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The speaker discusses various medications and their administration methods. They explain the use of inhalers, nasal cannulas, and nebulizer treatments for respiratory conditions. They also mention glucagon for treating low blood sugar and psych meds like risperidone and olanzapine. They discuss the use of Benadryl for allergies and mention the importance of carrying it in a liquid form for faster absorption. They also mention the duration of EpiPen and the use of Benadryl as a follow-up treatment. because her inhaler doesn't work. I've gone through three inhalers. He said, how do you show you use your inhaler? I know how to use an inhaler. I'm not an idiot. Blah, blah, blah, blah, blah. She's going on and on. He said, okay. She said, are you using that? He said, yeah. Show me how you use your inhaler. She said, try it like this. And he looks at her just like this. He goes, I don't know. Anyway, two puffs is one dose. So this again, just like nitro, is the patient's own. So it's patient assisted. So the way I have this set up is like this. When you do the practices with me, I'll have it set up so these are your administered. These are anti-administered meds. These are the ones you carry. Aspirin goes along with it. Aspirin goes with nitro though, so I put it here. These are the ones that are patient assisted. They have their own. You don't carry these. So that's kind of why I set it up the way I do like this. Next is, I didn't know I had an open one. Just so you guys know, I think I showed you this before, but I didn't. This is why nasal cannula goes in. I'm not putting it in my nose. And these two prongs go in the nose and that's the way you wear it. So if you see a patient breathing like this with a nasal cannula, they're not getting any oxygen. No, breathe through your nose. Next is the nebulizer treatment. The nebulizer treatment administers two different medications. And the nebulizer treatment works great, let me tell you. So the two medications that you're going to carry for the nebulizer, albuterol sulfate, just like in the inhaler. It's 2.5 milligrams in 3 milliliters of solution. And the solution comes in what looks like, we call it a bullet. It's a saline bullet. Or it's a medication bullet. So it's 2.5 milligrams of albuterol sulfate in 3 milliliters of solution. That's one of the meds. You can just give albuterol. But if your patient's got a real bad wheeze, if they're using their inhaler and it's not working, there's a combination, which is albuterol sulfate and ipitropium bromide. This is called atrovent. And this is dosed at 500 micrograms or 0.5 milligrams in 3 milliliters of solution. So it's a mix, but it's shaped differently. So if you open them both up, they would look different. So you would mix up and give the same meds. Albuterol sulfate is 2.5 milligrams in 3 milliliters of solution. Ipitropium bromide, which is atrovent, is delivered in 500 micrograms, in 3 milliliters of solution. And what is the... You might hear some of the old dinosaurs tell you that they want to do an updraft. You're updrafting the meds. That's what a nebulizer treatment is. They call it an updraft. Atrovent. So the way it works is I take this saline bullet, and I rip off the top. I open this up like this, and I squirt it in. Then I take the...if I'm doing a duo med, I put that one in, so you'll have that much fluid in. I close this, and I can do one of two things. I can either have... I can either have a hand-held tube that goes on this. It's kind of a T, and there's a part with a mouthpiece, and I just hold it and breathe it in. Or if you have a patient that probably can't hold it, they're very weak, then I can just turn it into a mask. The mask goes on my face. If it's in the tube, then I breathe it in through the T, and I breathe it in. And the patient just breathes normally. We ask them to take deep breaths. If they're doing the tube, they go... And they just breathe in, hold for however comfortable it feels, and then exhale. They don't have to hold their breath for long periods of time. They don't have to breathe fast. Just breathe normally. We want you to take deep breaths and hold it in as long as comfortable. You're allowed to give up to two nebulizer treatments. So you can give three albuterol, and then you can give two nebulizers. If you have albuterol, I would call the doctor. If you get three, and the patient's still wheezing, I would call to give more of this before I did the nebulizer. The nebulizer is really for a patient that has real severe