1 Oral Glucose Power / Gel 1.1 Oral Glucose Powder / Gel

Classification: Carbohydrates

Schedule: 1

1.2 PharmaCOLOGY

Study of properties & effects of drugs

Pharmacology effects: Therapeutic Effects (desirable)

Side Effects (undesirable / harmful)

Administration of oral glucose solution / preparation provides soluble (simple) carbohydrate to tissues in order to raise Blood Glucose Levels.

1.3 Adverse Effects

Hyperglycaemia

1.4 Indication

Acute management of Hypoglycaemia

HGT

1.5 Contra – Indication

No Absolute-contra indications

1.6 Precaution

Patient MUST be lateral if unconscious

Avoid aspiration

1.7 Packaging

Powder: 25g and 50g (per sachet)

Gel: 25g and 50g

1.8 Dosage and Administration

Gel: 25g gel applied to oral mucosa of pt. with gloved finger

Powder: dilute powder in glass of water (ONLY if pt. is conscious)

Repeat after 5min should blood glucose remain

2 Activated Charcoal 2.1 Activated Charcoal

Classification: Carbon

Schedule: 1

2.2 PharmaCOLOGY

Study of properties & effects of drugs

Pharmacology effects: Therapeutic Effects (desirable)

Side Effects (undesirable / harmful)

Activated Charcoal absorbs many poisonous compounds to its surface – this reduces the absorption by the GIT (Gastro-Intestinal Tract)

2.3 Adverse Effects

The patient may experience mild constipation

2.4 Indication

To assist in treatment of certain cases if overdoses and poisonings where agents/s have been orally ingested (ONLY within an hours of ingestion)

2.5 Contra – Indication

Should NOT be used with poisoning with: Boric Acid

Cyanide

Ethanol

Ethylene Glycol

Lithium

Methanol

Organophosphates

Petroleum Products

Iron

Strong acids and Alkalis

When a pt. has decreased levels of consciousness or is unconscious –

Unprotected airway

DO NOT USE if he container was not sealed properly –

De-activation due to moisture exposure)

2.6 Packaging

Powder: Fine black powder in bottles of 25g and 50g

2.7 Dosage and Administration

Adult: 1g / kg mixed with water, given orally

Paediatric: 0.5g / kg mixed with water, given orally

3 ENTONOX - Nitrous Oxide and Oxygen 3.1 Entonox – Nitrous Oxide and Oxygen

Classification: Analgesic Gas

Schedule: 4

3.2 PharmaCOLOGY

Study of properties & effects of drugs

Pharmacology effects: Therapeutic Effects (desirable)

Side Effects (undesirable / harmful)

· Colourless, sweet-smelling, non-irritant gas

· Heavier than room air / oxygen

· Mild analgesic and anaesthetic effect depending on the dose inhaled

· When inhaled it supressed the CNS (Central Nervous System) causing anaesthesia

· High concentrations of oxygen delivered along with nitrous oxide INCREASES oxygen tension in the blood thereby REDUCING hypoxia (Hypoxia – lack of oxygen)

· Provides rapid, easily reversible relief of mild to moderate pain relief

3.3 Pharmaco-KINETIC

HOW the body HANDLES the drug over period of time:

· Absorption

o Absorption begins at site of administration

o RATE and EXTENT of absorption depends on:

§ Route of administration

§ Dosage

§ Dosage form

· Distribution

o distribution is transport of the drug through blood stream to various tissues at its action site

o Barriers to drug distribution: blood barriers / placental barrier

· Biotransformation

o Process: drug is chemically converted to a metabolite (in order for body to metabolize drug)

· Excretion

o Is elimination of toxic / inactive metabolites

o Kidneys – primary organ for excretion

o Other organs: intestine / lungs / glands / skin

Above effects pt. response to drug therapy

· EXTREMELY bloods-insoluble

· NOT metabolised by the body

· Eliminated by the lungs (small amounts eliminated through skin)

· Onset action: 30-60 sec (MAX 3-4 min)

o Can last for up to 10 min

3.4 Adverse Effects

Light-headedness

Drowsiness

Nausea and Vomiting

3.5 Indication

· Relief from pain from:

o Acute Myocardial Infarction

o Musculoskeletal trauma

o Burns – NOT burn to respiratory tract

o Active labour

· Any other condition requiring pain relief – PROVIDED THERE ARE NO CONTRA - INDICATIONS

3.6 Contra – Indication

· GCS (Glasgow Coma Scale)

· Neurological impairment:

o ANY altered level of consciousness

o Inability to comply with instructions

o Head injuries

· Air Entrapment:

o COPD (Chronic Obstructive Pulmonary Disease)

o Asthma patient during an acute episode

o Acute Pulmonary oedema (Acute – Sudden / Oedema – Swelling)

o Chest Injuries

o Abdominal trauma

o Diving Accident – Specifically: Acute Decompression Illness

o Burns to the respiratory tract

· Other limitations:

o SPO2

o Major Facial Trauma

3.7 Precaution

· Oxygen and nitrous oxide disassociate at

· IMPERITIVE that cylinder is inverted a few times and then placed horizontally when used in cold conditions – pt. will otherwise inhale pure nitrous oxide

