- Chronic bronchitis
- Toxic exposure/smoke
- Shortness of breath
- Absence of lung sounds
- Pursed lip breathing
- Decreased ability to speak
- Increased respiratory rate and effort
- Use of accessory muscles
- Barreled chest
- Chronic signs of hypoxia
- waveform capnography indicative of constriction
- COPD (emphysema/bronchitis)
- Pleural effusion
- Pulmonary embolus
- Cardiac (MI or CHF)
- Pericardial tamponade
- Inhaled toxin (carbon monoxide/etc.)
- 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
- 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.