SUBJECT: Administration of continuous nebulized albuterol.

PURPOSE: To deliver high dose albuterol to patients with status asthmaticus in the Emergency Department or Intensive Care Unit.

1. There must be a written order.

2.Unless otherwise specified in the order: Dosage = 0.5 mg/kg/hr to a maximum dose of 15mg per hour.

3. Unless otherwise specified in the order: Titrate F_IO₂ to keep S_pO₂ > 92%.

4. Order expires after 4 hours of continuous albuterol nebulization. May be reordered by physician.

1) Place "Heart" nebulizer in holder and attach aerosol tubing with aerosol mask.

2) Attach connecting tubing from nebulizer to flow meter.

3) Add albuterol and normal saline to nebulizer cup.

4) Set oxygen blender at desired FIO2 and run flow to nebulizer at 10 LPM.

5) Monitor oximetry and ECG continuously.

6) Assess breath sounds, heart rate, and amount of remaining medication Q2 and prn.

7) Potentially affected laboratory values (such as potassium) will be monitored as ordered by physician.

1) "Heart" large volume nebulizer (Westmed, Inc.)

2) Oxygen connecting tubing

3) Aerosol tubing

4) Aerosol Mask

5) Oxygen blender with flowmeter

6) Medication (albuterol) and diluent (normal saline)

7) Continuous oximeter

0.5 x patient weight in kg = mg albuterol per hour.

Multiply the mg albuterol per hour by 0.2 (if the albuterol is 5mg/ml)* to get the ml albuterol per hour.

----------USE NO MORE THAN 15mg (3ml*) ALBUTEROL PER HOUR----------

Multiply ml albuterol per hour by the number of hours (4) to get the amount of albuterol to use.

Multiply number of hours (4) by the # ml the neb delivers per hour (30)** to get the liquid amount.

Subtract the amount of albuterol from the liquid amount to get the amount of normal saline to add.

* If the albuterol used is 5mg/ml, then 1 mg albuterol = 0.2 ml before dilution with normal saline (1/5=0.2).

** At 10 LPM the "HEART" nebulizer delivers 30ml per hour (120 ml in 4 hours).