Protocol Status: PUBLISHED
Protocol:
Version: 2026.01
Effective Date:
Last Reviewed:
Medical Director Approval:
Clinical Note: This content reflects current GCEMS clinical guidelines as of the dates listed above. If content appears inconsistent with current policy, use the most recent approved guideline and notify leadership for correction.

Reactive Airway Disease (BLS Only)

 

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

 

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

 

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.