Terbutaline

[okmedic]

I have read about a few services having Terbutaline SQ in there respiratory protocols. I was just looking for an alternative to SQ epi for pts having brochiocontriction with a history of cardiovascular disease. Does anyone in the city have any experience with this? If so, what does your protocol say about it and personally do you think the med has it's place in the pre-hospital community.

[crotchitymedic1986]

Brethine is a good drug --- if you dont have it, you should add Xopenex and Atrovent to your aerosol aresenal.

[okmedic]

Yea, we have albuterol, atrovent, and solu-medrol at our disposal. The only problem is the copd pt's that don't call untill they are fairly locked up, the a&a treatment doesn't do much good if it can't reach the lower airway. Epi does a good job, but I would like an option that doesn't increase peripherial vascular resistance and increase myocardial oxygen demand in a patient that is already oxygen comprimised. Especially in patient with a cardiovascular history.

[AZCEP]

Unfortunately, that is precisely what Brethine will do. It doesn't have as much of an effect on the PVR, but it will still increase the MVO2 through it's beta stimulation.

It is less drastic than epinephrine, but for the patient that you are considering it for epinephrine isn't going to work very well either. Dilating bronchial smooth muscle when the alveoli are collapsed doesn't usually help much. CPAP/BiPAP is a much better option.

[CBEMT]

We have it listed as an alternative to epi, 0.25mg SQ.

[HellsBells]

Interesting that you give Epi SQ, I thought that common practice was moving away from that, and going IM only.

[CBEMT]

Interesting that you give Epi SQ, I thought that common practice was moving away from that, and going IM only.

There's a lot of things that the rest of medicine is moving away from and we aren't. MAST, EOAs, lasix, coma cocktail....

[Fox800]

There's a lot of things that the rest of medicine is moving away from and we aren't. MAST, EOAs, lasix, coma cocktail....

There are services that still use EOA's? Yikes :shock:

[CBEMT]

There are services that still use EOA's? Yikes :shock:

Services? Try the entire state. Required equipment on every ambulance. Until about 2 years ago, ET kits were optional for ALS ambulances as long as the EOA was present and the owning service declared to the state inspector that "this ambulance does not intubate" (that provision was removed). Out of state EMTs have to learn how to use EOA and MAST from a licensed EMS Instructor before being granted a license.

Now. Is it ever used? Don't know anyone that has, and I've never seen a patient brought in with one. So "use" is something if a misnomer. "Have" and "carry" is more accurate. :wink:

[backinboston]

we have terbutaline as a med control option but I have found it takes 10-15mins usually to start to work on that locked up tight patient.

I have Mag in our standing orders and will usually go with 2grams in a 250cc bag wide open and have had excellent results. Usually throw on a combineb while its going in. Ive had impressive turn around prior to arrivial at the hospital.