Albuterol/Atrovent and Epinephrine

[rdenman26]

I can give salbutamol but only paramedics can give atrovent at the moment. I can use SC adrenaline for life threatening asthma.

[Alcomedicism]

Here in AR we are allow to assist the pt with taking their albuterol and epi-pen only after we have contacted med control and they have OK'd it.

-Alco

[craig]

over here we follow these pharmocologies

ADRENALINE

TYPE:

A sympathomimetic

ACTION:

Stimulates the ALPHA and BETA subdivisions of the sympathetic nervous system to produce the “fight†or “flight†reaction.

· ALPHA stimulation causes peripheral vasoconstriction. It raises the perfusion pressure of vital organs during cardiac arrest. In anaphylaxis it decreases capillary permeability

· BETA 1 stimulation causes increased myocardial excitability with tachycardia and increased myocardial contractility

· BETA 2 stimulation causes bronchodilation

USES:

· Cardiac arrest:

o To improve perfusion during external cardiac massage

o To stimulate myocardial excitability and contractility

· Bradycardia if pulse rate <50/min, poorly perfused and unresponsive to two doses of atropine

· Cardiogenic shock if pulse rate <150/min and poorly perfused with B.P. < 80 mmHg systolic

· Asthma if “in extremis†with decreased LOC or minimal air movement

· Anaphylaxis with upper or lower airway obstruction or shock

· Severe croup in children with stridor at rest and any one of:

o altered LOC

o retractions

o cyanosis

ADVERSE EFFECTS:

· tachycardia

· dysrhythmias, including ventricular fibrillation

· hypertension

· pupillary dilatation

· anxiety

· nausea and vomiting

PREPARATIONS:

1:10,000 adrenaline (Min-I-Jet preparation) – 1mg per 10ml Min-I-Jet

for IV/ET/Intraosseous use

1:1,000 adrenaline (ampoule) 1mg per 1ml ampoule

for subcutaneous, IM and nebulised use only

Because two concentrations are available, check the preparation you

are using carefully to ensure the correct concentration and dose are used.

DOSE:

ADULT

· CARDIAC ARREST:

Routes of administration: IV, ET

10 ml of 1:10,000 (1 mg) ADRENALINE IV as a bolus according to Protocol 15 and Protocol 16.

Repeat every 3 minutes while in arrest - there is no maximum dose.

Endotracheal dose: Give twice the IV dose (2mg) down the endotracheal tube if a vein is not available. Can be repeated 4 times.

· BRADYCARDIA:

Route of administration: IV

Bolus of 1 ml of 1:10,000 (100 mcg) ADRENALINE IV EVERY 30 SECONDS until pulse rate >50 or perfusion adequate or ADRENALINE INFUSION is running.

Commence a continuous ADRENALINE INFUSION:

o 10 ml of 1:10,000 (1 mg) ADRENALINE diluted in 90mls Hartmann’s in a burette

o Administer via a paediatric microdrip

o Commence at 30 drops a minute (5 mcg/min)

o Titrate to maintain a pulse rate of >50/min or perfusion adequate

· CARDIOGENIC SHOCK:

Routes of administration: IV infusion

ADRENALINE INFUSION:

o 10 ml of 1:10,000 (1 mg) ADRENALINE diluted in 90mls Hartmann’s in a burette

o Administer via a paediatric microdrip

o Commence at 30 drops a minute (5 mcg/min)

o Titrate to maintain a B.P. of >80 mmHg systolic

· ASTHMA OR ANAPHYLAXIS:

Routes of administration: IV, IM, SC

IM or subcutaneous administration:

0.5 ml of 1:1,000 (500 mcg) ADRENALINE SC or IM (into the deltoid muscle)

Can be repeated every 5 minutes if no response

IV administration:

If in extremis (signs of severe shock or impending arrest) 1 ml of 1:10,000 (100 mcg) ADRENALINE IV every 30 seconds or until patient is no longer in extremis.

