EMS Skills – BLS Medication Preparation and Administration

EMS Skills – BLS Medication Preparation and Administration


When intervening with
medications, it’s imperative to remember some standard
yet important points. Always use appropriate body
substance isolation precautions, or BSI. Medications should be
administered in compliance with your local protocols
and medical direction. A comprehensive assessment
must be performed on all patients to determine the
indication for the medication, contraindications, the
appropriate dose for the patient, as well as the expected
outcome or response to the medication itself. Before administering any
medication, always be certain you have the right patient,
the right medication, the right dose, the right time,
the right route. And we need to be prepared
to document the right information. Prior to administration,
inspect the medication packaging to ensure it
contains the correct medication, the correct dose. That your medication has not
expired or has not been contaminated in any manner. If you find packaging that is
not intact, that may indicate a loss of sterility of the
medication itself. And it should be discarded. Select a nebulizer delivery
method based on the patient’s ability to hold the device and
coordinate inhalation and breathing technique. Here, we are demonstrating using
the T fitting device. You can preassemble the
medication cup by screwing the top and bottom sections
together. Now take the T piece fitting,
place it on top, and connect a corrugated tubing to one side
and the mouthpiece to the other side. Now the top of the medication
cup can be unscrewed or the T piece fitting removed. Double-check the medication
expiration date and apply the appropriate medication and dose
into the medication cup. Reassemble the top of the
medication cup by threading the top on snugly. Attach the oxygen tubing to
the inlet port of the medication cup. Attach the other end of the
oxygen tubing to a source capable of delivering
6 to 8 liters per minute of oxygen flow. Turn the oxygen and adjust the
flow for best results. If there’s a problem and you
don’t see mist coming from both ends of the nebulizer,
recheck all your connections and flow rate. Explain the procedure
to the patient. Have them seal their lips around
the mouthpiece of the handheld nebulizer and take
slow breaths and inhale as deep as possible. Encourage the patient to hold
their breath as long as they are comfortably able to, and the
mist should disappear with each breath. As the medication is
administered and the level drops in the medication cup, the
cup may need to be tapped to deliver all the
medication during the breathing treatment. Finally, reassess the
patient and provide supplemental oxygen. There are some general important
points to remember when administering medications
which need to be injected. Maintain sterility of needles
and medications for injections. Utilize safety-engineered
devices to minimize risk of needle sticks. Always ensure that all sharps
are properly disposed of in a timely manner in an approved
sharps container. Route of administration and size
of the patient are used to determine the appropriate
size needle. Prefilled systems may have an
air bubble that needs to be purged prior to medication
administration. When drawing up medication from
a vial or ampule, draw up a little extra volume
that can be wasted when purging air bubbles. Assure the proposed site for
injection is free of inflammation, swelling,
infection, and any skin lesions. Never recap used needles. If blood is present when
aspirating, withdraw the needle and discard
the medication. Start over with a new medication
and a new site. When administering medications
using a syringe and vial system, inspect the medication
to verify the right medication, the right dose, the
right expiration date, the right route, and the
right patient. Select an appropriate size
syringe for the medication to be delivered. Remove the protective flip-off
cap from the top of the vial and wipe the rubber stopper
with an alcohol prep or another suitable antiseptic
swab. If at any time the rubber
stopper becomes contaminated, you will have to repeat
this procedure. Pierce the center of the
medication vial stopper with the needle on the syringe of
the diluting solution and inject the diluting solution
into the vial. Remove the needle and syringe
from the vial and place it in the sharps container. Now reconstitute the drug by
gently rolling the vial to assure that the medication
dissolves. It should become a
clear solution. Continue with the drawing up of
the medication using a new needle and syringe, repeating
the same steps. First, draw the same volume
of air as the volume to be withdrawn. Pierce the center of the vial
stopper with the needle on the syringe and inject the air. Holding the vial upside down
in one hand, be careful to keep the other end of the needle
within the fluid level of the vial. Also consider the exposed
portion of the needle sterile, so it should not be touched. Pull back gently on the plunger
to draw the medication or diluting solution
into the syringe. Withdraw the needle and
syringe from the vial, utilizing the safety feature. Remove and place the sharps
in a sharps container. Depending on the route of
administration, select the appropriate size safety
engineer needle. With the needle pointed upward,
gently tap the syringe to remove any air bubbles
to the top. Generally depress the plunger
of the syringe until air is expelled and only the desired
