Acute Asthma or COPD with Wheezing

Section 3 - RESPIRATORY

3.01 ACUTE ASTHMA / COPD WITH WHEEZING

INITIAL MEDICAL CARE (2.01) Obtain history of patient's current respiratory medications and time of last dosage.

DO NOT DELAY TRANSPORT WAITING FOR RESPONSE OF TREATMENT.

If bronchospasm worsens despite treatment, respiratory failure is imminent, or patient exhibits with an altered mental status, perform endotracheal intubation and ventilate with OXYGEN @ 100% via BVM.

Age GREATER than 13 years:

• Assist ventilations with BVM, 100% OXYGEN or Apply CPAP device as indicated.
• ALBUTEROL (PROVENTIL) 2.5 mg via updraft or CPAP device. After second updraft of ALBUTEROL, consider IPRATROPIUM BROMIDE (ATROVENT) .5 mg via updraft. ATROVENT is not for use in CHF or Cardiac Asthma. Repeat as necessary while monitoring heart rate.
• If the Pt has had multiple updrafts or had previously used their own Albuterol inhaler or nebulized treatment and have not had relief. Consider XOPENEX (LEVALBUTEROL) 1.25mg nebulized via updraft.
• Administer METHYLPREDNISOLONE (SOLU-MEDROL) 125 mg IVP once the breathing treatment has been initiated.
• If no response to the above, consider KETAMINE (KETALAR) 2 mg/kg IVP OR 4 mg/kg IM x 1 dose
• For deteriorating patients (if no renal disease or CHF is not suspected)
  • Administer MAGNESIUM SULFATE 2 gm IV in 100 ml NaCl via buretrol or secondary IV solution (piggyback), over 10-15 minutes.

If condition unimproved or patient exhibits acute hypoxia EPINEPHRINE may be administered: 1:1000 1mg/ml 0.3 - 0.5 mg IM.

Age LESS than 13 years: SLOW ONSET

• ALBUTEROL (PROVENTIL) refer to Handtevy System.
  • May administer second dosage if dyspnea unimproved.
• If patient exhibits acute dyspnea, as evidenced by AMS, administer EPINEPHRINE 1:1000 1mg/ml refer to Handtevy System
• If the patient is not responding to the above interventions, administer METHYLPREDNISOLONE (SOLU-MEDROL), refer to Handtevy System.

Age LESS than 13 years: RAPID ONSET

• In patients with rapid onset respiratory compromise due to asthma or bronchospasm, ALBUTEROL (PROVENTIL) refer to Handtevy System simultaneous with IM EPINEPHRINE 1:1000 (1mg/ml) every 10-15 minutes, refer to Handtevy System.
• If the Pt has had multiple updrafts or had previously used their own Albuterol inhaler or nebulized treatment and have not had relief. Consider XOPENEX (LEVALBUTEROL) nebulized via updraft refer to Handtevy System.
• Monitor heart rate. Continue therapy with heart rates <180-200 ages up to 6 years, <150-180 ages 6-18 years. Updrafts may need to be continuous.
• If the patient is not responding to the above interventions, administer METHYLPREDNISOLONE (SOLU-MEDROL), refer to Handtevy System.
• In the event of impending respiratory arrest and imminent death, EPINEPHRINE may be administered IV or IM. (Dose for IV same as in cardiac arrest patient)