January 26, 2023

Okay everybody today as we talked about earlier we’re in the phase of learning bls medications medications that you all can give or assist with giving with your paramedic partner it’s important to know these drugs of course we’ve talked about the five rights we’ve talked about a little bit about dosing on other medications as well today we’re going to talk about

One of the main medications you’ll see given most often uh in ems we give we respond to a lot of breathing problem type calls shortness of breath trouble breathing asthma allergic reactions etc so today we’re going to talk about albuterol sulfate also known you’ll hear hear it referred to as a duoneb a breathing treatment a puffer that’s what people have most

The time in their little puffers so with that um albuterol sulfate is in the drug class of sympathomimetic bronchodilators meaning that it is going to uh dilate our bronchioles and other parts of our airway specifically the smooth muscle of the bronchial tree um decreasing what that does is it decreases resistance and facilitates mucus drainage when someone

Is having bronchoconstriction so think of bronchospasms asthma copd allergic reactions smoke inhalation anything that’s going to cause the bronchials or the bronchi to narrow and condense down creating a higher difficulty of people being able to most the time being able to breathe air out to um exhalate so most of time you’ll see people not really having

As much trouble breathing in but breathing out is what is um a little bit more difficult for them when you see people with asthma copd etc so speaking of that those are indications indications uh main indications for albuterol sulfate are going to be um is your difficulty breathing your dyspnea secondary to bronchospasm so asthma copd allergic reactions

Smoke inhalation uh there are some others as well um we also want to talk of course with our indications we’re going to talk about our contraindications as well so anybody with hypersensitivity to albuterol or another main one we want to look out for is trouble breathing or dyspnea secondary to chf if we suspect a patient is having breathing difficulties due to

Congestive heart failure and might have some pulmonary edema or fluid in the lungs we want to be very cautious or most the time withhold albuterol administration unless we um your you know paramedic partner an als provider has other things in place uh a bureau can exacerbate the the edema in the lungs and cause more fluid into the lungs and essentially making

That disease process more powerful in that state you might hear it called flash pulmonary edema or flashing a patient this happens when congestive heart failure patients are given albuterol it’s not a guarantee but it’s definitely something that we want to use with extreme caution so let’s talk about the we talked about the pharmacodynamics the actions of

The medication uh of course which is it’s a beta-2 adrenergic stimulant okay so that’s going to cause smooth muscle relaxation in the bronchial tree it also has mild effects on your beta 1 which is your heart and your alpha 1 receptors which could potentially cause vasoconstriction or an increased heart rate um is what you’re going to get with your beta 1

Properties if it affects the receptors there so it can also decrease secretions uh during an allergic reaction so we’ll see how butyrol administered sometimes in allergic reactions as well along with epi and some other things so pharmacokinetics the way the drug the medication moves through the body and how fast so you’re going to see an onset in anywhere from

5 to 15 minutes with albuterol when given when administered to a patient with its peak effect being one to one and a half hours and a duration of three to six hours so um it’s distributed to muscle cells specifically within the bronchial tree and that’s where we want it to affect the most obviously without smooth smooth muscle relaxation and opening up those

Airways so we can assist that patient in breathing a little bit easier so some of the side effects you might see with albuterol tremors anxiety dizziness headache uh possibly a cough we want them to cough a lot of times that’s indicative of them that that fluid that mucous breaking up down in their airways um uh reflex bronchospasms palpitations tachycardia and

Some high blood pressure possibly some hypertension so butyrol is most likely going to increase the heart rate a little bit um uh the dose we’ll give it some dosing here for adult your your common dose is either going to be 2.5 or 5 milligrams nebulized or two and a half 2.525 milligrams nebulized um for a pediatric uh anything as far as this medication goes 15

Kilograms or less is going to be two and a half milligrams nebulous 2.5 milligrams nebulized it’s usually supplied in uh little vials 2.5 milligrams in three mils of the little vials you’ll just twist the top off and squirt those into the nebulizer reservoir which we’re going to get into in just a second so always as part of your five rights that we’ve already

Gone over of medication administration you’re always going to want to check the medication the expiration date and the concentration of the vials before we administer them to any patient so your common nebulizer is going to come in a few parts okay first you’re going to see in the packaging you’re going to see oxygen tubing of course one end is going to go to

Your oxygen supply whether it be a portable o2 tank or your onboard oxygen tank uh on your ambulance okay you’re gonna get a reservoir okay comes like this has a few pieces to it pay attention to how it’s set up okay this is where your fluid your medication the albuterol is going to get squirted into okay it’s gonna come with a t-piece adapter as well as a

Mouthpiece okay so we’re going to be using these later when we break off into small groups and run some scenarios okay so what you’re going to do you’re going to get your reservoir open it up make sure this piece is pointing up and you will simply open up the vial and squirt it into the reservoir okay and it’s gonna fill up it won’t fill it up all the way it’s

Gonna be down here at the bottom okay you’re gonna take the top make sure it’s screwed all the way on i’ve seen these pop off pretty easy okay take your t-piece adapter you can only fit on one way make sure it’s secure on there your mouthpiece is going to go in the wider of the two ends this one’s narrower this one’s wider okay lastly after you have your oxygen

Hooked up to your onboard or your portable o2 you’re gonna see a little nipple at the bottom side of this right here you’ll connect your o2 tubing to the bottom of that okay so when you turn on your o2 you should start to hear this start to nebulize at about six liters per minute you’ll start to hear kind of crack and pop and you’ll see a mist obviously coming

Out of the mouthpiece and the uh the expiratory valve here or the excretory opening here so that’s about the time i usually six liters a minute get it start popping and cracking crank it up in another liter or two okay and you’re going to want to instruct your patient to breathe in through this and open up their lungs and try to get this steam and this mist this

Nebulization medic this nebulized medication down into the bottom of their lungs that’s where it’s going to have the most effect okay so that’s a nebulizer all assembled you’ll see it start to condensate and be wet around here when it stops popping and cracking you know you’ve finished your medication you can also just keep an eye on it and that’s how we know

It’s getting to the end so any questions

Transcribed from video
Albuterol Video By Steven Belanger