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

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

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

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  1. Region X Medication Administration CE August, 2006Albuterol (Proventil)Benzocaine (Hurricaine)DextroseGlucagonDiphenhydramine (Benadryl)Glucagon Based on 2005 SOP’s Sharon Hopkins, RN, BSN, EMT-P

  2. 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%

  3. 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

  4. 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

  5. Albuterol Nebulizer • Nebulizer kit; kit used with aerosol mask

  6. 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

  7. Clear adapter with neb tubing connected to end of ETT In-line Albuterol Nebulizer Set-up Mouth piece removed, ambu bag connected Clear adapter to corrugated tube To O2 supply at 6L/min flow

  8. 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

  9. 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

  10. 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

  11. 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%

  12. 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

  13. 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

  14. 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

  15. 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

  16. 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)

  17. 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

  18. Epinephrine (Adrenaline) • 1:1000 ampule & vial • 1:10,000 prefilled

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