region x medication administration ce august, 2006 albuterol (proventil) benzocaine (hurricaine)...
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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
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
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