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This information covers the use of different devices for oxygen delivery, such as the maintenance device, non-rebreather mask, and bag drop mask. It also discusses the use of aspirin and nitro for chest pain, as well as the administration of epinephrine and Narcan for emergencies. Proper dosages, contraindications, and administration techniques are mentioned. Overall, it provides a comprehensive overview of these medical interventions. to 6 liters per minute, and it delivers anywhere from 24 to 45 percent oxygen. This is a maintenance device. We do use it in EMS, when the patient just needs a little extra oxygen, you know, just needs a little bump, but this is not a rescue device. For the national exam, you will not use this, because it is not high formal tube. Non-rebreather mask. It is literally a mask that goes over the face with a reservoir bag, just like the BBM has, and the bag inflates. As long as when the patient takes a deep breath, it does not completely deflate the bag, and the mask stays on his face, the patient is going to receive upwards of 95 percent oxygen, almost 100 percent oxygen. The delivery for this is anywhere between 6 and 15 liters, 6 and 25 liters, but we usually do 6 to 15. If you are delivering, and the reason why we do that is because if you deliver 6 liters of oxygen, 5 to 6 liters of oxygen for this, it is going to be like a rocket in the nose. It is going to dry out the nose, give headache, nose bleeds. So, unless you have humidified oxygen, if you are delivering more than 4 liters, just go to a non-rebreather. If they will tolerate it, this is good, if they will not tolerate a mask, then you would use this. These are both for patients who have a good respiratory drive, but need oxygenation, so they will be breathing between 12 and 20 per minute, right? Or 15 to 30 per child, 25 to 50 per infant. This is the BDM, the bag drop mask. You all know how to use this. This delivers anywhere from 10 to 15 liters, 10 to 25 liters, and basically the way you judge it is by the bag deflating. If I completely deflate the bag and re-inflate it, I am noticing the bag is completely deflated, you need to turn off the oxygen. Usually 10 to 15 liters is all we need. This delivers, if you get a good mask seal, you get a good chest rise, you are delivering upwards of 100% oxygen or pure oxygen. This is meant for patients with a poor respiratory drive, shallow, rapid breathing, or, you know, or very slow breathing, right, with very slow respirations. This is a patient with poor respiratory drive who needs oxygen. These are for patients with a good respiratory drive, but need oxygen, okay? You all know you guys can give oxygen whenever you want, right? We don't put oxygen on prophylactically, but you can give it whenever you want, okay? All of these meds that I'm going to talk about, as long as you have medical director option, you can give these meds. The next one we'll talk about is aspirin, and aspirin goes along with nitro, okay? So aspirin, acetylsalicylic acid, is dosed for chest pain. It will not relieve chest pain, but it keeps the clot from getting bigger. So you don't give aspirin until you feel better, because it won't, it won't take the pain away, it doesn't work like that. Aspirin is dosed in 81 milligram chewable baby aspirins. Your protocols are two to four baby aspirin, which is 162 to 324 milligrams of aspirin, and even once it's chewed and swallowed. We give the aspirin before we give the nitro, because the aspirin, nitro has to sit in the mouth where this is chewed and swallowed. If the patient only has, if you only for some reason have one adult aspirin, 325 milligrams, you can go ahead and give it. That's the maximum dose, 325, but the patient has to chew it and swallow it. Have you ever chewed an adult aspirin? Well, you're in for a treat if you ever try to do that, because they're nasty. The contraindications to this would be a patient has a bleeding disorder, a patient has liver failure, asthma, but in the presence of a true cardiac emergency, the only one that we would not give it for is if a patient has an allergic, is allergic to it, right? Like they have an anaphylactic allergic reaction. So the idea, when I take aspirin, I get a stomachache. Well, everybody does. Take the friggin' aspirin. That's a side effect. That's not an allergy, right? That's not a hypo-symptom for this, but we give it for chest pain. Asthma, bleeding, cardiac, and? Asthma, breathing, asthma, bleeding disorder, or liver failure. Liver. And it was 160 what? 162 to 324 milligrams. Two to four. 81 milligrams each. God bless you. Nitro. 