Pharmacology
Evaluating Medication Effectiveness in the Field
Identifying objective improvement after EMT-Basic medications and recognizing when reassessment demands escalation.
Objective endpoints by drug class
Effective epinephrine for anaphylaxis shows rising blood pressure, decreased wheezing, reduced angioedema, and improved mental status within minutes—not merely a resolved rash while stridor persists. Bronchodilators improve audible wheeze, work of breathing, and speaking ability; peak flow is rarely available in EMS but respiratory rate and SpO₂ trends matter.
Naloxone should restore respiratory effort and alertness without necessarily normalizing all vitals immediately.1 Nitroglycerin may decrease blood pressure modestly with chest pain reduction—confusing hypotension from overdose versus therapeutic effect requires exam and repeat vitals. Oral glucose raises blood glucose and improves cognition when hypoglycemia was the cause.
When improvement is absent
MedlinePlus warns that medicines can fail when wrong drug, wrong dose, or wrong indication is selected.2 Lack of expected improvement after correct dosing triggers protocol next steps: second epinephrine dose for anaphylaxis, additional bronchodilator per interval, ALS intercept, or rapid transport with continued airway support.
Document partial response explicitly: “Wheezing improved, angioedema persistent.” Partial responses guide hospital alerts. Do not declare success and downgrade transport when critical symptoms remain. Time-stamped reassessment proves standard-of-care in post-incident review.
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