View source for Acute Asthma or COPD with Wheezing

==Section 3 - RESPIRATORY==
=== 3.01 ACUTE ASTHMA / COPD WITH WHEEZING===

[[Initial Medical Assessment and Care|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 [[Medical Gases|OXYGEN]] @ 100% via BVM.
:

====Age GREATER than 13 years:====
* Assist ventilations with BVM, 100% [[Medical Gases|OXYGEN]] or Apply CPAP device as indicated.
* [[Bronchodilators|ALBUTEROL (PROVENTIL)]] 2.5 mg via updraft or CPAP device. After second updraft of [[Bronchodilators|ALBUTEROL]], consider [[Bronchodilators|IPRATROPIUM BROMIDE (ATROVENT)]] .5 mg via updraft. [[Bronchodilators|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 [[Bronchodilators|XOPENEX (LEVALBUTEROL)]] 1.25mg nebulized via updraft.
* Administer [[Corticosteroids|METHYLPREDNISOLONE (SOLU-MEDROL)]] 125 mg IVP once the breathing treatment has been initiated.
* If no response to the above, consider [[Anesthetics|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 [[Electrolytes|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====
* [[Bronchodilators|ALBUTEROL (PROVENTIL)]] refer to Handtevy System.
** May administer second dosage if dyspnea unimproved.
* If patient exhibits acute dyspnea, as evidenced by AMS, administer [[Adrenergics|EPINEPHRINE 1:1000]] 1mg/ml refer to Handtevy System
* If the patient is not responding to the above interventions, administer [[Corticosteroids|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, [[Bronchodilators|ALBUTEROL (PROVENTIL)]] refer to Handtevy System simultaneous with IM [[Adrenergics|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 [[Bronchodilators|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 [[Corticosteroids|METHYLPREDNISOLONE (SOLU-MEDROL)]], refer to Handtevy System.
*'''In the event of impending respiratory arrest and imminent death, [[Adrenergics|EPINEPHRINE]] may be administered IV or IM. (Dose for IV same as in cardiac arrest patient)'''

[[Category:Respiratory]]