Category Archives: Bronchoconstriction

Question in regards to the IM epi in 'less than 50 year old patients with Severe Respiratory distress, bronchoconstriction, and a history of asthma without other contributing cardiorespiratory comorbidities' Does this mean if the patients is less than 50 year old with Severe SOB and signs of bronchoconstriction and a history of asthma but also has a history of COPD or CHF, then we do not consider IM EPI?

I have two questions with regards to the Bronchoconstriction Medical Directive, under the current (February 22nd, 2021) Considerations for Paramedics Managing Patients during the COVID-19 Pandemic. 1) Are we still only administering IM epinephrine to patients who require BVM ventilations? 2) Are we only administering IM epinephrine under this medical directive to patients presenting with a cough? It was previously stated in the January 4th, 2021 update that: "Paramedics should consider administering IM epinephrine for severe respiratory distress with cough in known asthma patients..." I understand that the top of the new memo states: " This memo replaces both the May 6th, 2020 and the January 4th, 2021 considerations documents and memos." Just looking for some clarification on the current practice please. Thank you.

With the new bronchoconstriction update, saying you can’t give Epi to pt’s unless they’re <50, does this apply only to the covid guidelines where you can administer it up to 2x if conditions met (asthma, cough, severe respiratory distress) or does the age now apply to the normal bronchoconstriction directive for Epi where you can give up to 0.5mg once too?

Why was an age restriction of 50 years of age placed on utilizing IM epinephrine for the Bronchoconstrictive Medical Directive in the latest update to the COVID-19 Management considerations?

Question: Was just reviewing the SWORBHP document that came out yesterday, just hoping for a little clarification RE bronchoconstriction. In the document it states that we should consider IM administration of Epinephrine for severe respiratory distress w/ cough, hx. asthma. It also states that we should consider using MDI salbutamol only for severe respiratory distress without a cough... My understanding of it would be that we want to keep a surgical mask on the pt. to minimize risk of droplet transmission via cough which you can’t do while administering medication via MDI. I understand that if the pt. Has a cough we should use epinephrine as our first line medication same as we normally would if the pt. Is apneic but Are we to be considering these two separate cases for use of these medications and not giving them concurrently during this pandemic? Just wondering as I did not see it specify whether or not we should considering withholding ventolin if there is a cough.

Question: Who can receive IM epi under the new COVID-19 considerations?

Seeking clarification for salbutamol administration down ETT based on the Ask MAC posted April 3rd regarding ETT administration: Are we still able to use our MDI-adapter wherein the MDI canister is inserted and left in, creating a closed-system circuit?

With regards to considerations for Bronchoconstriction it says that with severe resp distress and a cough (with or without need for BVM) that we can consider IM epi “as per the bronchoconstriction medical directive”. Does that mean they still need to have a hx of asthma?

Does wheezing have to be present in the patient assessment to administer Ventolin?

Question: Case - Adult patient experiencing an asthma attack. Wheezing in all fields (air entry in all fields) and tachypnea. Historically, we've been taught to administer Epi in cases of 'silent chest', absent air entry in any fields or patient requiring BVM ventilation. The BVM ventilation has always been associated with diminished air entry/silent chest, but not really with hyperventilation. The old BLS stated to assist with BVM ventilation in any patient with a RR>28. Does this mean that if the patient has RR>28, therefore requiring BVM ventilation, he/she SHOULD receive Epi even if there is air entry (albeit wheezing) in all fields?

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