Albuterol - Generic Name
Albuterol - Trade Name
Albuterol - Class
Sympathomimetic, Selective Beta 2 Agonist
Albuterol - Actions
Activates the beta 2 adrenergic receptors to relax smooth muscle
Brochodilation, relieves bronchospasms, and reduces airway resistance
Albuterol - Onset & Duration
Onset: ~5 minutes
Duration: 3-4 hours
Albuterol - Indications
Respiratory distress with bronchospasms
Albuterol - Contraindications
MI - Myocardial Infarction
Cardiac Pulmonary Edema
Cardiac dysrhythmias associated with tachycardia (relative, >120)
Albuterol - Side Effects
Albuterol - Special Information
Albuterol may precipitate angina pectoris and dysrhythmias.
Check lung sounds, O2 saturation, capnography, respiratory rate before and after administration of Albuterol
Albuterol - Dosage & Route
Adults - 2.5mg Albuterol in 3mL of NS via SVN, repeat as needed.
Pediatrics - 2.5mg Albuterol in 6mL of NS via SVN, repeat as needed.
Connect oxygen to SVN at 6-8 lpm.
Albuterol - MDI dose
Aspirin - Generic Names
ASA, Acetylsalicylic Acid
Aspirin - Trade Names
Bayer, St. Josephs, multiple others
Aspirin - Class
Aspirin - Actions
Interrupts Thomboxane A2
Inhibits the normal tendency for platelets to accumulate inside injured or occluded cardiac arteries thereby promoting better blood flow through vessels to better perfuse the heart
Aspirin - Onset & Duration
Onset: 15-30 minutes
Duration: 4-6 hours
Aspirin - Indications
Chest pain of suspected cardiac origin
Aspirin - Contraindications
Unable to swallow
Caution if patient has history of active bleeding ulcer
Aspirin - Side Effects
Bronchospasms in some patients with asthma
Aspirin - Special Information
Pills need to be chewed and swallowed. Small amount of water can be used.
Aspirin interferes with Thromboxane A2 (TA2) "message" from being sent to other platelets, thus causing the platelets to pass by and not let the clot grow, minimizing the clotting process. ASA has no effect on existing blood clot. It just stops it from getting bigger.
Can be given if patient is on anti-coagulants.
Aspirin - Dosage & Route
Oral route (PO)
Dose can range from 162mg to 325mg 2-4 81mg tablets
It is highly suggested that the EMS provider administer a total of 4, 81mg tablets for a total of 324mg.
Nitroglycerine - Generic Name
Nitroglycerine - Trade Name
Nitrostat, Nitro-bid, Nitrolingual
Nitroglycerine - Class
Nitroglycerine - Actions
Relaxes systemic venous and arterial vessels causing vasodilation thereby
Decreasing cardiac preload and after load
Decreasing myocardial workload
Decreasing myocardial O2 comsumption
Dilates coronary arteries
- Decreasing cardiac preload and after load
- Decreasing myocardial workload
- Decreasing myocardial O2 comsumption
Nitroglycerine - Onset & Duration
Onset: 2 minutes SL; ~30-60 minutes topical
Duration: ~30-60 minutes SL; ~24 hours topical
Nitroglycerine - Indications
Angina or angina-equivalent discomfort
Cardiac pulmonary edema
Nitroglycerine - Contraindications
Systolic BP < 100
Suspected right ventricular MI
Phosphodiesterase inhibitor use with last 24 hours - ED medications such as Viagra (sildenafil), Cialis (tadalafil) or Levitra (vardenafil) taken along with Nitro can cause profound hypertension and tachycardia
Nitroglycerine - Side Effects
Nitroglycerine - Special Information
Nitro has a cumulative effect; repeat doses are usually necessary
Nitro has a short shelf life and is light sensitive
Don't shake the nitro bottle (spray or pill). Nitro in this form is not explosive; however, shaking the pill bottle will likely fracture the pills (never administer a partial pill) and shaking the spray bottle with break down the medication
Be sure to inform the patient that nitro can cause headache and increases heart rate, and that this is a normal side effect. Nitro may also cause vertigo and nausea.
Remind the patient not to swallow the nitro, spray or pill.
Inform the patient that they may expedience a burning sensation under their tongue after administration.
Nitroglycerine - Dosage & Route
Sublingual (SL) route
If systolic BP is >100 it is suggested that you administer 0.4mg SL q 3-5 minutes. Generally a total of 3 doses (3, 0.4mg SL) are administered as dosages beyond this recommendation tend to be less effective.
Oral Glucose - Generic Name
Oral Glucose - Trade Name
Oral Glucose - Class
Oral Glucose - Actions
After absorbing from GI tract, glucose is distributed in the tissues and provides a prompt increase in circulating blood sugar.
Glucose is the body's basic fuel and is required for cellular metabolism. A sudden drop in blood sure level will result in disturbance of normal metabolism, manifested clinically as decreased in mental status, diaphoreses, and tachycardia. Further decreases in blood sugar may result in coma, seizures, and cardiac arrhythmias.