PAEDIATRIC

· CARDIAC ARREST:

Routes of administration: IV, IO or ET

IV, Intraosseous dose:

o Initial: 0.1 ml/kg of 1:10,000 (10 mcg/kg) ADRENALINE IV as a bolus according to Protocol 15 and Protocol 16

o Subsequent: 1 ml/kg of 1:10,000 (100mcg/kg) ADRENALINE to a maximum of 10mls. This can be repeated every 3 minutes while in arrest. There is no maximum dose

Endotracheal dose:

0.4ml/kg OF 1:10,000 (40mcg/kg) ADRENALINE

This can be repeated 4 times

· BRADYCARDIA:

Routes of administration: IV, IO

0.1ml/kg of 1:10,000 (10mcg/kg) ADRENALINE

To be administered over 3 minutes, repeat as required whilst bradycardia persists, to a maximum of 4 doses

· ASTHMA OR ANAPHYLAXIS:

Routes of administration: IV, IM, SC

IM or subcutaneous administration:

0.01 ml/kg of 1:1,000 (10 mcg/kg) ADRENALINE SC or IM (in the deltoid muscle)

Can be repeated every 10 minutes if no response

IV administration:

If in extremis (signs of severe shock or impending arrest) 0.1 ml/kg of 1:10,000 (10 mcg/kg) ADRENALINE IV over 3 minutes or until patient is no longer in extremis.

Can be repeated every 5 minutes if the patient is still in extremis.

· CROUP:

Route of administration: nebulised

0.5 ml/kg of 1:1,000 (500 mcg/kg) ADRENALINE NEBULISED to a maximum of 5ml (5mg)

Can be repeated after 30 minutes if symptoms recur

Paediatric dose should not exceed adult dose.

Adrenaline and Sodium Bicarbonate precipitate when mixed together. Flush line between these drugs.

IPARTROPIUM BROMIDE (atrovent)

TYPE:

Anticholinergic bronchodilator

ACTION:

· Causes bronchodilation.

· Blocks vagal reflexes which mediate bronchoconstriction

· Synergistic when used in combination with salbutamol

Inhalation: Onset: 3 – 5 minutes Duration: 2 – 4 hours

USE:

Relieving air flow limitation as an adjunct to salbutamol

ADVERSE EFFECTS:

Mild anticholinergic effects eg urine retention

CONTRAINDICATION:

· previous adverse reaction

· glaucoma

PREPARATIONS:

· 500mcg in 1ml ADULT- nebule

· 250mcg in 1ml PAEDIATRIC - nebule

DOSE:

ADULT

500mcg (1ml) – mixed with first and third dose of salbutamol. Give via nebuliser with oxygen flow at 8 l/m attached to either a therapy mask or the “T piece†connected to the demand resuscitator or resuscitation bag

PAEDIATRIC

250mcg (1ml) - mixed with first and third dose of salbutamol. Give via nebuliser with oxygen flow at 8 l/m attached to either a therapy mask or the “T piece†connected to the demand resuscitator or resuscitation bag

TYPE:

Beta 2 agonist

ACTION:

Causes bronchodilation

SALBUTAMOL

USE:

To relieve bronchospasm

ADVERSE EFFECTS:

· Dysrhythmias in large doses

· Shakes and tremors

PREPARATIONS:

Salbutamol – 5mg in 2.5ml ADULT nebule

Salbutamol – 2.5mg in 2.5ml PAEDIATRIC nebule

DOSE:

ADULT

2.5ml (5mg) SALBUTAMOL ADULT NEBULE

Via nebuliser with oxygen flow at 8 litres/min attached to either a therapy mask or the “T piece†connected to the demand resuscitator or resuscitation bag

May be repeated when the nebuliser is empty, approximately 10 minutes

DO NOT wait at the scene to see if Salbutamol is going to be effective

PAEDIATRIC

2.5ml (2.5mg) SALBUTAMOL PAEDIATRIC NEBULE

Via nebuliser with oxygen flow at 8 litres/min attached to either a therapy mask or the “T piece†connected to the demand resuscitator or resuscitation bag

May be repeated when the nebuliser is empty, approximately 10 minutes

DO NOT wait at the scene to see if Salbutamol is going to be effective

Adult dose may be used in children over 5 years of age.

Stay safe

[EMSchicksrock]

In Michigan Basics can administer Epi-Pen and nebulized Albuterol with permission from Med. control. (Also Glucagon and ASA)

[Ace844]

Hello,

Here's a link addressing this topic:: http://loukymetro.louisvilleky.gov/Departm...hma_article.pdf

Hope this Helps,

ACE844

[medic001918]

I'm surprised this hasn't turned into a discussion of weather basic level providers should be giving albuterol/atrovent and epi medications.

