BLS Protocols

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.     

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