amount of medication remains in the syringe. The medication is now ready
for administration. Inspect the medication to verify
the right medication, the right dose, the right
expiration date, the right route, and the right patient. Select an appropriate size
syringe for the medication to be delivered. Though of appropriate size and
length to withdraw the medication and attach
to the syringe. Hold the ampule upright and
gently flick it to move any medication trapped in the head
of the ampule to the base. Wipe the areas between the
head and the base of the ampule with an alcohol
prep or other suitable antiseptic swab. Once the medication is removed
from the head of the ampule, use a commercially available
device or gauze square to grasp the head of the
ampule and break the head from the base. Hold the ampule at arm’s length
and break by snapping the top towards you. This will cause any glass shards
to be directed away rather than towards you when
the ampule breaks. If the ampule fails to break
cleanly and glass shards can be observed, dispose of the
ampule and replace with another unit. Now prepare your filter needle
and syringe in order to withdraw medication for
administration. Invert the ampule while
inserting the filter needle and withdrawing the
medication. After removing the medication,
discard any remaining medication and properly dispose
of both portions of the ampule in a sharps
container. Remove the filter needle and
properly dispose of in a sharps container. Replace the filter needle with
an appropriate size safety engineer needle for
a subcutaneous or intramuscular injection. With the needle pointing upward,
gently tap the syringe to move any air bubbles to
the top of the syringe. Then gently depress the plunger
of the syringe until air is expelled and only the
desired amount of medication remains in the syringe. The medication is now ready
for administration. When administering medications
with an auto-injector, remember to recheck
the medication for the patient’s rights. Select an injection site right
or left vastus lateralis, commonly called the
lateral thigh. Cleanse the injection site with
an alcohol prep or other suitable antiseptic swab in an
outward circular motion for about two inches. Allow the swab spot to dry for
approximately 30 seconds. Grasp the auto-injector by
wrapping your fist around the unit barrel. Never place your thumb or finger
over the ends of the auto-injector. Place the needle end of the
auto-injector against the prepared site on the lateral
thigh at a 90-degree angle and remove the protective
safety cap. Stabilize the patient’s leg to
prevent them from pulling away and apply gentle pressure
against the leg with the auto-injector until it clicks. Hold in place for 10 seconds
before removing the auto-injector in order
that all the medication can be delivered. Properly dispose of the
auto-injector in an appropriate sharps container and
apply a bandage over the injection site. When intervening with an
intramuscular injection, always make sure to recheck
the medication for the patient rights. Select an injection site, either
the deltoid or vastus lateralis, due to
accessibility. Cleanse the injection site
with an alcohol prep or another suitable antiseptic swab
in an outward circular motion for about two inches. Allow the swab spot to dry for
approximately 30 seconds for bacteria to be killed
and to minimize discomfort of the injection. Hold the syringe in your
dominant hand and remove the needle cover. Stabilize the injection site
with your non-dominant hand, using either the
pinch technique or the stretch technique. Tell the patient they
will feel the poke. And holding the syringe like
a dart, quickly but not forcefully insert the needle at
a 90-degree angle until the proper depth is reached. Release the skin while
continuing to hold the syringe in place with the
dominant hand. Grasp the plunger and pull back
to aspirate slightly. And wait five seconds. If no blood aspirates
into the syringe, proceed with the injection. Depress the plunger to
administer the injection at a rate of about 10 seconds
per milliliter. A slow, steady injection rate
allows the muscle to distend gradually and accept
the medication under minimal pressure. Once the medication has been
administered, withdraw the needle using the appropriate
safety features and properly dispose of the syringe and
needle assembly in an appropriate sharps container. Cover the injection site with
an alcohol or gauze pad and apply gentle pressure to the
area to help reduce the pain and improve absorption. Apply a bandage over
the injection site. When administering a
subcutaneous injection, always cleanse the injection site with
an alcohol prep or other suitable antiseptic swab. Allow the swab spot to dry for
approximately 30 seconds. Hold the syringe in your
dominant hand and remove the needle cover. Stabilize the injection site
with your non-dominant hand using the pinch technique. Quickly, but not forcefully,
insert the needle into the injection site at a
45-degree angle. Release the skin while
continuing to hold the syringe in place. Pull back and aspirate slightly
on the plunger and wait five seconds. If no blood aspirates
into the syringe, proceed with the injection. Properly dispose of the needle
and syringe assembly in an approved sharps container. Cover the injection site with
an alcohol or gauze pad and apply gentle pressure to the
area to help reduce the pain and improve absorption.

Author:

Leave a Reply

Your email address will not be published. Required fields are marked *