Bronchoconstriction + Allergy

Question 1

Bronchoconstriction Standard

What are the INDICATIONS?

Answer 1

Respiratory distress
AND
Suspected bronchoconstriction

Question 2

Bronchoconstriction Standard

What are the MEDICATIONS and what receptors of the body do they effect?

Answer 2

Salbutamol - selective beta 2 adrenergic receptor agonist
Epinephrine - alpha and beta adrenergic agonist (is a bronchodilator and anti-spasmodic)
Dexamethasone - steroid that binds to glucocorticoid receptors (inhibits pro-inflammatory
signals and promotes anti-inflammatory signals)

Question 3

Bronchoconstriction Standard

What are the CONDITIONS of salbutamol in bronchoconstriction?

What are the CONTRAINDICATIONS for salbutamol?

Answer 3

N/A

Allergy or sensitivity

Question 4

Bronchoconstriction Standard

What are the CONDITIONS for Epinephrine?

What are the CONTRAINDICATIONS for epinephrine?

Answer 4

BVM ventilation required
AND
hx of asthma

Allergy or sensitivity

Question 5

Bronchoconstriction Standard

What are the CONDITIONS for Dexamethasone?

What are the CONTRAINDICATIONS for dexamethasone?

Answer 5

Hx of asthma
OR
COPD
OR
20-pack year hx of smoking

Allergy or sensitivity to steroids
OR
currently on PO/parenteral

Question 6

Common Corticosteroids Include:

9 including dex

Answer 6

• Beclomethasone
• Betamethasone
• Budesonide
• Cortisone
• Dexamethasone
• Hydrocortisone
• Methylprednisolone
• Prednisolone and Prednisone

Question 7

What are the 5 Rights?

Answer 7

Patient
Drug
Dose
Route
Time

Question 8

Bronchoconstriction Standard

What is Salbutamol’s TREATMENT plan for either route in a patient LESS than 25kg?

Answer 8

MDI:
Dose - Up to 600mcg (6 puffs)

Max (Single) Dose - 600mcg

Dosing Interval - 5-15min PRN

Max # of doses - 3

NEB:
Dose - 2.5mg

Max (Single) Dose - 2.5mg

Dosing Interval - 5-15min PRN

Max # of Doses - 3

Question 9

Bronchoconstriction Standard

What is Salbutamol’s TREATMENT plan for either route for a patient GREATER/EQUAL to 25kg?

Can sabutamol be used with a BVM?

Answer 9

MDI:
Dose - up to 800mcg (8 puffs)

Max (Single) Dose - 800mcg

Dosing Interval - 5-15min PRN

Max # of doses - 3

NEB:
Dose - 5mg

Max (Single) Dose - 5mg

Dosing Interval - 5-15min PRN

Max # of Doses - 3

YES, you can administer salbutamol using a BVM MDI adapter.

Question 10

Bronchoconstriction Standard

What is the TREATMENT plan, concentration, and route for Epinephrine?

Answer 10

Dose - 0.01mg/kg

Max (Single) Dose - 0.5mg

Dosing Interval - no interval

Max # of doses - 1

Concentration is 1:1000
Route is IM

Question 11

Bronchoconstriction Standard

What is the TREATMENT plan AND route of dexamethasone for bronchoconstriction?

Answer 11

Dose - 0.5mg.kg

Max (Single) Dose - 8mg

Dosing Interval - no interval

Max # of doses - 1

Route is PO/IM/IV

Question 12

Which medication do you administer for an apneic patient?

Answer 12

Epinephrine

Question 13

What is the rate to give MDI medication?

Answer 13

100mcg (1 puff) every 4 breaths

Question 14

When is nebulization CONTRAINDICATED?

Answer 14

Patient is known or suspected to have a fever (FRI)

Patient is unconcious

Patient is not in a position (physical) to be nebulized

Question 15

What is a spacer?

Answer 15

The plastic apparatus that hold the medication between the MDI and the patients mouth

Question 16

Bronchoconstriction Standard

Symptoms of bronchoconstriction?

How do you hear that?

Answer 16

Wheezing, coughing, dyspnea, and decreased air entry with silent chest

Auscultation

Question 17

Bronchoconstriction Standard

When do you give Dexamethasone IM or IV over giving it PO.

Answer 17

extremely short of breath
suspected respiratory failure
and
all other care has been provided

Question 18

Bronchoconstriction Standard

Can you use Dexamethasone with any other bronchoconstriction medications?

Answer 18

Yes you can use it in conjunction with salbutamol, epinephrine, AND CPAP.

Question 19

Moderate to Severe Allergic Reaction Medical Directive

What are the INDICATIONS for Severe Allergic Reaction?

What’s the clinical consideration for epinephrine?

What are the clinical considerations for diphenhydramine?

Answer 19

Exposure to a probable allergen
AND
Signs + Symptoms of a moderate-severe allergic reaction

Epinephrine takes priority over IV access

ONLY IV autonomous PCPs can administer diphenhydramine

Question 20

Moderate to Severe Allergic Reaction Medical Directive

What are the MEDICATIONS used?

Answer 20

Epinephrine and Diphenhydramine (benadryl)

Question 21

Moderate to Severe Allergic Reaction Medical Directive

What are the CONDITIONS for Epinephrine?

What are the CONTRAINDICATIONS?

Answer 21

For anaphylaxis

Allergy or sensitivity

Question 22

Moderate to Severe Allergic Reaction Medical Directive

What are the CONDITIONS for Diphenhydramine?

What are the CONTRAINDICATIONS?

Answer 22

The patient must be GREATER/EQAUL to 25kg

Allergy or sensitivity

Question 23

Moderate to Severe Allergic Reaction Medical Directive

What is the TREATMENT plan, CONCENTRATION, and ROUTE for Epinephrine?

Answer 23

Dose - 0.01mg/kg

Max (Single) Dose - 0.5mg/kg

Dosing Intervals - minimum 5 minutues

Max # of Doses - 2

Concentration is 1:1000
Route is IM

Question 24

Moderate to Severe Allergic Reaction Medical Directive

What are the ROUTES and the TREATMENT plan for Diphenhydramine for a patient who is GREATER/EQUAL to 25kg up to LESS than 50kg?

What are the ROUTES and the TREATMENT plan for Diphenhydramine for a patient who is GREATER or EQUAL to 50kg?

Answer 24

Routes can be either IV or IM

Dose - 25mg

Max (Single) Dose - 25mg

Dosing Interval - no interval

Max # of Doses - 1

Route can be either IV or IM

Dose - 50mg

Max (Single) Dose - 50mg

Dosing Interval - no interval

Max # of doses - 1

Question 25

Moderate to Severe Allergic Reaction Medical Directive

What should you do if no urticaria?

Answer 25

The patient must present with at least one other sign or symptom involving another organ system or severe symptom.