Asthma/COPD/RAD - Adult
Asthma/COPD/RAD - Adult
A group of lung diseases causing difficulty breathing and obstructing airflow leading to a decrease in oxygen saturation
EMT Standing Orders
- Routine Patient Care
- Place the patient in a position of comfort. May prefer sitting up.
- Administer oxygen as appropriate with a target of achieving 94 - 98% saturation (88 - 92% in COPD); increase the oxygen rate with caution and observe for fatigue, decreased mentation, and respiratory failure. Consider:
- Albuterol metered-doseinhaler (MDI ) 2-4puffs assist patient medication if available. May repeat every 5 minutes for continued symptoms.
- Call for AEMT/Paramedic intercept. & Assisst AEMT/Paramedic in patient care..
AEMT/Paramedic Standing Order:
- Albuterol 2.5 mg via nebulizer. May repeat every 5 minutes for continued symptoms.
- Ipratropiumbromide 0.5mg and albuterol 2.5mg (DuoNeb) via nebulizer. May repeat every 5 minutes for continued symptoms (maximum 3 doses);
- For patients who do not respond to treatments, or for impending respiratory failure, continue nebulizers and consider CPAP up to a maximum of 10 – 15 cm H2O pressure support.
- For patients who do not respond to treatments, or for impending respiratory failure, consider epinephrine 0.3 mg IM (preferred) OR epinephrine (1:1,000) (1 mg/mL) 0.3 mg (0.3 mL) IM. Contact Medical Direction for additional doses.
- Consider IV access.
- Consider steroid: Methylprednisolone125mgIV/IO/IM OR Dexamethasone 10 mg IV/IO/IM/PO
- Magnesiumsulfate 2g in 50mL D5W or0.9%NaClIV/IO over 10minutes.
CAUTION:
- Caution is advised in the administration of beta-agonists to patients with coronary artery disease. Obtain and transmit ECG if possible. Contact Medical Direction for medication orders if in doubt.
PEARLS:
- IVs should only be placed when there are clinical concerns of dehydration, in order to administer fluids, or when administering IV medications.
- Beware of patients with a “silent chest” (absence of breath sounds) as this may indicate severe reactive airway disease (RAD) with bronchospasm and impending respiratory failure.
- Remember that not all wheezing is caused by asthma and that not all asthmatics wheeze.
- Patients with congestive heart failure may present with lung sounds that mimic asthma (cardiac wheeze)