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Region X Medication Administration CE August, 2006 Albuterol (Proventil) Benzocaine (Hurricaine) Dextrose Glucagon Diphenhydramine (Benadryl) Glucagon Based on 2005 SOP’s Sharon 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 – apprehension – dizziness - palpitations - tachycardia - 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 Mouth piece removed, ambu bag connected Clear adapter with neb tubing connected to end of ETT Clear adapter to corrugated tube To O2 supply at 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