Giving medication down ET tube

rhan101277

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Maybe this is a dumb question but when placing the ET tube you put it down in between the cords. Is there another tube that goes down the esophagus for medication purposes at the same time?

Isn't it true that medications given this route have the slowest absorption rate.

In what cases would you use this route if you could find good veins.
 

Linuss

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Are you talking about putting PO drugs down the esophagus in an intubated pt? PO drugs are the slowest (not counting transdermal). They have to go through the stomach, into the intestines, then pass through the liver.



Drugs down the ETT, into the lung, are actually fairly quick. You can give O-LEAN down the tube, but a few places around here are actually pulling back from pushing down the tube.



Granted I'm new to this, but I can't think of a single PO drug you'd give to an intubated pt (in the field). They are intubated for a reason, and as such you want the quickest route of drug administration, which is IV/IO.
 
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Linuss

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I lied, there is a drug.


You can use a Nasogastric tube to put activated charcoal down in to the stomach.
 

VentMedic

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There are many meds that we do put through an ETT but they are usually for special respiratory purposes or procedures if given as a liquid. There are also many other meds nebulized for a variety of different effects including reducing pulmonary hypertension, pain control or other off label use of meds such as lasix in the neonatal population.

However, for prehospital, peripheral IVs, including the EJ, and the IO are preferable.

Is there another tube that goes down the esophagus for medication purposes at the same time?

Here is an article that will explain many things about the OG, NG, NJ, G-Tube and J-Tube.

http://www.radiographicceu.com/article24.html

Meds, fluids and feedings will be given down these tubes and you should have already seen most of them if you have assessed your patients properly from home care situations and LTC facilities.

We usually drop an NG or OG tube when using a BVM to decompress the stomach. If intubated with thoughts of requiring a ventilator, the OG is placed rather than an NG for the long haul to reduce the possiblity of an infection leading to PNA.
 

ResTech

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In an emergency situation pre-hospital, only a select few drugs are able to be administered down the tube... Lidocaine, Epi, Atropine, and Narcan (LEAN). Many EMS systems are getting away from giving drugs down the tube due to unreliable absorption rates and questionable efficacy. It was once thought that due to the vast vascular network in the lungs that ETT admin was close to IV but they are finding this not to be true.

Maryland is one State that took ETT admin of meds out of the protocol. Its either IV or IO.
 
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rhan101277

rhan101277

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In an emergency situation pre-hospital, only a select few drugs are able to be administered down the tube... Lidocaine, Epi, Atropine, and Narcan (LEAN). Many EMS systems are getting away from giving drugs down the tube due to unreliable absorption rates and questionable efficacy. It was once thought that due to the vast vascular network in the lungs that ETT admin was close to IV but they are finding this not to be true.

Maryland is one State that took ETT admin of meds out of the protocol. Its either IV or IO.

How does this fluid effect oxygen absorption? I know gases diffuse, but fluid medicines in the lungs how does that work?
 

Linuss

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My money is on "very little to none"


When putting drugs down the ETT, you have to double the dosage just to get the same effect as doing it IV.

Even considering double the dosage, that's only a few mls of space in a 5-6l area.
 

ResTech

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All in all, the small volume of fluid from the medications isn't gonna cause any problem with diffusion distance or actual oxygenation. However, in cases of say CHF or Adult Respiratory Distress Syndrome (ARDS) where fluid in the lungs is already a problem, it doesn't make sense to be putting more fluid in the lungs even though in small amounts.
 

Linuss

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However, in cases of say CHF or Adult Respiratory Distress Syndrome (ARDS) where fluid in the lungs is already a problem, it doesn't make sense to be putting more fluid in the lungs even though in small amounts.

Let alone Epi ... ^_^
 
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falcon-18

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the medication in ETT is (NAVEL) all of it in double dose.:):):)

I think any medication in PO you can give by NGT.

I am not sure :unsure: . but I am see some doctors give by NGT.
 

