1. June 22, 2011 Washtenaw/Livingston MCA

5.  Albuterol – 3 unit doses  Aspirin – 4 baby chewable tabs  Hand held nebulizer  Use replacement form  Red seal tag

15.  Aspirin (ASA)  Ischemic chest pain  Ischemic Chest Pain Typical Characteristics  Chest Pain  Pressure, heaviness, squeezing, tight or fullness, may not be described as pain (elephant sitting on my chest)  May be in chest, jaw or arm (left most commonly)  May radiate into jaw or arm  Ischemic chest pain may presents atypically – sharp or burning  Usually not worsened with touch, deep breathing or movement

16.  Ischemic Chest Pain Typical Characteristics  Associated symptoms, not always present  Shortness of breath  Nausea and/or vomiting  Sweating, clamminess or diaphoresis  Age – typically 25 or greater though not always  Duration – usually lasts minutes to hours, constant, usually not days, usually not seconds or fleeting  Sometimes exertional, many times not exertional  Family history of cardiac disease often present  Smoking, diabetes, hypertension and high cholesterol are risk factors, not necessarily present

17.  Patient’s chest pain may be ischemic  Patient is not allergic to aspirin  Patient has not taken full dose of Aspirin (ASA) since the chest pain started or the dose was not within the last 24 hours. Full dose is one adult ASA (325 mg) or 4 – 81 mg baby chewable ASA (324 mg total).  If they took less than the full dose after the pain started (e.g. 1 baby chewable), give full dose ASA

18.  Patient on Coumadin (Warfarin) blood thinner may take ASA for ischemic chest pain. They may tell you they can’t because of the blood thinner, but reassure them that for this one dose it is OK and ASA should be given

19.  Patient is not alert or not able to protect the airway  Patient is allergic to ASA  Patient has taken full dose ASA at a time after the chest pain started, or within the last 24 hours.

20.  Remove 4 baby ASA from packaging in BLS Medication Kit  Have the patient chew and swallow the ASA.  May have small amount of water to wash down if requested.

21.  Alternative – Assist the patient in taking their own ASA  Check expiration date and dose if assisting the patient in taking their own ASA

23.  Although not in the BLS Medication Kit, the EMT may assist the patient in administration of their own Nitroglycerin sublingual tabs (check expiration date) provided the patient’s systolic BP is above 120 mmHg  Repeat doses, up to 3 doses, may be given every 3 to 5 minutes, if chest pain persists and the BP remains above 120 mmHg

24.  Albuterol is a beta-2 specific bronchodilator  Best primary bronchodilator  Effects lower airways  Not effective for upper airway constriction/swelling as is present in Croup  Side effects – may make patient jittery or anxious, should not dramatically affect heart rate. No heart rate restrictions on albuterol administration.

25.  Patient with respiratory distress and wheezing  Pre-existing bronchospastic disease  May have history of asthma, COPD (chronic obstructive pulmonary disease) or emphysema  Often a current or former smoker  Disease may be exacerbated by cold, flu or allergen exposure  Anaphylaxis (severe allergic reaction) with wheezing  Congestive heart failure (CHF) or pulmonary edema with wheezing

26.  Dosing  Albuterol 2.5 mg in 3 mL NS via Hand Held Nebulizer (HHN)  Unit doses in BLS Medication Kit is Albuterol 2.5 mg in 3 mL NS premixed and ready to administer  Same dose for adult and pediatric patients  Administered via HHN with oxygen 6 – 10 L flow rate  Administration is complete when HHN no longer has fluid in it or is no longer producing mist  Repeat doses may be given immediately, if wheezing is still present after completion of the first Albuterol treatment. Repeat as indicated.

27.  Adult or pediatric patient with respiratory distress and wheezing  Patient can hold Hand Held Nebulizer (HHN) in mouth  Alternative treatments that are indicated have already been given (e.g. Epi-Pen for anaphylaxis)  In pediatric patients who can’t hold the HHN in their mouth, the mouth piece can be obstructed and the mist administered by pointing the blue mist reservoir toward the patient’s mouth and nose. (Blow-by)

28.  Patient is not wheezing (e.g. only rhonchi or rales)  Patient allergic to albuterol (very rare)  Patient can’t tolerate use of HHN, in these cases support ventilation

29.  Assemble two halves of HHN  Remove top of Albuterol unit dose  Pour Albuterol into nebulizer  Complete assembly of HHN without pouring out the Albuterol from the nebulizer  Attach to oxygen source 6 – 10 L or until mist is produced by HHN  Have patient breath normally through HHN

35.  Administration is complete when HHN no longer has fluid in it or is no longer producing mist  Repeat doses may be given immediately, if wheezing is still present after completion of the first Albuterol treatment. Repeat as indicated.

38.  These protocols provide the basis for the EMT to give Albuterol for any adult indication where wheezing is present  The following State Protocols for Pulmonary Edema CHF and Anaphylaxis/Allergic Reaction provide the guidance for when to give the Albuterol  Even though these protocols list Albuterol as a paramedic skill, if in the judgment of the EMT, wheezing is present, based on the Nebulizer Procedure & Respiratory Distress/Wheezing protocol, Albuterol may be given by the EMT at the indicated points in the protocols

43.  Once a kit is used, complete the BLS Medication Kit Replacement Form  Place the completed form in the kit until exchanged at the hospital  Seal the kit with the Red Seal Tag  Exchange the kit with a fresh kit at your agency station  Kits must be kept in a locked container before and after use  Agency personnel must call their designated hospital during regular business hours to arrange for exchange of used or expiring kits  Review - BLS MEDICATION BOX CONTENTS AND EXCHANGE PROCEDURE