Region X Medication Administration CE August, 2006

Albuterol (Proventil)Benzocaine (Hurricaine)

DextroseGlucagon

Diphenhydramine (Benadryl)Glucagon

Based on 2005 SOP’sSharon Hopkins, RN, BSN, EMT-P

Region X Medication• Medications discussed in the following format:

– action/indication

– contraindication

– special considerations

– dosing

– side effects

• Skills practiced– assembly of albuterol nebulizer and in-line use

– calculating and drawing up D 12.5% from D 25%

Albuterol (Proventil)

• Bronchodilator used to treat asthma and reverse the bronchospasm associated with COPD

• Avoid use if hypersensitive to ingredients or presenting with symptomatic tachycardia

• Has greater selective action in the lungs than on the heart

Albuterol (Proventil)

• Dose same for all patients - adult & pediatrics– 2.5 mg in 3 ml solution

– given via nebulizer with 6L O2

– if patient unable to hold mouthpiece, use aerosol mask

– consider in-line set up for severe distress

• Side effects:– restlessness - palpitations

– apprehension - tachycardia

– dizziness - dysrhythmia

Albuterol Nebulizer• Nebulizer kit; kit used with aerosol mask

In-line Albuterol Nebulizer• Used for the patient in need of intubation• ETT placed in patient in usual manner and position

confirmed & documented• Albuterol placed in holding cup as normal• Neb oxygen supply hooked up to 6 L flow• Small clear adapter connected to distal end of corrugated

nebulizer tube (blue or white tubing) • Connect clear adapter to ETT• Mouth piece removed from nebulizer kit and ambu bag

used to start bagging patient

In-line Albuterol Nebulizer Set-up

Clear adapter with neb tubing connected

to end of ETT

Clear adapter to corrugated tubeMouth piece removed,

ambu bag connected

To O2 supplyat 6L/min flow

Benzocaine (Hurricaine)

• Topical anesthetic used to suppress the gag reflex during intubation attempts

• Avoid use if hypersensitive to ingredients

• Onset of action 15-30 seconds with a short duration

Benzocaine (Hurricaine)

• Use 1 - 2 short 1/2 -1 second sprays

– goal to numb back of throat and not the tongue

– use new red “straw” tube for each new patient

• Could cause impaired oxygen delivery to tissues if the sprays are too long in duration

Dextrose

• A carbohydrate used to replace decreased stores of glucose in the blood

• No major reason not to give dextrose when supported by documented low glucose levels

• Serious brain injury or death can occur if hypoglycemia left untreated

• Dosages should be delivered slow and steady; medication very irritating to veins; infiltration can cause tissue destruction

Dextrose• D50% (for those over 15 years of

age) - – 25 grams/50 ml

• D 25% - for ages 1 - 15– 2 ml/kg

• D 12.5% - for ages less than 1 – 4 ml/kg

– Once total volume is calculated, draw up 1/2 the volume as normal saline and mix with 1/2 the volume from D 25%

– Ex: 28 ml D12.5% = 14 ml NS; 14 ml D25%

Glucagon

• A hormone given in the presence of hypoglycemia in the absence of IV access

• Should not be used in the presence of allergies to proteins

• To be effective, there needs to be stores of glucose present in the liver

• Response, if it occurs, takes approximately 20 minutes

Glucagon• Need to reconstitute preparation 1 mg (unit)/1 ml

– withdraw fluid from one vial (or use prepped syringe)– add fluid to vial with compressed powder pill– gently roll to agitate and mix contents (no flakes left)– draw up 1 ml volume and prepare for injection

Diphenhydramine (Benadryl)• An antihistamine used during allergic reactions

• Use cautiously with heart disease and hypertension

• Effects may be short acting and provide only symptomatic relief; watch for rebound symptoms as the medication wears off

• Elderly are sensitive to this medicine - watch for hypotension

Diphenhydramine (Benadryl)

• Stable adult allergic reaction (hives, itching, rash)– Benadryl 25 mg slow IVP or IM

• Adult with airway involvement– Benadryl 50 mg slow IVP or IM– Used with epinephrine 1:1000 and possibly albuterol

• Anaphylactic shock - do not use

• Pediatric patient (<15 years old) - must call medical control for dosing

Epinephrine (Adrenaline)1:1000

• Bronchodilates smooth muscles in bronchial tree

• Useful in acute allergic reactions with airway involvement and in anaphylactic shock

• Avoid use if patient hypersensitive to medication

• Use with caution in the elderly (stresses cardiac system possibly B/P and pulse rate)

Epinephrine (Adrenaline)1:1000• Adult dose allergic reaction with airway involvement

– Epinephrine 1:1000 - 0.3 mg SQ one time dose

• Adult dose in anaphylactic shock– Epinephrine 1:1000 - 0.5 mg IM (more predictable absorption) one

time

• Pediatric dose (<15 years) in allergic reaction with mild respiratory distress and or severe cardiorespiratory compromise– 0.01 mg/kg (max 0.3 ml per single dose)– may repeat every 15 minutes

Epinephrine (Adrenaline)

• 1:1000 ampule & vial

• 1:10,000 prefilled