MDIs and IM Epi

Question 1

Prior to the first “puff”, an MDI should be primed ________ times

Answer 1

3 or 4

Question 2

when should you shake an MDI?

Answer 2

prior to every puff

Question 3

Describe procedures that maximize delivery of MDI medications to the lung mucosa

Answer 3

• Prime MDI prior to first administration
• Shake MDI prior to each puff
• Encourage patient to exhale fully prior to administration
• Encourage patient to inhale slowly while administering MDI and hold breath for 5-10 seconds afterwards
• Encourage patient to exhale through nose
• Wait 30 seconds between puffs to allow for repressurization
• Use an aerochamber if available

Question 4

Currently, when should nebulized medications be used?

Answer 4

never!

Question 5

Describe adult dosing of MDI ventolin

Answer 5

• 4x100 mcg “puffs” = 1 dose
• Doses given PRN at 3-5 minute intervals until symptoms resolve or adverse effects are noted
• No maximum dose

Question 6

List signs of salbutamol toxicity that would prompt discontinuation of administration:

Answer 6

H.R. > 150 (>200 in pediatric patients) or if severe tremor or ventricular dysrhythmias develop

adverse affects may incnlude:

• Restlessness, apprehension, fear, weakness, vertigo
• Nausea and vomiting
• Tachycardia, dysrhythmias
• Paradoxical worsening of respiratory distress, pulmonary edema
• Sweating, pallor, flushing

Question 7

Describe ideal BVM setup when using an MDI through the medication port

Answer 7

• Filter moved to exhaust port (not in between BVM and mask as this will block the medication)
• MDI canister in place in medication port, administered during rescuer ventilation
• Ideally a SGA (i-Gel) in place. Otherwise fastidious attention to a tight mask seal
• PEEP valve may not be combined with filter in this configuration and should be discontinued if in place