Pharmacology and Practice Scenarios

This study material covers the topics of pharmacology and practice scenarios. It provides information on adverse effects, indications, contraindications, and dosages of various medications. It also includes detailed assessment and treatment approaches for asthma, accidents, and substantial pain in a 10-year-old boy. Find comprehensive study solutions at Desklib.

PARAMEDICAL SERVICES

Table of Contents
Pharmacology..................................................................................................................................4
Practice scenarios...........................................................................................................................11
Scenario writing.............................................................................................................................12
Basic life support...........................................................................................................................13
Posture...........................................................................................................................................17
Patient Management......................................................................................................................18
Reference list.................................................................................................................................21
2

Anatomical Positions
1. The circle is located in the left-thoracic region, over the diaphragm and near the floating
ribs and the left lung. It marks the area that is closely related to respiratory abilities.
2. The circle marks the right squadron area in the abdominal region, near the liver, right
kidney. It may indicate complications arising from internal bleeding, renal or hepatic
complexities in patients.
3. The circle shows the minor pectoral area, near the heart. Markings in these regions can
indicate cardiopulmonary complications. Problems in costal cartilages can also be
indicated through this circle (Victorio et al. 2016: 28876).
4. The circle indicates a lower right pelvic region, just below the pelvic girdle and near
coccyx and sacrum. The marking can be related to problems, such as pelvic inflammatory
complications and abscesses.
5. The region marked is near left elbow. This region is connected to the stomach, sigmoid
colon, small intestine, left hepatic lobe and pancreas through superior vena cava. This can
involve lateral side and medium measurement.
6. This area is close to the right humerus bone and lung. The region marked in near the
clavicle and indicates the zone over pectoral muscles. This area encloses pectoralis minor
and subclavius through the thoracoacromial artery and cephalic vein.
3

Pharmacology
1. Adverse effects of Oxygen
● Chemical toxicity tracheobronchial tree capillary endothelium alveolar epithelium
● Retinal damage caused by oxygen
● Endocrine effects adrenal Gonads Thyroid due to excess presence of oxygen
● Toxic effects on cells and enzymes of the central nervous system
2. Indications for oxygen use
● In the case of reducing the oxygen level, the patient can be supported with the proper
amount of oxygen (Nunes et al. 2017:198).
● If there is any type of Peri and post-cardiac arrest, the doctor can refer to the use of
oxygen
● For the symptoms of shock and it can help to reduce the shock
● Metabolic acidosis
Administration Indication
Oxygen therapy Low blood oxygen, carbon monoxide toxicity
100% on demand 1. Shortness inbreathe
2. A headache
3. Chest pain
4. High blood pressure
5. Restlessness
Intermittent positive pressure Ventilation
(IPPV)
Use to provide large breath to patients
Table 1: Oxygen therapy
(Source: Created by the researcher)
Oxygen therapy
3. Adverse effects of Acetylsalicylic acid
● Chest pain and uncomfortability is the common effect
● Muscle cramping and weakness can happen due to this reason
● Vomiting
● The patient can breathe fast than normal percentage
4

4. Contraindications of Acetylsalicylic acid
● Varicella
● Deficiency of G6PD
● Aspirin triad
● GI bleeding
5. The adult dose of Acetylsalicylic acid
● Pain /fever - 325-650 mg
● MI prevention- 81-325mg
● Coronary syndrome- 162-325mg
6. Adverse effects of Entonox
● Nausea
● Dry mouth
● Dizziness
● Tingling fingers
● Dysphoria
7. Contraindications of Entonox
The seven contraindications of Entonox are:
● Hypersensitivity
● Renal impairment
● Peptic Ulceration
● Changed mental status
● Facial trauma
● Respiratory problems
● Using of drug or intoxication
8. Adverse effects of Methoxyflurane
● Damage of kidney due to excess amount of Methoxyflurane
● Delirium
● The patient can feel drowsiness
● There is a Throwing up feeling inside the body of the patient
7. Contraindications of Methoxyflurane
● The issue in the liver and kidney functioning reduced
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● Unconsciousness can be seen
● Reduced percentage of urine due to kidney problems
● Malignant hyperthermia
● Diabetes
● Those who are suffering from a reduced or eventual decrease in lung functions
● Pregnancy in seizures
● Unstable heart condition and blood circulation
10. Methoxyflurane dosage
● Daily dose- 6 ml
● Weekly- 15 ml
● Quantity in inhaler- 3 ml
● Age restriction- 5 years and older
● Activity - 25-30 minutes
11. Precautions for Paracetamol
● As suggested by Nasrollahi et al. (2017:232), paracetamol cannot be taken after 29 weeks
of pregnancy
● Prohibited for people who are carrying liver and kidney disease
12. Paracetamol dosage
● Adult (above 12 years) - 500-1000 mg in every 4-6 hours till the symptoms last in the
patient
● Paediatric (7-12 years)- 480 mg in every 4 hours and maximum until the symptoms
removed
13. Actions of Adrenaline
A. Increase heart rate
B. Enhance blood pressure
C. Extend blood glucose level
D. Expansion of air passage in lungs
E. Redistribute blood in the muscles
14. Response time: In case there is no response after 2-3 minutes after an initial dose, another
EpiPen can be tried.
6

