over-the-counter medications (oral glucose, aspirin for chest pain of suspected ischemic origin) | Medication administration routes: *SL nitroglycerin for chest pain of suspected ischemic origin *SQ and IM empinephrine for anaphylaxis *Glucagon and IV D50 for hypoglycemia *Inhaled beta-agonist for dyspnea and wheezing *Narcotic antagonist *Nitrous oxide for pain relief | Medication administration routes: *Physician-approved medications *Maintenance of blood administration *Initiation of thrombolytics | |
Emergency Trauma Care Minimum Psychomotor Skill Set | |||
| Manual cervical stabilization | Spinal immobilization | Morgan lens | |
| Manual extremity stabilization | Seated spinal immobilization | ||
| Eye irrigation | Long board | ||
| Direct pressure | Extremity splinting | ||
| Emergency moves for endangered patients | Traction splinting | ||
| Mechanical patient restraint | |||
| Tourniquet | |||
| MAST/PASG | |||
| Cervical collar | |||
| Rapid extrication | |||
Medical/Cardiac Care Minimum Psychomotor Skill Set | |||
| CPR | Mechanical CPR | Cardioversion | |
| AED | Assisted complicated delivery of an infant | Carotid Massage | |
| Assisted normal delivery of an infant | Manual defibrillation | ||
| TC pacing |
Normal Vital Signs by Age
Neonate (0 to 1 mo)
Pulse Rate: 100 to 180 beats/minRespiratory Rate: 30 to 60 breaths/min
Systolic Blood Pressure: 50 to 70 mm Hg
Body Temperature: 98 to 100 degrees F
Infant (1 mo to 1 yr)
Pulse Rate: 100 to 160 beats/minRespiratory Rate: 25 to 50 breaths/min
Systolic Blood Pressure: 70 to 95 mm Hg
Body Temperature: 96.8 to 99.6 degrees F
Toddler (1 yr to 3 yrs)
Pulse Rate: 90 to 150 beats/minRespiratory Rate: 20 to 30 breaths/min
Systolic Blood Pressure: 80 to 100 mm Hg
Body Temperature: 96.8 to 99.6 degrees F
Preschool Age (3 to 6 yrs)
Pulse Rate: 80 to 140 beats/minRespiratory Rate: 20 to 25 breaths/min
Systolic Blood Pressure: 80 to 100 mm Hg
Body Temperature: 98.6 degrees F
School Age (6 to 12 yrs)
Pulse Rate: 70 to 120 beats/minRespiratory Rate: 15 to 20 breaths/min
Systolic Blood Pressure: 80 to 110 mm Hg
Body Temperature: 98.6 degrees F
Adolescents (12 to 18 yrs)
Pulse Rate: 60 to 100 beats/minRespiratory Rate: 12 to 20 breaths/min
Systolic Blood Pressure: 90 to 110 mm Hg
Body Temperature: 98.6 degrees F
Early Adult (19 to 40 yrs)
Pulse Rate: 60 to 100 beats/minRespiratory Rate: 12 to 20 breaths/min
Systolic Blood Pressure: 90 to 140 mm Hg
Body Temperature: 98.6 degrees F
Middle Adult (41 to 60 yrs)
Pulse Rate: 60 to 100 beats/minRespiratory Rate: 12 to 20 breaths/min
Systolic Blood Pressure: 90 to 140 mm Hg
Body Temperature: 98.6 degrees F
Late Adult (61 yrs & older)
Pulse Rate: Depends on healthRespiratory Rate: Depends on health
Systolic Blood Pressure: Depends on health
Body Temperature: 98.6 degrees F
NREMT Study Guide Books
Kaplan EMT-Basic Exam by Richard Lapierre (Feb 1, 2011)
Barron's Paramedic Exam: with CD-ROM by Mark Marchetta (Oct 1, 2008)
EMT National Training AEMT Practice Questions & Study Guide by Mr. Travis W Holycross, Mr Arthur S Reasor, Mr Ryan L Asher and Mr Dustin Labrousse (Jan 8, 2013)
NREMT Skills Sheets
EMT-B / EMT Psychomotor Exam Skills Sheets
Medical Assessment
Oxygen Administration
Spinal Immobilization Seated
Spinal Immobilization Supine
Trauma Assessment Advanced Psychomotor Exam Skills Sheets
(AEMT, I-85, I-99, EMT-P)
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