Reactive Airway Disease

 

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
  • 12-Lead EKG
  • Initiate IV

 

Moderate: ?

 

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

 

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 Epinephrine 1:1,000 0.3 mg IM
  • Consider Terbutaline (Breathine) 0.25 mg SQ q 20 mins, Max 0.5 mg

 

PEARLS:

 

  • Treatment should escalate or decrease with patient presentation.
  • Terbutaline (Breathine) should be administered SQ to the lateral Deltoid area.
  • Methylprednisolone (Solumedrol) is for COPD, asthma and anaphylaxis only!
  • Magnesium Sulfate is administered by putting 2 grams/4 mL in a 50 mL bag with a 10 gtt set at 50 drops per minute.
  • 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.
  • All efforts at verbal coaching should be utilized prior to conscious sedation.
  • For Conscious Sedation, see Sedation/Anxiety protocol. Dose should be titrated to provide comfort without causing unconsciousness or respiratory failure. Be sure to monitor patient's breathing/ventilations, blood pressure and O2 saturation.
  • Combivent (DuoNeb) is packaged as 3.5 MG.