Automated External Defibrillation
1. a
2. c
3. d
4. a
5. a
6. b
7. True
8. c
9. c
10. b
11. d
12. d
13. d
14. b
15. d
16. d
17. True
18. c
19. d
20. Body jewelry, medication patches, transdermal patches, clothes
21. True
22. b
23. False
7

Advanced Resuscitation
1.
a. Hypoxic
b. Slow
c. Five indications for 100% on demand
i. Alveolar hypoventilation due to neuromuscular disorders or drug overdose
ii. Ventilation-perfusion mismatch between atelectatic and pneumonic lung
zones
iii. Tissue hypoxia with myocardial infarction
iv. Hypovolemic shock
v. Carbon monoxide poisoning
d. Two indications for IPPV
i. Apnea with intermittent respiratory arrest or bradypnea
ii. Tachypnea with the respiratory rate more than 30 breaths each minute
2. Hazards or adverse effects of oxygen use
a. Infection from tube slipping can cause injury to trachea and mucus blocks.
b. Epidermal irritation or bloody nose during oxygen administration
c. Headaches, fatigue or general malaise
3. Colour of a medical oxygen cylinder is white
4. Oxygen delivery mechanism
a. Devices
i. Oxygen connectors and tubing (for O2 therapy)
ii. Humidified, heated and high-flow oxygen nasal cannula (for 100% on
Demand)
b. Oxygen delivery
i. Resuscitation (delivery)
ii. Hyper-inflation systems (devices)
5. True
6. a
7. d
8

8. d
9. False
10. True
11. Definitions
a. Hypoxia can be defined as the deficiency of oxygen in tissues.
b. Ventilation is a clinical practice to provide breathable air in and out of lungs and
deliver breaths to an individual, who is otherwise unable to proceed with normal
breathing.
c. External respiration is defined as the process of breathing that involves a
pulmonary gaseous exchange between the extrinsic environment and the lungs
through the process of diffusion.
d. Internal respiration is referred to oxygen diffusion from blood into interstitial
fluids and cells.
e. Hypoventilation takes place in the presence of inadequate ventilation, thereby
resulting in respiratory acidosis and hypercapnia.
f. BVM refers to bag valve masks, which are hand-held devices that offer pressure
ventilation to individuals who are unable to breathe adequately (Victorio et al.
2016: 28876).
g. MTV or manually triggered ventilator is referred to as an oxygen-powered, flow-
restricted ventilation device that assists ventilation or offers supplemental oxygen
in hypoventilating or apneic patients.
h. Pulmonary Oedema is referred to a condition that is driven by excessive fluid
content in the lungs.
12. Three causes of Hypoxic hypoxia can be
a. Trauma or pulmonary damages (emphysema, bronchitis, COPD and edema)
b. Availability of insufficient oxygen to lungs due to a blocked airway, partial
pressure reduction or drowning
c. interstitial lung complications or neuromuscular diseases.
13. Causes of Ischaemic Hypoxia
a. Diseases which interfere with blood oxygenation and respiration
b. Severe asthma
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c. Working in nitrogen-rich ambiances.
14. Anemic hypoxia is caused by decreased tissue perfusion, iron deficiency, and
downregulated erythropoietin.
15. The main cause can be disabled oxidative phosphorylation enzymes. Furthermore, agents
that decrease cellular respiration are responsible for histotoxic hypoxia (Stetzik et al.
2015: 107). These agents can be cyanide, formaldehyde, narcotics, acetone, alcohol or
anesthetic compounds.
16. Four common signs and symptoms of hypoxia are given below
a. changes in skin color (blue to red)
b. Confusion
c. wheezing
d. irregular heart rate
17. Complications during fluid removal from patients' airways can involve, blocked cannula
from mucous plugging, tracheostomal bleeding or cellulitis, pneumothorax, subcutaneous
emphysema or pneumo-mediastinum, granulation tissue or tracheo-oesophageal fistulas.
18. The primary indication for utilization of oropharyngeal airway is impending risk of
airway obstruction for the patient due to relaxations or blockage of upper airway muscles
by the tongue (Maleh et al. 2016: 99). It can also be used to open or maintain a blocked
airway of a patient.
19. Complications of oropharyngeal airways
a. Induction of vomiting that can lead to aspiration.
b. It can worsen or cause airway obstruction in case an ineffective sized airway is
utilized.
c. Inappropriately sized tracheal pathway can give rise to laryngospasm.
d. Damage to dentition or oral structures can result from oropharyngeal insertion can
take place (Horsting et al. 2015: 65).
e. Soft tissue damage can happen to the pharynx, tongue, and palate.
10

