SWORBHP Ask MAC

Answer:

Although prehospital CPAP has a proven mortality benefit in some disease processes, the COVID-19 pandemic represents an extenuating circumstance in which the usual care of the ALS-PCS is not clinically justified, possible or prudent.  As such, the provincial Medical Advisory Committee has provided considerations for care to protect yourselves and the public to help limit spread of the virus.  The OBHG MAC continues to monitor the current situation and treatment considerations, including the use of CPAP that balances provider and public safety with patient benefit. We will be sure to let you know when it is decided, provincially, to lift some of these procedural restrictions, including the use of CPAP.

You are correct (and highlighted in the most recent,4^th iteration of the Considerations for Paramedics Managing Patients During the COVID-19 pandemic) that oxygen flow rates using a Non-Rebreather Mask (NRB) <16L/min are not considered an AGMP (here). 

Answer:

With regards to epinephrine route of administration in croup: nebulized epinephrine works in croup to alleviate the laryngeal edema, by local effect. If given systemically (IM) it may alleviate the edema, similar to anaphylaxis. However, the IM injection can cause the child distress which can worsen their edema and tip them into apnea/arrest. In this situation, you should patch to the BHP for direction, as any treatment now falls outside your Medical Directives.

If the child is in extremis (apneic, silent chest) prepare for impending cardiac arrest. You may even consider asking for IM epinephrine should the child arrest (PCP scope of practice, ACPs should follow their Medical Cardiac Arrest Medical Directive).
Make sure to consider other potential causes of stridor, including foreign body aspiration, in which case the treatment is removal of the foreign body, and anaphylaxis, wherein IM epinephrine is indicated in pre-arrest and during arrest.