For those that can give the albuterol and atrovent, do you know when to use one over the other? Just curious if this is taught in your in service sessions.

Shane

NREMT-P

[Ace844]

For those just joining this old thread or who are interested... here are soem other threads where this was also discussed...

http://www.emtcity.com/phpBB2/viewtopic.php?t=4010

http://www.emtcity.com/phpBB2/viewtopic.php?t=3794

Hope this Helps,

ACE844

[Ace844]

(J Appl Physiol 101: 30-39 @ 2006. First published February 9, 2006; doi:10.1152/japplphysiol.01190.2005

8750-7587/06 The structural basis of airways hyperresponsiveness in asthma

Robert H. Brown,1,2,3 David B. Pearse,3 George Pyrgos,3 Mark C. Liu,3,4 Alkis Togias,3,4 and Solbert Permutt3

1Department of Anesthesiology and Critical Care Medicine, 2Department of Environmental Health Sciences, Division of Physiology, Department of Medicine, 3Division of Pulmonary and Critical Care Medicine and 4Division of Allergy and Clinical Immunology, The Johns Hopkins Medical Institutions, Baltimore, Maryland

Submitted 19 September 2005 ; accepted in final form 1 February 2006)

We hypothesized that structural airway remodeling contributes to airways hyperresponsiveness (AHR) in asthma. Small, medium, and large airways were analyzed by computed tomography in 21 asthmatic volunteers under baseline conditions (FEV1 = 64% predicted) and after maximum response to albuterol (FEV1 = 76% predicted). The difference in pulmonary function between baseline and albuterol was an estimate of AHR to the baseline smooth muscle tone (BSMT). BSMT caused an increase in residual volume (RV) that was threefold greater than the decrease in forced vital capacity (FVC) because of a simultaneous increase in total lung capacity (TLC). The decrease in FVC with BSMT was the major determinant of the baseline FEV1 (P < 0.0001). The increase in RV correlated inversely with the relaxed luminal diameter of the medium airways (P = 0.009) and directly with the wall thickness of the large airways (P = 0.001). The effect of BSMT on functional residual capacity (FRC) controlled the change in TLC relative to the change in RV. When the FRC increased with RV, TLC increased and FVC was preserved. When the relaxed large airways were critically narrowed, FRC and TLC did not increase and FVC fell. With critical large airways narrowing, the FRC was already elevated from dynamic hyperinflation before BSMT and did not increase further with BSMT. FEV1/FVC in the absence of BSMT correlated directly with large airway luminal diameter and inversely with the fall in FVC with BSMT. These findings suggest that dynamic hyperinflation caused by narrowing of large airways is a major determinant of AHR in asthma.

[beckoncall62]

Are Basics where you're from allowed to give Albuterol/Atrovent or Epinephrine?

I know in NYS, in the REMAC system I'm in that is, a Basic can use Albuterol and Epi-Pens if they've had the REMAC class, or if their squad does an inserviec training with them.

A campus first response team I'm on carries both Albuterol and Epi, and all are fully able to use them. The paid agency I work for however, seems to think that since we have fully staffed ALS rigs, Basics are somehow incapable of giving Albuterol or Epinephrine.

There have been innumerable times where I have had to meet my ALS on scene, and he hasn't arrived yet. (We run a weird program here, ALS isn't required to stay in house if they live in town)

I've beaten the ALS to the scene before, and had a patient that could have used Albuterol, but all I could do was stand there with my ass cheeks clenched.

When is Epi and Albuterol better now or later eh? lol

anyway, enough ranting, some thoughts?

In our area, BLS is only allowed to assist pt. w/ their prescription or upon medical director's ok.

[scratrat]

I'm surprised this hasn't turned into a discussion of weather basic level providers should be giving albuterol/atrovent and epi medications.

For those that can give the albuterol and atrovent, do you know when to use one over the other? Just curious if this is taught in your in service sessions.

Shane

NREMT-P

You know, I was thinking the same thing. Back in my EMT days, I remember little emphasis placed on these drugs. Here's when you can give them and that was it. NJ hasn't changed much since then either so I know there is still little emphasis placed on these drugs. I can guarentee only few basics would understand the appropriate times to administer them. Not to be offensive, I just know NJ doesn't teach Basics enough to safely administer a medication to a pt.