Oral Glucose - Onset & Duration
Onset: 1-10 minutes
Oral Glucose - Indications
Hypoglycemia (altered mental status with history of diabetes)
The ability to swallow the medication
Oral Glucose - Contraindications
Unable to swallow
Oral Glucose - Precautions
Altered LOC - Level of Consciousness
Ascertain the patients ability to swallow an oral preparation of glucose without airway compromise.
Must be swallowed, not absorbed sublingually, or buccally.
Oral Glucose - Side Effects
Nausea is the most typical side effect
Can cause hyperglycemia; however this is not common with oral glucose
Typically no side effects if administered properly
Oral Glucose - Special Information
Symptomatic hypoglycemia nearly always means an altered mental status. Altered mental status often means a scene safety issue. Make sure you are aware of your environment and have the assistance you need.
Check a glucometer reading before administering glucose if at all possible.
It is possible and acceptable to revive a hypoglycemic patient without using an entire 45 gram tube. Base your treatment/dosage on the promptness of the patient response.
If the patient refuses transport it is important to get them something supplemental to eat. Also consider who is there with the patient (family, bystanders) and suggest that someone remains with them for awhile.
Commonly, there is an explanation for hypoglycemia if you look for it. Poor compliance, increased stress, decreased sleep, illness, change in insulin regiment, etc...
Glucose comes in various forms. Gel is the most common form administered by EMS. Also note that it comes in liquid (Dextrose) and tablet forms as well.
Oral Glucose - Dosage & Route
1 tube of oral glucose PO as the dose, or a total of 15 grams. Most protocols suggest 2-3 tubes PO, or a total of 30-45 grams, for patients with intact gag reflex and who are able to manage their own airway.
Can either be packaged in 15 gram tubes or 45 gram tubes.
It is suggested that pediatric patients receive the same dosage as the adult patient. However, note that some protocols may vary. Some protocols suggest 5-45 grams for pediatrics.
Activated Charcoal - Generic Name
Activated Charcoal - Trade Name
SuperChar, InstaChar, Actidose, LiquiChar, others...
Activated Charcoal - Class
Activated Charcoal - Actions
Binds to certain poisons and prevents them from being absorbed into the body.
Not all brands of activated charcoal are the same; some bind much more poison that others, so consult with medical direction regarding any questions about the brand that you carry.
Activated Charcoal - Indications
Poisoning by mouth, oral poisoning
Activated Charcoal - Contraindications
Ingestion of acids or alkalis.
Some protocols also suggest petroleum products.
Unable to swallow.
Patients with oral acids, alkalis, and petroleum product poisoning.
Activated Charcoal - Side Effects
Patients that have ingested poisons that cause nausea may vomit.
Activated Charcoal - Special Information
If the patient vomits, the dose should be repeated once.
Reassessment strategies - be prepared for the patient to vomit or further deteriorate
Activated charcoal adsorbs many but not all toxins. Some of the things that do not stick to charcoal can generally be remembered using the mnemonic PHAILS
- Hydrocarbons (gasoline, kerosene, lighter fluid, etc...) Heavy metals (arsenic mercury, etc...)
- Alcohols / Acids / Alkalis
Activated Charcoal - Dosage & Route
Dose is based off of body weight; 1 gram per kilogram of body weight (1g/kg)
Obtain orders from medical directions
Container must be shaken thoroughly
Epinephrine - Generic Name
Epinephrine - Trade Name
Adrenaline, Epi-Pen, Epi-Pen Jr.
Epinephrine - Class
Epinephrine - Actions
Bronchodilation of the bronchi
Vasoconstriction of the peripheral vasculature
Increased heart rate, increased contractility and increased automaticity of the heart
Epinephrine - Onset & Duration
Onset: IM tends to be variable, SQ 5-10 minutes
Duration: 1-4 hours (can as short as 5-10 minutes)
Epinephrine - Indications
Must meet the following 3 criteria
- Emergency medical care for the treatment of the patient exhibiting the assessment findings of an allergic reaction.
- Medication is prescribed for this patient by a physician.
- Medical direction authorizes use for this patient.
May also be authorized for patient having an asthma attack if patient is prescribed medication by physician.
Epinephrine - Contraindications
None if used in a life threatening situation
Administration caution must be observed if patient is experiencing a possible MI
Epinephrine - Side Effects
Increased heart rate, pallor, vertigo, chest pain, headache, nausea, vomiting, anxiousness
Epinephrine - Special Information
Administration increases myocardial oxygen demand; therefore, your patient with an allergic reaction (or severe asthma attack) should be on high flow oxygen not only before, but after the administration of epinephrine.
Epinephrine - Dosage & Route
Obtain orders from medical direction
Ensure that the epinephrine is prescribed to that patient and that the medication is not discolored.
Remove safety cap from the auto-injector
Place tip of auto injector against patients thigh
- Lateral portion of the thigh
- Midway between the waist and the knee
Push the injector firmly against the thigh until the injector activates
Hold the injector inlace until the medication is injected
Record activity and time
Dispose of injector in sharps container
- Adult: one auto injector contains 0.3mg (1:1000 epi)
- Pediatric: on auto injector contains 0.15 mg (1:2000 epi)