Microsoft word - ee-1 acute asthma copd with wheezing

 Adult Patient Assessment and Initial Medical Care protocol  Focus on history of patient’s current asthma/COPD meds, time, and amount of last dose.  Consider possibility of CHF/Pulmonary Edema. o If wheezing present in patient with history of COPD/Asthma  Treat per appropriate Cardiac/Pulmonary Edema SOP.  Asthma - Oxygen at 4-6L/nasal cannula.  COPD - Oxygen at 2-4L/nasal cannula. Patient with History of Asthma. Moderate to Severe Distress:  (BLS) Age > 12 years: Albuterol 2.5 mg in 2cc NS via nebulizer
o Medical Control order needed for albuterol administration to patients > 50 y/o or Patient with History of Asthma, Extreme/Severe Distress (absent/diminished breath sounds due to bronchoconstriction or patient is hypoxic and/or exhausted).  Assist ventilations with a BVM at 100% O2, and prepare to fully support ventilations Patient with History of COPD with Wheezing: Moderate to Severe Distress:  (BLS) Age > 12 years: Albuterol 2.5 mg in 2cc NS via nebulizer
 Medical Control order required to administer albuterol to patients that have history of o Albuterol can be given prior to Medical Control contact if patient receives albuterol Patient with History of COPD with Wheezing: Extreme/severe distress (absent/diminished breath sounds due to bronchoconstriction or patient is hypoxic and/or exhausted).  Assist ventilations with a BVM at 100% O2, and prepare to fully support ventilations  Adult Patient Assessment and Initial Medical Care protocol  Focus on history of patient’s current asthma/COPD meds, time, and amount of last dose.  Consider possibility of CHF/Pulmonary Edema. o If wheezing present in patient with history of COPD/Asthma  Treat per appropriate Cardiac/Pulmonary Edema SOP.  Asthma - Oxygen at 4-6L/nasal cannula.  COPD - Oxygen at 2-4L/nasal cannula. Patient with History of Asthma. Moderate to Severe Distress: o Do not delay treatment attempting an IV.  Continuously monitor ECG and pulse ox  Age > 12 years: Albuterol 2.5 mg in 2cc NS via nebulizer
o Medical Control order needed for albuterol administration to patients > 50 y/o or  If no response to Albuterol or severe distress: Epinephrine (1:1000) 0.3 mg IM/SQ.
Patient with History of Asthma, Extreme/Severe Distress (absent/diminished breath sounds due to bronchoconstriction or patient is hypoxic and/or exhausted).  If imminent respiratory arrest, prepare for endotracheal intubation  Consider in-line albuterol through ET tube. Patient with History of COPD with Wheezing: Moderate to Severe Distress: o Do not delay treatment attempting an IV.  Continuously monitor ECG and pulse ox  Age > 12 years: Albuterol 2.5 mg in 2cc NS via nebulizer
 Medical Control order required to administer albuterol to patients that have history of o Albuterol can be given prior to Medical Control contact if patient receives albuterol  If no response to Albuterol or severe distress: Epinephrine (1:1000) 0.3 mg SQ.
Patient with History of COPD with Wheezing: Extreme/severe distress (absent/diminished breath sounds due to bronchoconstriction or patient is hypoxic and/or exhausted).  If imminent respiratory arrest, prepare for endotracheal intubation.  Consider in-line albuterol through ET tube.  Epinephrine must be ordered by medical control before giving to a COPD patient with wheezing. Albuterol can be given prior to radio contact if the patient has own prescription and receiving it at home.  Do not delay transport waiting for a response to Albuterol or Epinephrine.  Albuterol may be administered via nebulizer/mouthpiece device, nebulizer/mask or in- line nebulization on intubated patients.  Supplemental oxygen may be administered via nasal canula in the patient using the nebulizer/mouthpiece device if the patient is exhibiting signs/symptoms of hypoxia.  CPAP is very effective in the treatment of CHF/Pulmonary Edema and should be applied  CPAP should not be initiated on patients with a systolic BP < 90mmHg. CPAP increases intrathoracic pressure and can decrease venous return to the heart (compromising the patient’s perfusion). Consult with Medical Control and use CPAP cautiously if the systolic blood pressure is between 90mmHg and 100mmHg for the same reason.

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