Saturday, June 22, 2024

EMS Medfication Administration - Oral (PO) Route


EMS Providers should be well-informed about oral medication administration to ensure patient safety and effective treatment. 

Here are some key points they should know:

1. Indications and Contraindications

Indications:

Situations where the patient can safely swallow and absorb medications.

Management of mild to moderate pain, allergic reactions, nausea, or chronic conditions.

Administration of medications such as aspirin (for chest pain), glucose (for hypoglycemia), or activated charcoal (for certain poisonings).

Contraindications:

Altered mental status or decreased level of consciousness, posing a risk of aspiration.

Difficulty swallowing or a risk of choking.

Severe nausea or vomiting.

Certain medical conditions or contraindicated medications.

2. Types of Oral Medications

Tablets and Capsules: Solid dosage forms that may need to be swallowed whole or chewed.

Liquids: Solutions, suspensions, or syrups.

Orally Disintegrating Tablets (ODTs): Tablets that dissolve quickly in the mouth.

Buccal and Sublingual: Medications placed in the cheek pouch or under the tongue for rapid absorption.

3. Preparation and Technique

Verification:

Verify the “Six Rights” of medication administration: right patient, right medication, right dose, right route, right time and right documentation

Patient Positioning:

Ensure the patient is in an upright position to facilitate swallowing and reduce the risk of aspiration.

Medication Administation:

For tablets/capsules: Provide a full glass of water and instruct the patient to swallow the medication.

For liquids: Measure the correct dose using an appropriate measuring device and ensure the patient drinks it all.

For ODTs, buccal, and sublingual: Place the medication in the patient’s mouth as directed and ensure they do not chew or swallow it prematurely.

4. Patient Communication and Education

Explain the Medication: Inform the patient about the medication’s purpose, expected effects, and any potential side effects.

Instructions: Provide clear instructions on how to take the medication, including any specific considerations (e.g., take with food or on an empty stomach).

5. Monitoring and Follow-Up

Observe for Effects: Monitor the patient for expected therapeutic effects and any adverse reactions.

Reassessment: Regularly reassess the patient's condition to determine the effectiveness of the medication and any need for additional intervention.

6. Complications and Management

Aspiration: Recognize signs of aspiration (e.g., coughing, choking) and know how to manage it (e.g., positioning, suction, airway management).

Allergic Reactions: Be prepared to manage allergic reactions, including anaphylaxis, by monitoring for symptoms and having emergency medications available.

Gastrointestinal Upset: Some oral medications can cause nausea or gastrointestinal discomfort; provide supportive care as needed.

7. Special Considerations

Pediatric and Geriatric Patients: Adjust dosages appropriately and consider additional challenges in administering oral medications to these populations (e.g., difficulty swallowing, altered taste).

Patients with Chronic Conditions: Be aware of any chronic conditions that may affect medication administration or absorption.

Medication Interactions: Understand potential interactions with other medications the patient is taking.

8. Legal and Ethical Considerations

Scope of Practice: Adhere to the legal scope of practice for their certification level and local regulations.

Informed Consent: Obtain informed consent from the patient or guardian whenever possible.

Documentation: Accurate documentation of medication name, dose, route, time of administration, and any observed effects or adverse reactions.

Conclusion

Effective oral medication administration requires EMS providers to combine theoretical knowledge with practical skills.

Continuous training, adherence to protocols, and understanding the indications, techniques, and potential complications are essential for safe and effective patient care.

Further Reading:

Alexander, M. & Belle, R. (2017) Advanced EMT: A Clinical Reasoning Approach (2nd Ed). Hoboken, New Jersey: Pearson Education

Bledsoe, B. E., Cherry, R. A. & Porter, R. S (2023) Paramedic Care: Principles and Practice (6th Ed) Boston, Massachusetts: Pearson

Bledsoe, B. E. & Clayden, D. (2018) Prehospital Emergency Pharmacology (8th Ed). Pearson.

Guy, J. S. (2019) Pharmacology for the Prehospital Professional (2nd Ed) Burlington, Massachusetts: Jones & Bartlett Learning.

Mistovich, J. J. & Karren, K. J. (2014) Prehospital Emergency Care (11th Ed). Hoboken, New Jersey: Pearson Education

Peate, I. & Sawyer, S (2024) Fundamentals of Applied Pathophysiology for Paramedics. Hoboken, New Jersey:  Wiley Blackwell

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