Pulmonology

Question 1

Albuterol

Answer 1

For: Bronchospasm (COPD and asthma)

Adult dose: 2.5mg via nebulizer over 10-15min

Ped dose: 2.5mg via nebulizer diluted in 6mL

Contraindications: Tachycardia, digitalis dysrhythmias

Notes: Synergistic with sympathomimetics. Antagonized by beta-blockers

Question 2

Ipratropium bromide

Answer 2

For: Bronchospasm (COPD and asthma)

Adult dose: 0.5mg via nebulizer

Ped dose: 250mcg via nebulizer

Contraindications: Hypersensitivity to atropine

Note: Usually given with albuterol

Question 3

Albuterol / Ipratropium

Answer 3

For: Bronchospasm (COPD and asthma)

Adult dose: 2.5mg / 0.5mg via nebulizer over 10-15min

Ped dose: From 1.25mg / 0.25mg to 2.5mg / 0.5mg via nebulizer

Contraindications: Tachycardia, digitalis dysrhythmias, hypersensitivity to atropine

Note: Synergistic with sympathomimetics. Antagonized by beta-blockers

Question 4

Epinephrine (pulmonary)

Answer 4

For: (1) Anaphylaxis and other severe, immediate hypersensitivity reactions, or (2) Severe bronchospasm, asthma, bronchiolitis

Adult dose (1): 0.3-0.5 mg IM of 1:1 (1mg/mL). If refractory, 0.06-0.2 mcg/kg/minute continuous IV/IO infusion of 1:10 (0.1mg/mL), titrated to response

Ped dose (1): 0.01 mg/kg IM of 1:1 (1mg/mL). If refractory, consider 0.1 mcg/kg/minute IV/IO of 1:10 (0.1mg/mL) titrated to response (max of 10mcg/minute)

Adult dose (2): 0.3-0.5 mg IM (eg. 0.3-0.5mL of 1:1)

Ped dose (2): 0.01 mg/kg IM (eg. 0.01mL/kg of 1:1), max of 0.5mg

Contraindications: Non-anaphylactic shock (particularly hypovolemic shock), coronary insufficiency, hypothermia, pulmonary edema, HTN

Question 5

Epi Autoinjectors

Answer 5

For: Anaphylaxis

Adult dose: 0.3mg IM

Ped dose: 0.15mg IM

Contraindications: Non-anaphylactic shock (particularly hypovolemic shock), coronary insufficiency, hypothermia, pulmonary edema, HTN

Question 6

Solu-Cortef

Answer 6

For: Asthma, croup, anaphylaxis, adrenal insufficiency

Adult dose: 2mg/kg IV bolus, maximum of 100mg

Ped dose: same

Contraindications: Hypersensitivity

Question 7

Solu-Medrol

Answer 7

For: Asthma, croup, anaphylaxis, adrenal insufficiency

Adult dose: 2mg/kg IV bolus, maximum of 125mg

Ped dose: same

Contraindications: Hypersensitivity

Question 8

Levalbuterol

Answer 8

For: Bronchospasm (COPD and asthma)

Adult dose: 2.5mg via nebulizer every 20min

Ped dose: 0.075mg/kg/dose via nebulizer every 20min

Contraindications: Hypersensitivity

Notes: Synergistic with sympathomimetics. Antagonized by beta-blockers

Question 9

Magnesium sulfate (pulmonary)

Answer 9

For: Severe bronchospastic disease

Adult dose: 2g IV, usually in 100ml NS, given over 20 minutes

Ped dose: 50 mg/kg/dose IV, usually mixed in 50-100mL NS, given over 20 minutes (maximum dose: 2g)

Contraindications: Heart blocks; Myocardial damage

Question 10

Racemic epinephrine

Answer 10

For: Laryngeal edema, croup, bronchial asthma

Adult dose: 11.25mg via nebulizer (typically 0.5mL solution diluted in 2.5mL NS)

Ped dose: same

Contraindications: HTN, epiglottitis, underlying cardiovascular disease

Note: Excess use may cause bronchospasm. Watch for rebound effect after drug wears off

Question 11

Dexamethasone (pulmonary)

Answer 11

For: Asthma, anaphylaxis

Adult dose: Considerable variability (medical control option) but often a 1mg/kg slow IV bolus

Ped dose: Considerable variability (medical control option) but often 0.25-1mg/kg/dose IV, IO, IM

Contraindications: Hypersensitivity

Question 12

Furosemide (Lasix)

Answer 12

For: CHF, pulmonary edema

Adult dose: 0.5-1mg/kg slow IV (medical control option)

Ped dose: 1mg/kg slow IV/IO (medical control option)

Contraindications: Hypovolemia, anuria, hepatic coma, severe hypotension

Note: Must be pushed SLOWLY to avoid ototoxicity