Practice scenarios
Question 1: Assessment and treatment in detail using API in case of asthma
To identify the type of asthma, it is necessary to classify according to the types. As for, a mild
intermittent, asthma effect can stay up to two days in a week or two nights in one month. On the
other hand, for those who are mild persistent. Symptoms can last more than twice a week. Severe
asthma persistent can suffer throughout a whole day and frequently in the night. The child can be
assisted with short-acting beta-agonists that will be helpful to access quick-relief bronchodilators
(Rizzo, 2015:12). This strategy can be helpful to work within a minute and reduce the symptoms
of an asthma attack. In these case ProAir HFA, Ventolin HFA is suggested with levalbuterol.
Apart from this, Ipratropium can also be a good help that is quick and effective to relax the way
of air (Shier et al. 2015:45). She can have more quick responses as it is easier to breathe. This
help is appropriate for chronic bronchitis. Medication with oral and intravenous corticosteroids
can release airway inflammation.
Question 2: Assessment and treatment with API in case of accidents
To diagnose the back pain, it will be helpful to conduct a CT scan, X-ray or MRI can be done to
conduct a proper physical exam. Spinal stenosis and the herniated disc can be identified. Non-
steroidal anti-inflammatory drugs like Advil, Naproxen Sodium or Motrin IB can help to relieve
the acute back pain. Edlow et al. (2014: 2064) said that the medical practitioner could provide a
muscle relaxant in case the situation is not improved after using OTC pain relievers. After, the
patient can be taken to the health support center and injected with anti-inflammatory medication
process. Antidepressant medication can be prescribed in a lower dosage, like ibuprofen or
aspirin (Miguel-Montanes et al. 2015:574).
On the other hand, for the larger issue, it is helpful to use chemotherapy. Permanent lasting of
paresthesia is a very rare case, and it hardly stays for a month. Thus, the back pain, in this case,
should be given more attention than the leg paresthesia.
Question 3: Assessment and treatment for substantial pain for a 10-year-old boy
In this case, the primary reason can be reflected on the overuse injury, muscle strain from
playing a sport such as golf, rugby or tennis. Thus, it is necessary to provide primary relief to
him in this condition. Initially, his forearm can be rest over some solid part which will give him
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relief from hanging the hand. Fatemian et al. (2016:1197) suggested that icing can be done in the
affected areas that will reduce the scope of swelling. The splint can be used to reduce the
mobility, and it will also be helpful to heal the injury.
Extending the forearm from shoulder and bending the wrist will be helpful to keep the blood
circulation normal. Reduction of inflammation in muscle can be done with cortisone that is
helpful to reduce the forearm pain (Futier et al. 2016: 1888-1898). On the other hand, the place
should be monitored as the pain can also generate from a blood clot. Pain or tenderness not only
caused by injury can also be the reason for the blood clot.
Question 4: Assessment and treatment for a patient with a gunshot on chest
Initially, the pressure is the most important thing. It is necessary to identify if the blood is
coming out fr4om the hole. The dressing is required to do with gauze as it can make blood clot
and seal the wound immediately. As opined by Hussain et al. (2014: 396), the seal of a gunshot
wound with some plastic material can be helpful as air usually sucked in the wound. It is helpful
to prevent the collapsed lung. Direct pressure on wound and IV fluids can prevent dehydration
and increase blood flow in major organs. Inserting the chest tube as a suction device can remove
air and relieves and keeps circulation normal.
Scenario writing
Scenario:
Tom is a 70-year-old male who had undergone a hip injury in the left leg at Parramatta Football
stadium at 13.00 p.m. The temperature at this time is 40 c. He was approaching the gate when
directly hit with an iron stand. He had a medical history of slight dementia and Angina 16 years
ago and has breathing problems as well as a tendency of allergies. GCS rate was exactly 13;
blood pressure was 160/90, respiratory rate was 30, and the heart rate was 100. SPO2 was 95;
capillary refill was 54. According to a preliminary examination, it has identified that his situation
is combative, but he is confused as well as feared due to the condition of the leg. He was
complaining that his left leg is in pain and he can’t walk by himself. Initially, the assistance had
provided with hemodynamics. Drs ABCD was applied for his first assessment while second
assessment had done with COWS, AMPLE and PQRST. Epipen can be given according to his
health condition, and he was on the full requirement of therapy musk (Hassani et al. 2015, 4)..
He has undergone a dislocated knee and can be supported by general pain relief drugs. After
proper diagnosis, he can be provided with surgery or any other necessary medication.
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Basic life support
1. Three prominent signs that can confirm cardiac arrest are
a. Discomfort, palpitations or acute angina
b. Unconsciousness and difficulty in normal breathing
c. Dizziness or light-headedness
2. d
3. a
4. Checking for unconsciousness
a. It is to be checked whether the person is breathing.
b. Legs have to be raised more than 12 inches above the ground.
c. Any restrictive belt or clothing must be loosened.
d. The airways must be checked to ensure lack of obstruction.
5. Sigmund Freud segregated human consciousness into three major levels, namely, the
conscious, preconscious or subconscious, and lastly, the unconscious.
6. Resuscitation
a. 30:2
b. 120 compressions, 5 to 6 cm depth
c. 2
d. 2
e. 1
f. tilted
7. c
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8.
9. A sign is referred to the objective evidence of a disease, which is a phenomenon
experienced by the patient (Beaudin et al. 2015: 1072-1083).
A symptom refers to the subjective evidence of a disease, detected by other individuals in
the vicinity of the patient.
10. Possible causes of coma
a. Traumatic neural injuries caused by collisions or violent force
b. Interrupted or reduced blood supply to the brain, resulting from blocked or burst
blood vessels
c. Tumors in the brain or brainstem
d. Extreme blood sugar levels (hyperglycemia or hypoglycemia)
e. The absence of oxygen resulting from asphyxiation or drowning
f. Infections like meningitis or encephalitis that can cause cerebral inflammation
11. Possible causes of hypoventilation
a. Chronic obstructive pulmonary diseases like bronchitis or emphysema
b. Deformities in the chest wall, such as fibrothorax, kyphoscoliosis, and post-
thoracoplasty
c. Myxedema
d. Abnormal obesity
e. Depression in the central respiratory drive from drug abuse, neurological disorder
or alveolar hypoventilation
f. Failure of physiological mechanisms of the respiratory system
14

