Paramedic Pitstop Jan-17

This month I decided to hit on a type of call we see quite a bit around this time of the year due to several factors such as holiday relations to family, winter dreary weather, etc. Suicide attempts by meds are not isolated to the winter time and can be seen throughout the year. There are some unique things that come along with these calls. Things like scene safety, professional suspicion of drug use, social affects to the patient and their family, as well we the amount of whatever item they ingested.
Scene safety is number one for us. We can’t help someone if we too are in jeopardy of being harmed. This can be by the patient or even another person on scene we may or may not be aware of. As we enter any premise, especially someone’s home, we should be very aware of our surroundings. Where are other people in the home? Where are my exits? Has the patient been cleared or secured by PD? Don’t leave this job to one person. Everyone should be vigilant at situational awareness.

As we approach an altered or unconscious patient, we should again be situationally aware of our surroundings, but also be professionally suspicious of over medication, drug/alcohol use or any other causes that are harmful to the patient. This suspicion should not delay appropriate care as many of these patients will need immediate treatment of the ABC’s. I have listed what seems like the most common types of medication’s that are detrimental if used inappropriately along with their appropriate treatments.

TCA – Prescribed for depression

❖ Medication name

• Amitriptyline

• Amoxa[pine

• Desipramine (Norpramin)

• Doxepin

• Imipramine (Tofranil)

• Nortriptyline (Pamelor)

• Protriptyline (Vivactil)

• Trimipramine (Surmontil)

❖ Physiological problems

Causes cardiac arrhythmia’s due to acidosis. Can cause CNS depression.

❖ MGMT

Aggressive ABC’s if pt. unresponsive – Sodium Bi-Carb 1mEq/kg

Activated charcoal

 

Antiarrhythmic – Prescribed to pt.’s with premature atrial and ventricular beats, tachycardia’s’ involving the atria and AV junction as well as bypass tracts between the atria and ventricles, intermittent atrial fibrillation and flutter, after conversion from atrial fibrillation or flutter to prevent recurrence and ventricular tach.

❖ Medication Name

• Tambocor (Flecanide)

• Procanbid (Procainamide)

• Cordarone (Amioderone)

• Betapace (Sotalol)

❖ Physiological problems

These inhibit sodium influx and decreases cardiac action potential amplitude.

❖ MGMT

GI decontamination

Hemodialysis

Sodium bicarbonate

Magnesium

Seizure control (benzodiazepines)

B-blocker – Prescribed for fast heart rates, premature beats, high blood pressure. Beta blockers counteract the stimulatory effects of Epinephrine.

❖ Medication name

• Sectral (Acebutolol)

• Zebeta (Bisoprolol)

• Brevibloc (Esmolol)

• Inderal (Propranolol)

• Tenormin (Atenolol)

• Normodyne, Trandate (Labetalol)

• Coreg (Carvedilol)

• Lopressor, Toprol (Metoprolol)

❖ Physiologic problems

Bradycardia, Heart block, Hypotension, Delirium, Seizures, Coma

❖ MGMT

Bradycardia tx.

Atropine and IV fluids – If atropine increases the heart rate, effect is often brief, and bradycardia will recur

Glucagon is beta blocker overdose antidote

Calcium Channel Blocker – Prescribed for the treatment of hypertension, angina, atrial dysrhythmias and the control of migraine headaches.

❖ Medication name

• Norvasc (Amlodipine)

• Plendil (Felodipine)

• Cardizem (Diltiazem)

• Calan (Verapamil)

• Adalat (Nifedipine)

• Cardene (Nicardipine)

• Sular (Nisoldipine)

• Vascor (Bepridil)

❖ Physiologic problems

Reduce muscle contractility and relax both coronary and vascular tone(hypotension), cause negative inotropic effect, vasodilatation and subsequent decreased cardiac afterload and lowering of the aortic pressure.

❖ MGMT

Aggressive ABC ‘s as needed

Glucagon

Calcium

Fluid resuscitation for hypotensive/shock pt.’s

 

Anti-coagulants – Prescribed for atrial fibrillation, deep vein thrombosis, mechanical heart valves, stroke prevention, heart attacks, heart failure, pulmonary emboli, angina, stents, orthopedic procedures, wound care, just because……

❖ Medication name

• Dalteparin (Fragmin)

• Danaparoid (Orgaran)

• Enoxaprin (Lovenox)

• Heparin

• Tinzaparin (innohep)

• Warfarin (Coumadin)

• Xaralto (Rivaroxaban)

• Rat poison (Rodenticide)

• Clopidogrel (Plavix)

• Salicylates – Asprins

❖ Physiologic problems

Nose bleeds, hematemesis, hematochezia, rectal bleeding, bruises under skin, hemorrhages in excess such as in gums and general weakness causing dizziness and instability.

❖ MGMT

Aggressive ABC’s as needed

Fluid resuscitation

Rapid transport