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RCEMS Protocols 9/24 > Reactive Airway - Adult > Flashcards

Reactive Airway - Adult Flashcards

1
Q

What medication is indicated with wheezing?

A

Duoneb: 2.5mg/3ml nebulized. May repeat 5 times PRN.

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2
Q

What is the dosage for a duoneb?

A

2.5mg/3mL

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3
Q

How many times can you repeat a duoneb?

A

5 times, PRN

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4
Q

What medication is indicated with stridor in reactive airway issues?

A

Epinephrine: Nebulized 2mg of 1:1,000 diluted in 3ml NS. May repeat once.

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5
Q

What is the dosage for nebulized Epi?

A

2mg of 1:1,000 diluted in 3ml NS

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6
Q

How many times can you repeat dose nebulized Epi?

A

May repeat once.

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7
Q

Which concentration of Epi is used for nebulizer?

A

1:1 / 1:1,000

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8
Q

What medication can be given after a Duoneb?

A

Solu-Medrol: 125mg IM/IV/IOP over 3min

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9
Q

What is the dosage for Solu-Medrol?

A

125mg IM/IV/IOP over 3min

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10
Q

What kind of medication is Solu-Medrol?

A

Inhibits cell-mediated immunologic functions, especially those dependent on lymphocytes

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11
Q

How does Solu-Medrol work?

A

Decreases inflammation in bronchial tubes.

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12
Q

What does Solu-Medrol NOT affect?

A

Air sacs in lungs.

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13
Q

What is the onset time of Solu-Medrol?

A

Within 1 hour

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14
Q

Why is Solu-Medrol pushed SLOWLY?

A

It can cause cardiac arrhythmias and arrest if pushed too rapidly.

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15
Q

Over how long is Solu-Medrol pushed?

A

3 mins

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16
Q

What is the other name for Solu-medrol?

A

Methylprednisolone

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17
Q

What drugs are in a Duoneb?

A

Albuterol and ipratropium bromide.

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18
Q

What are common side effects of a Duoneb?

A

Tachycardia, jitters, coughing

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19
Q

What kind of medication is a Duoneb?

A

Bronchodilator

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20
Q

What is the time onset of a Duoneb?

A

Within minutes.

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21
Q

What other drugs commonly negatively interact with a Duoneb?

A

Beta-Blockers

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22
Q

What is a medication that can be given after Solu-Medrol administration?

A

Magnesium Sulfate: 2g in 100mL IV infusion over 10min

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23
Q

What is the dosage for Mag in reactive airway issues

A

2g in 100mL IV infusion over 10min

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24
Q

Over how long should Mag for reactive airway issues be given?

A

10min

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25
Q

When is Mag indicated for a reactive airway issue?

A

When first-line treatments are not responsive. Duoneb (bronchodilator) and Solu-Medrol (cortico-steroid) has already been given.

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26
Q

What is the mechanism of action for Magnesium Sulfate?

A

Physiological blood coagulation mediator that aids in releasing histamine and acetylcholine. Acts as a bronchodilator.

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27
Q

What patient should NOT receive Mag?

A

Heart-block patients - Mag can make the conduction even slower. Any patient with heart damage, persistent HTN, and/or hypocalcemia.

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28
Q

Is asthma a ventilation or respiration issue?

A

Ventilation

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29
Q

What are some common medications a patient might take for asthma?

A

Albuterol, Symbicort (inhaled steroid), oral steroids, Omalizumab, Methylxanthines, salmeterol, formoterol, and vilanterol., terbutaline/Brethine.

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30
Q

What class of medication is Alubterol?

A

Beta-2 agonist

31
Q

What class of medication is Solu-Medrol?

A

Corticosteroid

32
Q

What are some common COPD medications?

A

Fluticasone (flovent), Beclometasone, Budesonide, ipatropium, albuterol, Doxycycline (rescue)

33
Q

What medication can be given after Epi if stridor is present?

A

Magnesium sulfate: 2g in 100ml IV infusion over 10min.

34
Q

If LIFE THREATENING airway issues are present, what medication is IMMEDIATELY adnimistered?

A

Epinephrine (1:1,000): 0.3 - 0.5mg IM ever 5-15min PRN

35
Q

What is the dosage of IM Epi?

A

Epinephrine (1:1,000): 0.3 - 0.5mg IM every 5-15min PRN

36
Q

How often can IM Epi be administered?

A

Every 5-15min PRN

37
Q

When should CPAP be considered?

A
  1. Signs of respiratory failure or fatigue
  2. Pulse oximetry below 88% that doesn’t improve with standard therapy
  3. ETCO2 above 50mmHg
  4. Accessory muscle use or retractions
  5. Respiratory rate above 25
  6. Wheezing, rales, or rhonchi
38
Q

When should CPAP NOT be considered or is considered contraindicated?

A

AMS, failure to follow directions, failure to control own airway, respiratory arrest, obstruction, hypotension, airway or facial trauma, recent facial/esophageal/gastric surgery, barotrauma, N/V, suspected pneumothorax.
CAUTION with emphysema patients!

39
Q

What could you consider to calm CPAP patients if verbal comfort does not work?

A

Chemical sedation

40
Q

What medications can be used to sedate a CPAP patient?

A

Ketamine: 0.5mg/kg IV/IO
or
Versed: 2mg IV IO (if hypertensive)

41
Q

When should you use Versed to sedate a CPAP patient instead of Ketamine?

