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
  • Fever/cough
  • Tachycardia
  • Barreled chest
  • Clubbed fingers
  • Chronic signs of hypoxia

 

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.)

 

Assessment:

 

  • Assess symptom severity; allow patient to maintain a position of comfort (usually sitting).

 

Treatment:

 

 

 

  • Oxygen and O2 sat

 

 

 

 

 

 

  • 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

 

 

 

 

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

 

 

 

 

 

 

 

PEARLS:

 

  • 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.
  • Do not administer Combivent (DuoNeb) if patient is allergic to soybeans or peanuts.
  • All efforts at verbal coaching should be utilized prior to conscious sedation.

 

    • Midazolam (Versed) 1-2 mg slow IV push.
    • Lorazepam (Ativan) 1-2 mg slow IV push if hypotensive.
    • Benzodiazepines may precipitated respiratory depression or worsen compliance with CPAP patients who are already tired.

 

NREMR

National Registry Emergency Medical Responder

NRAEMT

National Registry Advance Emergency Technician

NREMT

National Registry Emergency Medical Technician

NREMT-I

National Registry EMT-Intermediate

NRP

National Registry Paramedic

NRP

National Registry Paramedic

NRAEMT

National Registry Advance Emergency Technician