1. 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

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 O 2 –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. In-line Albuterol Nebulizer Set-up Clear adapter with neb tubing connected to end of ETT Clear adapter to corrugated tube Mouth piece removed, ambu bag connected To O 2 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