SQ Terbutaline in Asthma?

[Turk II]

Does anyone work for a service that uses terbutaline in asthma cases refractory to albuterol and other nebulized medications? Personally I don't know much about the indications or side effects... the service I work for uses Albuterol, SQ Epi, and Mag Sulfate for severe asthma cases but the ED we transport to usually substitutes terbutaline for the Epi.

Turk

[shfd739fm]

Ive heard it used for that but we dont.We have albuterol,epi then mag if you can get a dr to order it.If Im that far doen my list Im usually at the er or really close to it.Supposed to be getting solumedrol also in the near future though.

[medic pathetic]

we carry Albuterol, Atrovent, Solu Medrol, epi and Mag sulfate. I've never seen the mag used before. Generally we have short transport times, and usually we give a breathing treatment or epi in the house, and solu medrol en route.

[kjrff23]

We have terbutaline in RI. Usually used in the pt.s you wouldn't want to hit with the epi, i.e. over 70 or heart hx. We can use it after the epi as well.

[paragoon]

The service I now work for uses terbutaline (aka brethine) It's in our protocol as well as albuterol, atrovent, sub-Q epi and mag sulfate, and solu-medrol. But we usually don't use it because of the side effects (i.e. chest pain, increased HR.) especially after we give epi. We can use it in O.B. pt.s for contractions.

[RichmondMedik]

I know Terbutaline is in the drug boxes in Mass.

Here in Richmond we use basically the same as others -- Albuterol / Atrovent - PO Prednisone - Mag - Sub Q epi and in that order -- we push a lot of Mag here and have had great results

[brandon911]

We carry albuterol, atrovent, epi, mag and RSI for the really severe ones. I do know a few services in my area that carry terbutaline and the feedback I've gotten is very positive. I have never used the mag for asthma and if I felt I needed too, I would tell my partner to drive faster. :icon_santa:

[croaker260]

We have albuterol, atrovent, solu-medrol, mag, and in worst case SQ epi for oh sh*t situations, all on standing order (no call in). RSI is of course an option. We dont carry Ketamine for asthmatic RSI though.

I used Terb (Brethine) once at a P-T gig many moons ago, cant say it worked any different than the epi I have used. I have been told that it is prefered in the elderly over SQ Epi, but have not seen any comparitive studies to back up this claim.

[CornholioMedic]

Until we get the new regional boxes all we get in Detroit is Albootyrall. 5mg max cause all we have is 5mg. Well...SQ Epi too....and Mag. Like any one here ever uses it. At least not in recent years.

[kjrff23]

Not to get too off topic but from what I've read, Mag Sulphate is supposed to stop an asthma attack cold if you give the right dose, for some reason 400mg IV sticks in my head. Eventually we will probably be using that when they figure out how to raise the price of it.

[CornholioMedic]

Yeah, I can't remember right off myself...I used to know but I forgot...Freaking Alzheimers! But, it sounds about right.

[croaker260]

Not to get too off topic but from what I've read, Mag Sulphate is supposed to stop an asthma attack cold if you give the right dose, for some reason 400mg IV sticks in my head. Eventually we will probably be using that when they figure out how to raise the price of it.

Our dose is 1-2 GM over 1-2 minutes, IVP.

[musicemt]

Don't know of any services that use brethine around here, but I also live smack dab in the middle of COPD valley. I never really understood why my EMT book talked so much about asthma and so little about COPD, until I realized that outside of KY, not everybody has COPD. Also, howdy croaker, welcome to the site.

[Turk II]

Our dose is 1-2 GM over 1-2 minutes, IVP.

Our protocols call for Mag Sulfate in a drip... 2 GM mixed in 50cc bag of NS with a 60gtt set wide open. Although I suppose that's about the same as 1-2 minute IVP.

[strwblue]

Musicemt...technically asthma is a type of Cronic obstructive Pulmonary Disease. So I guess it depends on how you think about it.

[croaker260]

Don't know of any services that use brethine around here, but I also live smack dab in the middle of COPD valley. I never really understood why my EMT book talked so much about asthma and so little about COPD, until I realized that outside of KY, not everybody has COPD. Also, howdy croaker, welcome to the site.



Tennessee is that way too. Same for CHF (lots of diabetes, HTN, heart conditions).


I grew up in Lexington, and many years ago new peopel from LCEMS....many moons ago anyway.

Thanks for the welcome.

[FF/EMTP1317]

I've never heard of mag sulfate for asthma. In Maryland we have albuterol/atrovent neb and then if pt has cardiac Hx or is over 45 we use terbutaline. The pt has to be really severe for us to be allowed to give epi. I have used Terbutaline several times and it works pretty good.

[damnblindmedic]

Its in my asthma/copd protocol for severe cases but we need to call first for the order.

double albuterol first

call for the order

then .25mg SQ terbutaline
2gm mag IV
125mg IV solu-medrol

[MedicMike]

I can give 3 albuterols, then I can only give Epi/Brethine SQ w/ Med Control approval...

[NightShiftMedic]

I LOVE terbutaline for asthma/COPD patients. Our protocol is as follows:

2.5 mg Albuterol/.5mg Atrovent Neb, may give another Albuterol only neb

.3 mg Epi 1:1000 SC q5 min up to 3 doses prn

OR

.25 mg Terbutaline Sulfate SC

Medical consultation required only for additional doses of the above meds.

We're supposed to use the Terbuatline in patients over 45 years or with cardiac conditions. I find that it works at least as well as Epi if not better.