Category Archives: Bronchoconstriction

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?

Question: In the Bronchoconstriction Medical Directive, would a patient ever receive salbutamol followed by epinephrine? Is epi there in case that the patient does not respond to salbutamol and instead gets worse after salbutamol administration? If the patient does not require epi at first, but instead is given salbutamol, then gets worse requiring epi, could that epi administration follow with salbutamol again?

Question: I have a question about the benefits between using MDI vs. nebulized ventolin. I understand the direction is to use MDI as the preferred route. It certainly makes sense with anybody who is infectious but seems counterintuitive when you could be administering drug with oxygen at the same time as with the case of nebulization. There is also a perceived psychological benefit when patients can feel and see the mist. I have heard about studies that were done at Sick Kids to support MDI use. I was unable to locate them. Is there any other evidence you can suggest as to why MDI is the preferred route? Thank you so much for your time.

Question: Some years ago during a recert in the fall a question was posed regarding administering a nebulized treatment of ventolin to a patient who otherwise would not tolerate an MDI but also had a fever above 38C (all other conditions met). The question was answered by stating if all attempts fail for use of the MDI, a nebulized treatment could be administered if all droplet precautions were taken (N95 worn, gown worn closed window to cab area, goes without saying truck disinfected). Is this in fact the case? (Updated)

Question: Would it be a waste of a paramedic’s time to deliver Salbutamol through a BVM to an unconscious patient while setting up for Epi in the case of an Asthma or anaphylaxis? Would the OPA if used, not block the mist and prevent inhalation? To me, Epi administration (scenario dependent) would be the priority. Thanks

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