g. Oxygen desaturation during sleep as a form of ventilatory response to enhanced
PaCO2 and hypoxia
h. Carotid body resection resulting from one or the other forms of injury
12. Control of external bleeding
a. Covering of injury with tourniquet, bandage or moist cloth
b. Application of direct gentle pressure on the wound to reduce bleeding
c. Elevate wounds above the heart to reduce blood flow
d. Pressing on pressure points can slow down blood flow
13. Signs and symptoms of the fracture
a. Pain, swelling, bruising or discoloration of the affected skin
b. Angulation of the affected region in an unusual angle
c. Inability to press on or move the injured area
d. The grating sensation on the affected joint or bone
e. A patient may look pale, clammy and feel dizzy or nauseated
14. A traction splint is used in case of mid-shaft femur fracture.
15. Injury management
a. Hospital sling: Injuries in the rotator cuff, arm fracture, glenohumeral
acromioplasty,
b. Elevation sling: Shoulder injuries such as fracture or dislocation (Nunes et al.
2017:198).
c. Collar and cuff sling: Injuries on shoulders or arms
16. True or false
a. False
b. True
c. False
d. False
e. False
f. False
17. Flail segment of the chest is a medical condition that can occur when segments of rib
cage break under trauma and grow detached from the remaining chest wall. It is a
15