0.3 to 0.4 milligrams, either one sublingual tablet or one sublingual spray. This is used as a vasodilator for chest pain. We give this after we give the aspirin. You give one dose of aspirin, one 324 milligram, boom, you're done, put it away. Nitro, you can give up to three doses, five minutes apart, provided the patient doesn't hit a contraindication. Okay. Contraindications would be, I already took three. You can't give them a fourth. My blood pressure is less than 120 systolic. You don't give it. Patients taking sexual enhancing drugs within the last 24 hours, you don't give it. Or if the patient doesn't have it, it's not dosed to them. This is your aspirin you carry. You can administer that. Nitro is patient assisted. They have it, you assist them with it. So, you don't carry nitro. Next, we'll go to epinephrine or the EpiPen. Epinephrine will be dosed as a check-and-inject or an EpiPen. Most likely, you're going to have the check-and-inject. Check-and-inject consists of a vial of one milligram and one milliliter of solution adrenaline or epinephrine. You can see how this is yellow. This is expired. It's got to be clear. If it's yellow, it's no good. One syringe, one milliliter syringe. You'll have a band-aid in there and there's a check-off. There will be alcohol prep pads and a little checklist. This comes right, this is a page off of your protocols. The date, this, and each company has their own set-up, but this is ours because this has to be submitted to the state. Date, PCR number, who the EMTs are, where you give, this tells you where to put it in, tells you where the deltoid, where you inject it. It tells you what the syringe should look like when you draw up the correct dosage. Does the patient meet criteria that you draw up. It's kind of a checklist that you can follow and check. And on the back, it gives you the protocol for anaphylaxis or bronchospasms. For the EpiPen, if you happen to have an EpiPen, basically all you do is, no matter what style it is, open the back, this is fake, press it against the lateral aspect of the thigh, insert it. It'll pop, patient will go, hold it there for 10 seconds, release. This is a sharp, goes in the sharps containers. Very simple. Most companies don't use that, they're going to use the check-and-inject. For the check-and-inject, they have a clear, yes. So the dose is 0.3 for an adult, 0.15 for a child, and the break-off is 8 years or 55 pounds. If I do this, if I pop off the needle, these actually, in Massachusetts you have to have retractable needles. So once you inject it, you push it all the way in, the needle retracts, so there's no shock, and you can throw it away. So there would be a needle here, and what I would do is I'd simply expose the arm. You could use alcohol prep pad, but in anaphylaxis I wouldn't worry about it. I'd pinch the muscle, and I'd just inject it. What I do is I go three fingers down from the top of the deltoid, so I'm going just like this, I'm going to go right here. Pinch it, pop it in, squeeze it, and it pops, take it out, and you're done. And I put a band-aid on as if it bleeds. Right about from the top, three fingers down, right about there. This will be a separate course that will be sent to this check-and-inject thing. You won't do this for the exam. But if one of our employers wanted us to do this, they would send us to another course. They won't send you to a course they'll teach you. They have to go over a check. You have to do a check-and-inject, you have to do a check-and-inject twice. So you go in, and they'll go over every day, and I'll bring in some, one of the practical days, I'll bring in a couple of oranges and some syringes, and you guys can practice. I used to have to find syringes, but we can practice. Yeah, just pick them up off the street. Normally you need somebody who orders medical supplies. Yeah, exactly. I have a ton of syringes at home. If you have syringes that you want to bring in, if you have syringes to bring in that you're not going to use. Yeah, they're all like, sterile. No, bring them in, because we're just going to stick them in oranges, and then you can orange them. I'm kidding. We're just going to stick them in oranges. So, if you want to bring some in, that's fine. If nobody sticks people, you can stick oranges. So, I'll remember that. Why are you looking at me? This is one milliliter with one milligram, and what I would do is I would draw up, let's say I have a needle here, I would draw up 0.3 of air, which would come right to there, of air. I take the needle, pop the top off of this, and I insert the needle into the gasket, and then I squirt the air in, and then I draw out the 0.3 of, which would go right to there, of fluid, and then just pop it in. It's not that difficult, believe me. You put oxygen inside here? You put oxygen air inside? You're drawing up air. If I squirt air into this bottle, it pushes out that much fluid, so it's easier to draw up. You don't have to, but it's easier when you do that. So, 0.3, 0.15. Really, in a true anaphylactic emergency, there