A

If patient is hypertensive.

42
Q

Can I get a refusal on a patient I gave airway medication to? Even if just a diagnosed asthmatic and a duoneb was given?

A

No refusal may be obtained in any patient receiving medication for respiratory distress.

43
Q

What tool should be sued in addition to SPO2 monitoring?

A

ETCO2 / waveform capnography

44
Q

If CPAP at 5cmH20 is ineffective to assist WOB, what can be done?

A

Ventilation assistance with BVM attached to PEEP valve.

45
Q

When can CPAP be considered for CHF or pulmonary edema?

A

If WOB is effective

46
Q

What setting should be used for starting CPAP?

A

5cmH20, titrate to effect

47
Q

What medication can be given to a CHF/pulmonary edema patient that has rales and/or wheezing?

A

DuoNeb: 2.5mg/3ml nebulized. May repeat 5 times PRN.

48
Q

If CHF/pulmonary edema patient is unresponsive to DuoNeb treatment and starts to present with stridor, what medication can be given?

A

Epinephrine (1:1,000): 0.3 - 0.5mg IM every 5-15min PRN

49
Q

What medication can be given to a CHF/pulmonary edema patient as first line treatment?

A

Nitroglycerin

50
Q

What forms of nitro can be given to a CHF/pulmonary edema patient?

A

NTG paste: 1-1.5 inch on left chest (additional dose of 0.5-1 inch can be placed on right side)

or

NTG infusion: 60mcg/min IV with rapid titration to relief of symptoms (max dose 200mcg/min)

51
Q

If NTG is used for a CHF/pulmonary edema patient, what vital sign is imperative to maintain?

A

SBP over 90mmHG

52
Q

If a CHF/pulmonary edema patient is being administered NTG and becomes hypotensive, what should be done?

A

Immediate reduction of NTG dose.

53
Q

What is the max dose of a NTG infusion?

A

200mcg/min

54
Q

What is the min dose of a NTG infusion?

A

60mcg/min

55
Q

What class of medication is NTG?

A

Vasodilator

56
Q

What are the contraindications of administering NTG?

A

ED / vasodilator medications (Viagra, Cialis, Levitra, Stendra, Staxyn, sildenafil, avanafil, tadalafil or vardenafil) in the last 24hrs, hypotension

CAUTION: Women are also rx’d these meds

57
Q

What is a sign to look for on ETCO2/waveform capnography for bronchoconstriction?

A

Shark fin

58
Q

Can breath sounds be diminished or absent during an asthma attack?

A

Yes - these patients need IMMEDIATE intervention.

59
Q

What is a normal ETCO2?

A

35-45mmHG

60
Q

Other than shark fins, what is another sign of reactive airway issues on waveform capnography?

A

Air trapping

61
Q

What is hypoxia considered in reactive airway issues?

A

A late finding. Pulse oximetry provides no indication of how hard the patient is working to breathe or if ventilation is effective.

62
Q

What is another name for Ipatropium bromide?

A

Atrovent

63
Q

What kind of medication is Atrovent?

A

Mucolytic, anticholinergic bronchodilator

64
Q

How can hypotension be treated in a CHF/pulmonary edema patient if HypoTN stems from a cardiac origin?

A

Epinephrine (1:1,000): 2mg/250mL NS (8mcg/ml), given at 2-10mcg/min
Titrate at 1mcg/min at 2min intervals

or

///CRITICAL CARE ONLY///
Phenylephrine: 10mg in 100ml (100mcg/ml), given at 50-200mcg every 2-5min IVP

65
Q

What can a critical care medic given for hypotension in a CHF/pulmonary edema patient?

A

///CRITICAL CARE ONLY///
Phenylephrine: 10mg in 100ml (100mcg/ml), given at 50-200mcg every 2-5min IVP

66
Q

What can a medic given to a hypotensive CHF/pulmonary edema patient if they are NOT a critical care medic?

A

Epinephrine (1:1,000): 2mg/250mL NS (8mcg/ml), given at 2-10mcg/min
Titrate at 1mcg/min at 2min intervals

67
Q

For critical care medics, what is the dosage of phenylephrine for a hypotensive CHF/pulmonary edema patient?

A

10mg in 100ml (100mcg/ml), given at 50-200mcg every 2-5min IVP

68
Q

For non-critical care medics, what is the dosage of Epinephrine 1:1,000 for a hypotensive CHF/pulmonary edema patient?

A

2mg/250mL NS (8mcg/ml), given at 2-10mcg/min
Titrate at 1mcg/min at 2min intervals

69
Q

For critical care medics, is phenylephrine a push dose or slowly given for a hypotensive CHF/pulmonary edema patient??

A

IVP, push dose pressor

70
Q

For non-critical care medics, how is Epinephrine 1:1,000 titrated for a hypotensive CHF/pulmonary edema patient?

A

Titrate at 1mcg/min at 2min intervals

71
Q

In what positioning should patients with CHF/pulmonary edema be placed?

A

High fowlers or head elevated to 45 degrees.

72
Q

If a patient has taken a medication ending in -il within the last 24 hours, should they receive NTG?

A

No

73
Q

What PEEP should be considered for an intubated CHF/pulmonary edema patient?

A

5-15cmH20

RCEMS Protocols 9/24 (17 decks)

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