bronchospasms, that isn't working by the neb, by the, by the neutered dose inhaler, or a patient that doesn't have a neutered dose inhaler. A dual neb works great, and a dual neb can work with CPAP. Oh, there's a tube right here. I can show you the tube anyway. What's that? Two holes. Oh, that's so if you run out of oxygen, you won't suffocate. And so this goes like this, and this goes on here, and there'd be a little mouthpiece here, and I breathe in just like that, and you'd see the aerosolized gas come out of this. You just breathe like that. So you can either use a handheld, or you can, you know, not be breathing out. All right, so now, I'll put that there so you have these two meds. You see that. Some other meds I want to talk about. You won't see them at the national exam, but we need to talk about them. Glucagon. Glucagon, if your medical director allows you to carry it, it's two vials. It's one, and they look like the albuterol. They look like these vials here. Do you want to show mine? I'll take yours to show it. I won't open it up. All right, so this is glucagon here. You may carry it like this, or you might have vials. What it is, is this is one milliliter of sterile water, not normal saline, it's sterile water, and one milligram of glucagon. See, it's a white powder. So what I do is I insert the needle into the glucagon, squirt those sterile water in it, and I kind of shake it up a little bit. The same way you deliver EpiPen, right in the deltoid, and deliver it. Glucagon is used when a patient cannot take oral glucose. For whatever reason, they can't take oral glucose. So if they're unconscious, for example? Yeah, or they can't protect their AOA, I would use glucagon. The idea of glucagon is it draws up, it will jack up your blood sugar, as long as you haven't burned up your glucose store, your glycogen stores, it converts glycogen into glucose. And it will jack up your blood sugar up like 20 to 30 points, which is enough to wake you up enough to take oral glucose. So that's what it's used for, it's used for patients where you can't give oral glucose right now, but you want to. So you give them the glucagon, it brings them up enough when they're awake, okay, now take this. That's kind of the way it's used. And then you have to, you can administer as an EMT, so you need to know it. So it's one milligram of glucagon with one milliliter of sterile water, and you mix it up and administer it. Next one is, the next two is risperidone and olanzapine. Risperidone and olanzapine. Risperidone and olanzapine are psych meds. And they're not sedation medications, but they calm the patient. They're like a mild form of an antipsychotic, right? So risperidone is delivered in two milligrams by what they call OBT, oral disintegrating tablet. So if you have a patient that's kind of out of it, they're kind of really hyperactive and they're not being calm, and they're not being cooperative, you can give them one. I think it's stupid to do this, but the state does it. God bless you, even oral disintegrating tablets, God bless you, it takes about ten minutes to do it. The next one is olanzapine. Olanzapine is an oral disintegrating tablet, OBT, as it were. The next one I want to talk about is Benadryl. Now Benadryl can come as an oral disintegrating tablet, or we carry the liquid Benadryl in children's Benadryl bottles. The dose is 25 to 50 milligrams, and I think in the children's Benadryl, I think that's like 15 milliliters. It's 12.5 milligrams for each milliliter. So if you want to get 50, that's 4 milliliters. Is it 5? Yeah, I'm trying to figure, is it 5? I'm not sure if it's 5. It might be 5 milligrams for every 5 milliliters. Check the boxes. It could be 5. So the child dose is... I don't have it in there. It's 12.5 milligrams for every 5 milliliters of children's Benadryl. So you give 20 milliliters for 50 milligrams, which is an adult, maximum adult dose. So it's 12.5 milligrams. So pediatrics, you deliver 1 milligram per kilogram up to 25. So basically the dose is 1 milligram per kilogram up to 50 milliliters. Up to 50 milligrams, that's the way you deliver it. It's the same as activated charcoal, 1 gram per kilogram. Benadryl is 1 milliliter per kilogram up to 50 milligrams. That's the maximum dose. 1 milligram per kiloliter, and if they're over 50... 1 milligram per kilogram. 