Transcript Region X Medication Administration

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