is really no contraindication to epinephrine. You're not supposed to give it to a patient with hypertension, but you wouldn't probably give it to a patient that had severe hypertension anyway. So, that's epinephrine. Next one we'll talk about is Narcan. Narcan, we'll talk about, it's really not, it's not a station that's tested in the national exam, but you need to know what Narcan is. So, Narcan that most people carry looks like this. This is the Narcan Med, and this is the MAD, the mucosal atomizer device. They call it the MAD device, right? This is what actually aerosolizes it. So, this contains, you open it up, and obviously, the first thing we're going to do is ventilate the patient, right? And then, by the way, the EpiPen, the dose for an EpiPen adult, you can give it twice, once, and then you can give it again within five minutes. For the EpiPen junior, you can give one dose, and you have to call medical control for a second dose for the junior. So, it looks like this. This is the Narcan. You have two milliliters of Narcan, two milligrams of Narcan, and two milliliters of solution. This is the Olorlock device that you're going to use to administer it. You pop the ends off like this. Pop the purple top off. It looks like that. Make sure it's not broken. I take it, and I screw it in like that. It's ready to administer. Now, I take my mucosal atomizer device, and I screw it to the top. This is called the Olorlock device. It's ready to go. I stick it in this nostril all the way, bury it, close this nostril, and I squirt half of it in. Then, I switch, go to the other side, squirt the other half in. That doubles the nasal mucosa, so I absorb more. You can give, technically, you can give up to four doses of Narcan in Massachusetts. You carry like eight doses in your ambulance, even as BLS providers. You give them every three to five minutes. So, I come in, I start bagging the patient while somebody sets up the Narcan. We administer the Narcan. We continue bagging and watch them for three to five minutes. If they don't stop breathing, give them another dose. In the meantime, ALS should be on the way, and after a couple doses, we can, after we do the second dose, we load them up in the ambulance, we can give a third dose on the way to the hospital. Doesn't PD carry it with them, too, now? PD, everybody carries it with them. PD does, fire does. So, make sure you find out if somebody's giving it to them already. You don't want to give more than one dose every three to five minutes, because you can cause flash pulmonary edema. Some companies use four-dose administration kits. It's a single plunger. You stick it in the nose and push it, and it just delivers four milliliters right up the nose, four milligrams right up the nose. If that's what you carry, that's what you use. This is what we carry, so this is what we use. So, whatever your medical director allows you to do. Then you just take that, you throw it in the sharps container, and you get a whole other setup. If you want to reuse the mucosal atomizer device, you can, or you can get another one. It's up to you. They are expensive, those. These are like 20 bucks a piece, believe it or not. They're expensive. I don't know if different patients know this. What's that? You can't reuse those on different patients. No, you're going to use them on the same patient. All right, I just wanted to clarify that. Do you have them like a mass overdose? No, like the seventh person I've used this on, you know. Major. Who believes in COVID? All right, so that's the Narcan right there. But remember, the most important thing is to ventilate the patient. Glutose. Glutose, this particular tool most commonly that you carry, is 15 milligrams, 15 grams of pure glucose, and 37.5 grams of total weight, okay? And the dose is one tube for an adult, over 55 pounds, 25 kilograms, and a half a tube for a child, under 55 pounds, 25 kilograms. We test the blood sugar, it's less than 70. We don't give it 70 and above. It must be less than 70 milligrams per deciliter. We administer one dose, it's bucaly. We literally open it, squeeze it between the right, like between the cheek and the gums, and we ask the patient to leave it in their mouth. Now they're going to swallow it, we know that, but try and leave as much as you can in your mouth. And then we're going to recheck the blood sugar in about five minutes. And if the blood sugar is still below 70, we can give another dose, either a half tube to a child, or a full tube to an adult, okay? So you'll actually carry four tubes on your endos. Does that make sense? How many for an adult? Can you give two doses? Two doses, two single tubes. Yeah, yeah, 15 grams of glucose will bring your blood sugar up probably 30 points. So two will bring it up 60. So unless your blood sugar is less than 30, two tubes is going to bring you