1 milligram per kilogram. Mig per kg, that's the way it is, mig per kg. You can say 1 mig kg, 1 milligram per kilogram. As the director allows you, if you carry it on your ambulance, yes you can. According to protocol. We don't give the pills, because they take up to 20 minutes for the pills to take action. We either want oral disintegrating tabs or the liquid, because that's rapidly absorbed. If you have somebody in your family that has a serious allergy and you want to carry Benadryl, you want to carry Benadryl. I didn't realize until this class, actually, that the EpiPen... I knew that once you deliver the EpiPen, you'd get to take it to the hospital, but I didn't realize that EpiPen really only lasts like 10 minutes. An EpiPen dose, provided the patient wasn't too far along, you can get a good 7 to 10 minutes off it. What I would do is, if I had a two anaphylaxis, and I know ALS wasn't available, I would give, as a BLS provider, I would give an EpiPen, and then I would give 15 milligrams of Benadryl, and then by the time it wears off and he knows another dose, the Benadryl will take an effect, it'll shut off the rest of the histamine being made, so once the second dose of epinephrine comes in, they're not going to have a repeat. This is something that we didn't know. We were literally in East Iceland, and my wife got... It's a beautiful place, but my wife got shrimp, and she's allergic to shrimp, and fortunately she fizzed out and didn't, but we had our EpiPen, but we were not 20 minutes from any sort of EMS, so now we actually... Yeah, keep liquid Benadryl, so what you do is you give... I mean, I wouldn't worry about it here, because you'd have an ambulance, and they would come give IV Benadryl, which works almost instantaneously, but in a situation like that, you carry some liquid Benadryl with you, you give a dose of EpiPen, take some oral Benadryl, and you're probably... And that's one of the reasons why they make the oral disintegrating tablets, for people that don't want to carry bottles, you can carry the small tablets. So you hit yourself with the EpiPen, and you pop in a Benadryl. Then you may take another epinephrine, but you know that your histamine counts are going to go down. So when I had my emergency reaction, I actually took Benadryl before, because normally it didn't get bad, so normally I just take Benadryl, and then I ended up having to use my EpiPen, but they didn't end up giving me one or anything, because I already took it. Because you already took it. Because you don't want to give multiple doses of Benadryl, because that can cause all kinds of problems. We talked about that. Hot as the air, red as the bead, blind as a bat, mad as a hatter. You can go from normal to seizure, coma, and death with a Benadryl overdose in 30 minutes. So you don't want to do that. So then the other two we talked about is acetaminophen and ibuprofen. Those can come in oral disintegrating tablets or liquid form, usually children's Tylenol, children's ibuprofen. The dose for pediatrics for acetaminophen is 15 milligrams per kilogram up to a maximum dose of 1,000 milligrams. So just remember, 15 milligrams per kilogram. It doesn't matter what age you are or what size you are. You get 15 milligrams per kilogram up to 1,000 milligrams. That's the max dose. For pediatrics, for ibuprofen, it's 10 milligrams per kilogram up to 600 milligrams max dose. So you know, if your doctor gives you ibuprofen, you usually get 600 to 800 milligrams. You get the big horse pills, right? So that's 600 milligrams is the max dose you can give an EMS. And it does work. If you give the oral disintegrating tablet or the liquid children's Tylenol or ibuprofen, it does work. It does help. Sometimes we give ibuprofen to patients. They have, like, liver issues. I don't give Tylenol to metabolize the liver. I'll give ibuprofen. Or if somebody's allergic to acetaminophen, you give ibuprofen. What's this? All those pills? Just remember, 15 milligrams. Because you can calculate it for anybody. That's the easiest way to remember. 15 milligrams per kilogram up to 1,000 milligrams. 10 milligrams per kilogram up to 1,000, up to 600 for ibuprofen. If you just remember that, that's easier. Because the adult dose for acetaminophen is 650 to 1,000. The adult dose for ibuprofen is 600. Any questions on that? All right. So some of those meds that I gave you, like risperidone, olanzapine, ibuprofen, Benadryl, those have to be authorized by medical director option. That's not a state standard. The medical director said option that they can have. The other ones that I talked about here, this is all required. Any questions on that? So this is the way I set it up. Now, the other thing we talked about, there's usually an NPA and OPA airport at the station. Remember, this is a trauma