ASTHMA

Adult Medical Protocol 2.2.2

ASTHMA / BRONCHOSPASM

• This protocol is used for patients who are complaining of

dyspnea and who are wheezing.

• Whenever possible, allow these patients to assume

whatever position is comfortable (they may not tolerate

laying flat).

• A patient with a history of CHF that has wheezing on

auscultation of lung sounds should not be automatically

classified as an “asthma patient.”

• If the CHF patient does not have a history of asthma or

allergic reaction, the more prudent assessment would be

that of CHF (cardiac asthma) (See CHF/Pulmonary

Edema protocol 2.2.4)

Procedure:

BASIC LEVEL: EMT and PARAMEDIC

• Initial Patient Assessment Protocol 2.1.1

• Airway Assessment/Management Protocol 2.1.2

• If severe distress CPAP may or may not help (keep in

mind, it is the medications that will work best to break the

bronchospasm)

• Attach cardiac monitor and pulse oximeter.

• Transport to designated hospital.

ALS LEVEL 1: PARAMEDIC ONLY

• Administer Albuterol (Ventolin) 2.5mg (in 3 cc normal

saline) by nebulizer. May repeat twice PRN. DO NOT

GIVE ALBUTEROL OR IPRATROPIUM BROMIDE IF

THE HEART RATE IS > 140

• May add Ipratropium Bromide (Atrovent) 0.5 mg

(0.5ml) to the first Albuterol neb only.

ALS LEVEL 1: (con’t)

• If indicated, start IV of Lactated Ringer’s or Normal

Saline at TKO.

• For persistent respiratory distress, give

Methylprednisolone Sodium Succinate (Solu-Medrol)

125mg IV. (NOTE: If patient already on a steroid, give 80

mg of Solu-Medrol IV).

ALS LEVEL 1: (con’t)

• For severe dyspnea, Epinephrine (1:1000) 0.4 ml

subcutaneous Adult (Peds: 0.01 ml/kg.) Caution should

be used with administration of Epinephrine when the

patient has a history of hypertension or heart disease

(call med control if you have any concerns).

• Consider need for

endotracheal intubation.

ALS LEVEL 2: MEDICAL CONTROL

• Repeat Epinephrine (1:1000) 0.4 mg SubQ

• If patient still has dyspnea after:

- SubQ Epi

- 3 Albuterol nebs (first with Atrovent)

- and Solu-Medrol

• Med control may order

Magnesium Sulfate 2 gms IV

(mixed with 50ml of D5W given

over 10 – 15 minutes)

Contact medical control

or medical director for

any questions or

problems.