· Nitrogen has DECREASED solubility in blood

o Once in gas-containing space – the gas dissociates and NITROGEN diffuses OUT SLOWER than NITROUS OXIDE diffuses IN

o Causes a NET INCREASE in GAS VOLUME

· When masked is removed after prolonged use

o gas will come out of solution in lungs and displace the oxygen in the alveoli – causing hypoxia

o Prevention: Mask must NOT be strapped to pt. face. Pt. must receive oxygen for 5-10min

· Nitrous oxide is a NON-explosive gas

3.8 Packaging

Pressurised cylinders: mixture 52% nitrous oxide + 48% oxygen

(N2O+O2 52%: 48%)

3.9 Dosage and Administration

Entonox is predominantly a self-administered gas

Administration is to be explained carefully to pt. beforehand – prevent unnecessary complications

Once pt. has inhaled enough Entonox to control the pain, they must remove the mask – preventing chances of overdosing

If pt. becomes drowsy – REMOVE Entonox and replace immediately with oxygen

ONLY registered ALS may administer Entonox to pt.

As it require careful monitoring of pt. in order to prevent complications arising.

4 Medical Oxygen 4.1 Medical Oxygen

Classification: Natural Occurring Atmospheric Gas

4.2 PharmaCOLOGY

Study of properties & effects of drugs

Pharmacology effects: Therapeutic Effects (desirable)

Side Effects (undesirable / harmful)

· Colourless, tasteless, odourless gas

· Present in atmosphere – approx. 21% local atmospheric pressure

· Reverses deleterious effects of hypoxeamia on the brain, heart and other vital organs

o (decrease amount of oxygen in tissue)

· Expired air contains 16%-17% oxygen

· During optimal active CPR only 25%-30% of normal cardiac output is maintained – and for these reason supplemental oxygen should be administered

o Good CPR with supplement O2 – you can maintain normal cardiac output of 25-30%

4.3 Indication

· GCS (Glasgow Coma Scale)

· Any respiratory insufficiency or arrest

· Acute de-compensation of COPD / Asthma

· Chest pain (medical / trauma origin)

· Cardiac arrest / cardiac failure

· Toxic inhalations

· SPO2

· ANY pt. with abnormal vital signs

· Confirmed / suspected hypoxia (lack of O2 in blood)

· Severe anaemia

· Multiple/ severe trauma

· Scuba diving accident (Nitrogen bubbles created in gaseous spaces in our bodies)

· Prophylactically during are transport

4.4 Contra – Indication

NO absolute contra-indication for use of oxygen in emergency setting

4.5 Precaution

· Production of superoxide radicals in presence of paraquat (herbicide – used to kills marijuana plants in Mexico) – paraquat and oxygen enhance each other’s toxicity – causing severe pulmonary injury

· High concentrations of oxygen may REDUCE respiratory drive of COPD pt. – careful monitoring of pt. required – DO NOT without oxygen from these patients if condition is such the oxygen is required

· Neonates with patent ductus arteriosus (PDA):

o should cyanosis and signs of hypoxia develop after oxygen administration – remove oxygen

o Some infants with PDS and congenital heart disease – the presence of PDA may be lifesaving because of ductal-dependent systemic / pulmonary blood flow

§ Increased oxygen concentration tends to constrict foetal ductus arteriosus

· Long exposure to high concentrations of oxygen may result in retrolental fibroplasia in neonates and pulmonary fibrosis

· Oxygen support combustion – DO NOT use in presence of fire / smoke / cigarette smoking

· High pressured oxygen should NOT be used with oil / grease based substances – causes exothermic reaction – risk of explosion

· REMOVE oxygen source to one metre away from defibrillation pads / paddles

4.6 Packaging

Pressurised cylinder containing 100% medical oxygen

4.7 Dosage and Administration

Administered via: Oxygen masks

Simple Mask

Venturi Mask

Partial Re-Breather Mask

Non-Re-Breather Mask

Nasal cannulae

Nebulizer device (5ml of saline)

Jet insufflation

Bag-Valve Mask/Tube (BVM)

Bag-Valve Mask/Tube – Reservoir Device

Correct Flow rates (FiO2):

Nasal Cannulae

21-40%

@ 1 – 6 L/min

Venturi Mask

24-50%

@ 4 – 12 L/min

Simple Mask

35-60%

@ 6 – 10 L/min

Partial Re-Breather Mask

35-70%

@ 6 – 10 L/min

Non-Re-Breather Mask

60-100%

@ 6 – 15 L/min

Bag-Valve-Mask/tube

50%

@ 12 – 15 L/min

Bag-Valve-Mask/tube – reservoir device

95-100%

@ 15 L/min

(Adequate flow rate = Reservoir bag inflated > 1/3 at all time) Just under 1/3.

	Created by mgavinster about 10 years ago

BLS Emergency Medical Care Note on BLS Protocols, created by mgavinster on 05/04/2014.

BLS Protocols