station, a medical station. You're going to be putting in an airway for your trauma patients. Then I put out your vital signs. You have to do your vital signs. So I will put at the station a BP cuff stethoscope and pen light and your glucometer. So you'll remember, okay, I have to do that. So I'll set it up like that so you'll see that. And again, I put this here so you remember. The next thing we put out is these are the chest seals. So you see how big they are? Two chest seals will cover the whole chest. So that's what I mean. You could cover a whole lot of space with it. The new chest seals, what's that? What about a B station? It still will cover a big space. I mean, you're talking about small. I mean, if you've got more holes, then they're probably not going to make it anyway. You do the best you can. So with these chest seals, these are the old ones. The new ones have that flutter valve in it. And you just put the flutter valve over the hole like that. These you can cut. So you can cut them, like if you have multiple bullet wounds and in different places, you can cut it and cover it. But remember, you're only covering from the umbilicus to the neck. So this area here, all the way around, that's going to cover an awful lot. So you carry two of them. You just open them up. They are extremely sticky. So once you peel that backing off, put it right on the chest. Don't get it stuck on anything because you're going to have a hell of a time getting it off. If they have a lot of chest hair, yeah, probably. But this should stick to it. Just like the pads. Because you want to get that good airtight seal. You're not going to get that. So yeah, I would cut the hair back. You don't have to shave it. Just take your trauma shears and cut it. So I put those there, just so you know they're there. There is always a collar at the station. It is a trauma station. So you will put on a collar. Remember, trauma stations, you will put on a collar. So I put the collar there. This is the cat tourniquet. Combat Applied Tourniquet. It comes in a little case like this. Oh, this one is the red stuff. And the way you apply it is you open it up, unfold it like this. Put it about one to two inches above the wound. Bring it around and apply it. Now this is meant to be self-applied. This is meant to be able to put it on on my own. That's the kind of way it's designed to do. But we put it on for patients. Then, this is called the windlass. This is called the windlass. And what I do is I wind it up like this. And I keep going until I can't feel a pulse. Then I lock it in place and I write the time that I put it on. So you wind it up until you don't feel a pulse. And then you put it on. I will tell you that this hurts to put this on. The patient is going to go, ow, ow, ow. Suck it up. You're going to bleed to death if I don't. I mean, for your own sake. But that's the mentality of it. Matter of fact. Now I got a slight pulse. And you tighten it until you don't have a pulse. I'm showing you. You can put it on. It's not going to do anything. There you go. Now the pulse is gone. Now my hand, see how many hands turn the book? Now it's uncomfortable. I'm not liking it. But it's on. I can also put it across my leg. Then you write the time. Do not cover it. Now if I put this on and it starts bleeding through, don't take it off. Just put another one on further down. That's why we kind of want to get it up as high as we can. So this I would get up as high as I can. And then if that doesn't work, then I would put another one a little bit lower. So again, I have this up here. You guys can play with this up here. You can give yourself tourniquets if you like. So again, it's a trauma call. The trauma scenario. So I put that up there as well. And then the only other thing that I put up here, medical alert bracelet. This one says allergic disease. So you always want to look for medical alert tags. So this is going to be up here. You guys are welcome to come up, take pictures of this. You can pick up all the toys and play with them if you want. I'll leave this here too. I set this up like this. Because I want to jog your memory of the things that you're going to need. When you get to the national exam, they don't do this. There's a beefy cup and a stethoscope. That's all there is at the station. There's nothing else. So everything is verbalized. The only reason the beefy cup and stethoscope is there is to remind you to use them. You don't actually use them. Okay? So that will be up here. Every time we practice this, I'll set this up so you can use it as well.