ResTech

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No you wouldnt give Epi to a CHF or even ARDS patient normally, but if they happen to arrest than you would... admittingly if someone arrests due to CHF they are long gone anyway... just a principle to be cognizant of.
 

VentMedic

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the medication in ETT is (NAVEL) all of it in double dose.:):):)

I think any medication in PO you can give by NGT.

I am not sure :unsure: . but I am see some doctors give by NGT.

For the code situation the "V" in NAVEL is now Vasopressin.

Most meds taken by PO can be given by NGT provided they can be made into a form the tube can accomondate and provided they are not a time (extended) release med or capsule where changing the form changes the release time.
 
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emtjack02

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the medication in ETT is (NAVEL) all of it in double dose.:):):)

I think any medication in PO you can give by NGT.

I am not sure :unsure: . but I am see some doctors give by NGT.

If giving ntg po that would be extended release, not something I assocciate with prehospital needs. imho
 

ResTech

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Pre-hospital no PO meds are gonna be given by NG tube... especially considering the only time a NG tube is placed is during arrests.

However, PA protocols do allow for PO benedryl pre-hospital for mild allergic reactions.
 

VentMedic

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Pre-hospital no PO meds are gonna be given by NG tube... especially considering the only time a NG tube is placed is during arrests.

Not exactly. Since many of your patients from LTC facilites or home care will have g-tubes of some kind and maybe even NGT depending on time of placement and reasons. It is always wise to check what meds (especially PRN) have been recently given by the RNs or family members down the NGT or peg(G-Tube) so you can inform the ED staff so there won't be a double dose given or if your patient goes somnolent or apneic after you also give something for sedation.

NG tubes are also not just placed during cardiac arrests. We may place one during transport for N/V or if intubation is anticipated. If you do CCT or Flight, there is a fairly long list of reasons to have an NGT placed.

Like many of the venous access devices, the NGT is the most under utilized device that is within the scope of practice for most Paramedics.
 
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ResTech

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Im talking straight 911, station to scene EMS... it is safe to say PO meds are not ever gonna be administered pre-hospital especially by an NG tube. The absorption rate is way to slow. For one, you kinda have to carry PO meds in your drug box for PO administration to even be considered. No Paramedic service I have ever seen carries PO meds except for ASA which when chewed gets absorped pretty quick.

And in over a decade of career experience working for FD's and running with my volly EMS service, I have never seen a PO med given pre-hospital (except for ASA of course).

No protocol I have seen allows for an NG tube insertion for N&V and doubtful med command is gonna give orders for one given a short transport time.
 
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rhan101277

rhan101277

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I guess I need to re-phrase my question. I want to make sure I understand how the medicine makes it to the bloodstream. Are individual molecules able to pass through the alveoli to the capillaries?
 

VentMedic

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Im talking straight 911, station to scene EMS... it is safe to say PO meds are not ever gonna be administered pre-hospital especially by an NG tube. The absorption rate is way to slow. For one, you kinda have to carry PO meds in your drug box for PO administration to even be considered. No Paramedic service I have ever seen carries PO meds except for ASA which when chewed gets absorped pretty quick.

And in over a decade of career experience working for FD's and running with my volly EMS service, I have never seen a PO med given pre-hospital (except for ASA of course).

What I am trying to tell you is the meds don't have to be given by you. The nurses or family members could already have given the meds prior to your arrival. I consider ALL meds given from the time the emergency starts till the patient's arrival to the ED as prehospital. Thus, some EMS providers believe, wrongly, that since there is not an IV established, no meds were given or don't think that there may have be a PO med given through that tube which will take effect shortly have they give something IV. We do have to reverse patients in the ED because the Paramedics did not take into consideration the other meds. It may not mean you withhold what you are giving but you need to be prepared for whatever happens when all the meds are in the body.

All paramedic units should have the capabilty of sinking an NGT for the unconscious patient especially with vomiting.
 
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