up, even if you're in insulin shock, it'll still bring you up. And you administer it under 70? Under 70. So if they're at 69, give a tube. If they're at 70, don't give any. Can you pass any of these things around, like that glucose for adults? Actually, what I'm going to do is I'm going to set, I set up a display, and you guys can come out and play with it, as long as you put everything back, because I set up a specific way. You can come out and play with it. I recommend taking a picture of it. This is all the stuff that you may use on the national exam. So I set it all up so you guys can look at it, all right, so you know. So that's why I'm going over it as I cover it. You're going to let us try those things? No, you can't try them, but you can look at them. You can set it up. It's a national exam. We need to actually... No, no. It's all verbalized. Everything in the national exam is verbalized. The only thing you physically have to do is physically have to touch the page that you hand on a cell phone. Everything else is verbalized. Any treatments you do, ventilations, seat collar, back boarding, all verbalized. Oh, really? So no splinting, really, none of that? Nothing, nothing. You're supposed to already know it. In other words, you've gone over it already. This is a pen light, by the way. I've never had to do it. I don't remember I had to verbalize it. For those of you who haven't, this is a pen light. These are the most common ones, and this also tells you the millimeter of pupil size. So three to four millimeters is normal size of pupils. So you can tell, are the pupils dilated? Oh, it's nine millimeters. On a pen point, it's two millimeters. So this is the most common one you're going to see. These are like a buck a piece, Boundary Medical makes them. What else do we got? I thought you said we have to bring our own victim to the national exam. To the national exam, you do. Can you bring my victim? Yeah. Don't get into that national exam now. We'll talk about that later, because we're going to have a whole playoff. I want you to concentrate on this. So next is the meter dose inhaler. The meter dose inhaler diminishes albuterol, 90 micrograms per puff, two puffs per dose. You're allowed to give three doses up to five minutes apart. God bless you. Thank you. And this is made for bronchospasms and wheezing. Just like all the others, the number one contraindication is the hypersensitivity. But you don't carry this. This is peer assistance. So if they don't have it, you can't give it. So they're not going to have it if they're hypersensitive to it. So what if they have one, but they forgot it at home? Then you wouldn't be able to give it to them because you won't have one. So you'd have to do a nebulizer treatment, which is the same thing I'm talking about. It's 90 micrograms per puff, two puffs per dose. Up to three doses, five minutes apart is your protocol. Thank you. And like I said, just like the nitro, usually a doctor will say, look, take a couple of hits from your inhaler. If it doesn't work, take a couple more hits, call 911. Same thing with the nitro. Take a dose of nitro, sit down, relax. If that doesn't work, take another nitro and call 911. That's why you're allowed three doses because usually the patient's not going to take all three before you get there. So they expire. How long can you use it after it expires? Because I... In Massachusetts, in federal law, you cannot give an expired med to a patient and charge them for it. Almost many companies will collect expired meds and sell them in Mexico and Africa. Provided it's not discolored or like the nitro is not tasty or chalky, it works. I use expired because we have expired meds like ibuprofen and Tylenol, liquid Tylenol, and Benadryl. I take the expired stuff one more time because they just throw it away. I don't buy Tylenol. I don't buy Benadryl. I just bring the expired stuff home. It's good for the ears. The reason why... Tongue depressors have expiration dates. And the reason why... There's two reasons. The number one reason is because the manufacturer wants you to buy more. So they put an expiration date on it. But truth be told, packaging does degrade. So the reason why it doesn't... If the package degrades, it no longer stays sterile. So that's the reason why. That's one of the main reasons they say you need to replace because of packaging. But some medications will degrade. It's not like milk. It doesn't curve. It just goes... It loses its efficacy. That's what happens with nitro. So the way you administer these is the patient is supposed to exhale. And then when they breathe in, they're supposed to breathe in as deeply as they comfortably can as you squirt it into their mouth. And then they... And then they just hold it for however comfortably long they can hold it. 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