common occurrence when multiple ribs suffer from breaks in various places which
enable the chest wall to move independently (Sato et al. 2016: 152-161).
18. Symptoms of tension pneumothorax
a. Sudden angina and cardiac tightness
b. Shortness of breath
c. Increased heart and breathing rate
d. Coughing, wheezing, and nausea
e. Malaise and fatigue
19. b
20. c
21. Signs and symptoms of Hypothermia
a. Cold skin with shivers
b. The problem in speech, such as mumbling or slurring
c. Shallow, slow breathing rates with a weak pulse
d. Lack of coordination, confusion, and clumsiness
e. Drowsiness, loss of memory and consciousness
22. Signs and symptoms of Hyperthermia
a. Coma
b. Confusion and dizziness
c. Fast heart rate
d. Unconsciousness
e. High body temperature and headache.
23. Management of burns is to cool then cover them.
24. Poison can enter the body through
a. Oral pathway and swallowing
b. Absorbed through the epidermal layer
c. Injecting inside the skin through bites, stings or syringes
d. By inhaling
25. c
26. Pressure immobilization technique
a. True
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b. True
27. List of creatures
a. red back, mouse or white-tailed spiders
b. Box or bluebottle jellyfish
c. Stonefish
d. Venomous snakes
e. Wasp
17

Posture
18

Patient Management
1. Stages of complete Spinal immobilization
a. Placing the patient's head in midline
b. Logrolling the said patient
c. The utilization of special mattresses, cervical collars, backboards, straps, and
sandbags
d. Check for discomfort and tissue pressure
2. a
3. Complications of the rigid cervical collar
a. Pressure Sores
b. Intracranial pressure due to the snug fit of the collar that can
c. Distortion of jugular venous architecture
4. KED complications
a. The requirement of significant movement of the patient to apply a device that can
cause further aggravation or pain
b. It can expose rescuer and patients to risk owing to operating under on-scene
conditions
c. The requirement of a minimum of two operators that burden emergency services
crews to search for other personnel
5. KED point of contact
a. Thorax
b. Abdomen or pelvic girdle
c. Neck
d. Legs
6. a
7. Allergies, Medications, Past Medical History, Last Eaten, Events Leading
8. The burns are assessed using an APOMI structure.
a. Action: The burn is immediately cooled by applying wet and cold compresses for
10 minutes.
19

b. Planning: A burn protocol is planned for application of petroleum jelly for three
times for the next week.
c. Observation: It is observed that he has partial and full thickness burns to the
posterior and anterior aspects of his body.
d. Medication: The burn areas are covered non-stick and sterile bandages.
Medication involves ibuprofen or acetaminophen to reduce inflammation and
relieve pain (Samadzadeh et al. 2017: 11-16).
e. Inference: The burnt area is to be protected from direct sun rays. Appropriate
information chart must be maintained.
9. Alert, voice, pain, and unresponsive
10. Questions
a. What instrument has been used to hit the woman?
b. How long ago (in minutes) has the incident taken place?
c. Has she taken any medication or remedy after this incident?
d. Is she feeling dizziness or nausea?
e. How many times has the woman been struck?
11. P: Precipitating or palliative factors; Q: Pain quality; R: Radiation or region of pain; S:
Subjective overview of pain; T: Time or temporal nature of the pain
12. Case study
a. Action: Temperature is checked to determine core body temperature and amount
of heat absorbed in the body
b. Planning: Blood test is done to potassium, sodium and gaseous content in the
blood.
c. Observation: Skin is pressed over the abdomen to check for lump or swelling
d. Medication: Muscle relaxant like benzodiazepine can be given, or ice packs can
be applied to pressure points
e. Inference: Heatstroke treatment focuses on making the body return to its normal
temperature and reduces or prevent damage to the brain or vital organs.
13. X-rays and other imaging tests to check for damage to your internal organs.
14. True
15. d
20

16. Case study
a. Action: The patient is interviewed to know whether he is suffering from
headaches, fatigue or insomnia. The wound is bandaged and pressured to prevent
blood loss.
b. Planning: Appropriate wound management is planned to reduce swelling or
infection (Platz et al. 2015: 906-916)
c. Observation: Skin is observed so that no additional infection is contracted.
d. Medication: Vasoconstrictor and Blood pressure support
e. Inference: Supportive care with fluid and oxygen management
17. True or false
a. True
b. False
c. False
d. True
e. True
f. True
g. False
20. Shocks
a. Hypovolemic shock
b. Neurogenic shock
c. Cardiogenic shock
d. Anaphylactic Shock
21. Multiple choice questions
a. a
b. b
21

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