BLS Albuterol Administration

1. BLS Albuterol Administration Louisville Metro EMS for Suburban Fire Districts and LFR

2. Objectives 1. Demonstrate successful preparation of an albuterol nebulizer and administer albuterol. 2. Demonstration of comprehension of the indications, contraindications, pharmacology, effects and side effects of albuterol administration.

3. Pharmacology Basics • Expiration date • Color • Particulates • Storage/ Temperature regulation • DRUG ALLERGIES • Generic names- Ventolin, Proventil

4. Nebulized Albuterol Administration • Six Rights of Pharmacology • Right medication • Right dose • Right time • Right route • Right patient • Right documentation

5. What first? • Asses LOC • Asses ABC’s • Vital signs and perfusion status • Assess for decreased breath sounds, wheezing, accessory muscles, or pursed lips. Lack of wheezing does not always indicate improvement. • Assess skin color and for the presence of diaphoresis.

6. BLS Airway and Ventilation • A,B,C’s • Without an airway and adequate ventilation you have NOTHING. • Assist ventilation if signs of impending respiratory failure or respiratory arrest

7. Lung Anatomy • Trachea • Right and Left Main stem bronchus • Bronchioles • Alveoli

8. Beta 2 Agonist Pharmacology

9. Pharmacokinetics • Sympathomimetic- Stimulates the sympathetic NS • Bronchodilator- Relaxes smooth muscle of the bronchial tree • Beta 2 Adrenergic Agonist- relatively selective. • Peripheral vasculature vasodilation

10. Onset and Duration • Onset- 5-15 Minutes after inhalation • Duration- 3-4 hours • Consider resistance and tolerance.

11. Indications • Relief of bronchospasm in patients with reversible obstructive airway disease. • Age 6-65 • Difficulty breathing consistent with patient’s past history of asthma only. • Considerations • One dose only may be given under standing orders • Evaluate medication use for respiratory conditions including home oxygen • Ask patient “Is this your asthma getting worse?

12. Contraindications • Allergy to albuterol • Tachydysrythmias

13. Contact Medical Control • Must be advised prior to administration to any patient with symptoms or history of: • Angina • Myocardial infarction • Arrythmia • CHF • Repeat administration

14. Contact Medical Control • Get Med Channel with UL • BE Brief • Identify yourself • ASK FOR AN ORDER NUMBER 3. Patient demographic and transport hospital 4. Patient assessment findings 5. Patient treatment to present 6. Your request 7. Repeat the instructions given.

15. Side Effects • Restlessness, apprehension • Dizziness • Palpitations • Elevated blood pressure • Dysrythmias • Paradoxical bronchospasm

16. Albuterol Protocol (State) • NEBULIZED ALBUTEROL ADMINISTRATION • FOR PATIENTS AGE 6 AND OLDER • EMT – BASIC PILOT PROGRAM • Protocol: • 1. EMT – Basics may administer Nebulized Albuterol via a hand held nebulizer (HHN) to patients • Experiencing respiratory difficulty in situations such as: • a. Asthma • b. COPD • c. Other conditions that create respiratory distress. • 2. Patient History • a. Onset, duration, response to home therapies, and recent illness. • b. Past history of asthma or COPD, medication use for respiratory conditions, home oxygen • use, other associated respiratory symptoms, allergies or cardiac problems. • 3. Patient Examination • a. Assess level of consciousness. • b. Assess ABC’s • c. Assess vital signs and perfusion status. • d. Assess for decreased breath sounds, wheezing, use of accessory muscles; or pursed lips. • e. Assess skin for color and presence of diaphoresis. • 4. General Patient Treatment • a. Provide initial medical care • i) Determine level of consciousness • ii) Determine the presence of a patent airway and adequate respirations • iii) Obtain O2 sats. If less than 94% take immediate connective action • iv) Determine the presence, rate, and quality of pulse. If not, initiate CPR. • v) Perform a rapid mental assessment including: • (1) Pupiltary reaction. • (2) Distal motor function and sensation • (3) AVPU or GCS • vi) Place the patient in a position of comfort unless precluded by other conditions or • injuries. • vii). Concurrently complete, utilizing teamwork, the following: • (1) Determination of the chief complaint • (2) Vital signs • (3) Pertinent current and past medical history. • (4) Medication use, including compliance, and known allergies. • (5) Appropriate physical examination • (6) Assess blood glucose levels, if allowed by protocols • b. Determine severity by measuring the Peak Expiratory Rate (PEFR) and BORG scale • c. Assess need for ALS back – up • d. Treat according to severity • e. Treatment may be initiated at the scene but must not delay transport.

17. 5. Mild Severity Treatment – These patients appear to be short of breath and have auscultatory • wheezing. Respiratory rate can be normal to slightly elevated. The PEFR is 80 – 100% of the normal value found in the attached chart. • a. Administer oxygen at 1-2 LPM via nasal cannula initially, increasing gradually to meet • the patient’s oxygen demands. • b. Assess O2 saturation. • c. Administer nebulized albuterol: • i) <3 year of age: 0.25 ml of 0.5% Albuterol with 3 ml NS • ii) >3 year of age: 0.5 ml of 0.5% Albuterol with 3 ml NS • 6. Moderate Severity Treatment – These patients present with an increased respiratory effort and • rate. There are auscultatory wheezes, diminished air movement and/or use of accessory • muscles. The PEFT is less than 60-80% of that value found on the attached chart. • a. Summon ALS assistance if available. • b. Administer oxygen at 1-2 LPM via nasal cannula initially, increasing gradually to meet • the patient’s oxygen demands. • c. Assess O2 saturation. • d. Administer nebulized albuterol: • i) <3 year of age: 0.25 ml of 0.5% Albuterol with 3 ml NS. • ii) >3 year of age: 0.5 ml of 0.5% Albuterol with 3 ml NS. • e. If the patient’s condition does not improve or deteriorates, contact Medical Control for • possible repeat administration of albuterol. • 7. Severe Severity Treatment – These patients will present with significantly diminished minute • volume. Auscultation of wheezes will be dependent upon the patient’s tidal volume. The • patient appears to be in or near respiratory failure with significant use of respiratory muscles. • The PEFR is less than 60% of the value found on the attached chart. • a. Summon ALS assistance if available. • b. Administer oxygen at 15 LPM via non-rebreather mask. • c. Assess O2 saturation • d. Administer nebulized albuterol: • i) <3 years of age: 0.25 ml of 0.5% Albuterol with 3 ml NS. • ii) >3 years of age: 0.5 ml of 0.5% Albuterol with 3 ml NS. • e. Contact Medical Control to request immediate repeat administration of albuterol. • f. Be prepared for possible respiratory arrest.

18. Drug Interactions • Other sympathomimetics may exacerbate cardiovascular effects • Beta blockers may antagonize albuterol

19. Special Considerations • Pregnancy- category C • Pediatric • Geriatric • May precipitate angina pectoris, dysrythmias, or increased bronchospasm.

20. Preparing the Nebulizer • Assemble the nebulizer. • Apply tubing to oxygen • Adjust oxygen at a rate to nebulize the albuterol over 5-10 minutes. Usually 4-6 LPM.

21. Conclusion • NEVER delay transport for delivery of medication. • Ask for ALS back up early