History:

 

• Asthma/COPD
  • Chronic bronchitis
  • Emphysema
  • CHF
• Home Treatment
  • Oxygen
  • Nebulizer
• Medications
  • Theophylline
  • Steroids
  • Inhalers
• Toxic exposure/smoke

 

Significant Findings:

 

• Shortness of breath
• Absence of lung sounds
• Pursed lip breathing
• Decreased ability to speak
• Increased respiratory rate and effort
• Wheezing/rhonchi
• Use of accessory muscles
• Tachycardia
• Barreled chest
• Chronic signs of hypoxia
• waveform capnography indicative of constriction

 

Differential:

 

• Asthma
• Anaphylaxis
• Aspiration
• COPD (emphysema/bronchitis)
• Pleural effusion
• Pneumonia
• Pulmonary embolus
• Pneumothorax
• Cardiac (MI or CHF)
• Pericardial tamponade
• Hyperventilation
• Inhaled toxin (carbon monoxide/etc.)

 

Treatment:

 

• Oxygen and O2 sat

• Combivent (DuoNeb) 3.5 mg OR Albuterol (Ventolin) 5.0 mg via nebulizer ; Contact Medical Control to repeat Albuterol

• 12-Lead EKG

• Initiate IV

 

Mild: ?

 

• Speak in full sentences
• RR <30
• O2 sat >94 on room air
• Wheezing
• Minimal accessory muscle use

 

Notify receiving facility or contact Medical Control

 

Moderate: ?

 

• Speak in short sentences
• RR 30 - 40
• O2 sat: 91-94 on room air
• Diminished lung sounds
• Normal mental status
• Accessory muscle use

 

• Consider CPAP at 5 cm/H20; monitor closely for signs of barotrauma
• DO NOT increase pressure

 

REQUEST ALS

 

Life threatening/severe exacerbation:?

 

• 1-2 word sentences
• RR >40 or <10
• O2 sat <91% on room air
• Little or no lung sounds
• Accessory muscle use with tripod position
• Diaphoretic and anxious
• High EtCO2

 

• Consider CPAP at 5 cm/H2O
• DO NOT increase pressure

• Consider Epinephrine 1:1,000 0.3 mg IM

 

REQUEST ALS

 

PEARLS:

 

• Treatment should escalate or decrease with patient presentation.

• Pulse oximetry should be monitored continuously if initial saturation is less than or equal to 96%, or there is a decline in patient status despite normal pulse oximetry readings

• Contact (Medical Control) prior to administering Epinephrine in patients who are greater than 50 years of age, have a history of cardiac disease, hypertension, or if the patient's heart rate is greater than 150. Epinephrine may precipitate cardiac ischemia.
• A silent chest is respiratory distress is a pre-respiratory arrest signs.
• EtCO2 should be used when respiratory distress is significant and does not respond to initial beta-agonist dose.
• Combivent (DuoNeb) is packaged as 3.5 mg.