Drug Box 1-3

albuterol sulfate

Proventil, Ventolin

sympathomimetic, bronchodilator

Treatment of Bronchospasm

Give 2.5mg of premixed solution for inhalation (0.083%) via SVN, or in-line with a wentilatory device. Repeat doses per medical control

• * Inhaler, Pt own
• * In line with Endo-tracheal Tube/Naso-Tracheal Tube

Must be sulfite-free

dexamethasone sodium phosphate

Decadron

synthetic adrenocorticoid/glucocorticoid with a predominance of glucocorticoid action, anti-inflammatory

• * Reactive airway desease: Acute exacerbation of bronchial asthma
• *Anaphylaxis
• *Cerebral edema (non-traumatic)

• * Reactive Airway Dicease, Anaphylaxis- 8-24mg IV/IO or Deep IM
• * Cerebral Edema- 1-5mg/kg IV/IO or Deep IM

Dexamethasone is not compatible with benadryl or versed in IV tubing.

diphenhydramine HCl

Benadryl

antihistamine, anticholinergic

• * Anaphylaxis (2nd line)
• * Phenothiazine reactions (extrapyramidal symptoms)
• * Antiemetic

• * Anaphylaxis/Severe Allergic Reastions: 25-50mg slow IV push or Deep IM
• * Acute Dystonic Reaction: 10-50mg IV or Deep IM, dose individualized according to the needs and Pt response

• * Not used in newborn or premature infants, used in pregnancy only if clearly needed.
• * In anaphylaxis, used as a 2nd line treatment after epinephrine and steroids.

furosemide

Lasix

loop diuretic

Pulmonary edema; congestive heart failure

• * On oral furosemde therapy: Consider intial dose of 2 times daily oral dose, if no effect in 20 mins may double initial dose.
• * Not on oral furosemide therapy: 0.5-1mg/kg to a max of 2mg/kg (usually 20-40mg) IV/IO slowly.

• * Ototoxicity and resulting deafness can occur.
• * Since furosemide is a sulfonamide derivative, it may induce allerfic reastions in PT with sensitivity to sulfonamides (sulfa drugs)

ipratropium bromide

Atrovent

anticholinergic, bronchodilator

Treatment of bronchospasm associated with COPD (emphysema and chronic bronchitis). To be used either alone or in combination with Albuterol

• * give 500mcg in 2.5ml normail saline (1 unit dose vial) via SVN or in-line with a ventilatory device. Repeat according to medical control preference.
• * May mix one unit dose vial of inpratropium with one unit vial of albuterol.

• * Anticholinergics produce preferential dilatation of the larger central airways, in contrast to beta agonists, which affect the peripheral airways.
• * May be more effective used in combination with beta agonists.
• * Should be kept out of light in foil pouch and avoid execessive humidity.

methylprednisolone sodium succinate

Solu-Medrol

Corticosteroid, glucocortcoid, steroid, anti-inflammatory

• * Reactive airway desease: Acute exacerbation of emphysema, chronic bronchitis, asthma
• * Anaphylaxis
• * Burns potentially involving the airway

Reactive Airway Dicease, Anaphylaxis, Burns Potentially Involving the Airway: Usual dose 125mg slow IV bolus (much larger doses can be used)

**Acute Spinal Cord Trauma: Should be within 6 hours of insult and Pt meets criteria, initial bolus dose of 30mg/kg IV administered over 15 mins; bolus followed by a 45 min rest peiod, then a 23-hr continuous infusion of 5.4 mg/kg/hr.

• * Use for spinalcord trauma is limited to prehospital providers that have completed a special training curriculum in accordance with their medical control authorities. Proper administration of methylprednisolone for spinal cord trauma is imperative.
• * Infusions: An infusion pump is required for continuous infusions of corticosteroids during interfacility transports; a minimim of microdrip tubing is required for field use if administering loading dose therapy for spinal cord trauma.
• ** Indicates special training requirement.

phenylephrince nasal spray 0.5%

Neo-synephrine Nasal Spray 0.5%

topical vasoconstrictor

Facilitation of nasotracheal intubation

2-4 sprays in each nostril before attempting tube insertion

• * Single Pt use only
• * Air or strong light causes potency loss; do not use solution if brown in color or precipitate is in bottle.