Respiratory Pharmacology
This is the dosage for diphenhydramine (Benadryl)
50mg PO
or
1mg/kg IM/SIVP/IO to a single max dose of 50mg
This is the first action you should take in the presence of an allergic reaction IF POSSIBLE.
Discontinue exposure to potential allergen (ie. remove stinger)
This high-pitched, musical lung sound heard primarily on expiration is commonly associated with bronchospasm in asthma or COPD.
What is wheezing?
These are the indicators of mild/moderate Bronchospasm. (Name 2/4)
- Expiratory with/without inspiratory wheezes
- Speaking in full or partial sentences
- SOB at rest, tachypnea less than 40/min
- Normal mentation
This is the basic tool/direction to use for a patient with a partial obstruction who is able to speak or cry.
What is "encourage coughing?"
These are all of the medications that can be provided by a PCP in the presence of an allergic reaction/anaphylaxis. (Name all 4)
What are Epinephrine, diphenhydramine, normal saline, and oxygen
This is the name for the intense swelling or the mouth, face, tongue, and lips that can occur in an allergic reaction
What is Angioedema?
This inspiratory high-pitched sound heard over the upper airway suggests obstruction and may require immediate airway management, including advanced airway readiness.
What is stridor?
These medications can all be given concurrently with a patient presenting with critical, life-threatening bronchospasm
What are: all of the medications within the protocol?
This type of obstruction is defined as: poor air exchange, cyanosis, stridor, and a weak or silent cough
What is a patrial or Complete obstruction (conscious)?
These are the maximum dosages for our inhaled bronchospasm medications, both MDI and Nebulized
What are:
Salbutamol (MDI and Neb) - continuous as needed
Ipratropium - MDI 15 puffs, Neb 1500mcg
This other protocol would typically be followed concurrently with the anaphylaxis protocol? (based on patient presentation)
Bronchospasm
These fine, crackling sounds at the bases of the lungs are often heard in patients with congestive heart failure and may indicate pulmonary edema requiring considerations such as CPAP or nitrates (ACP).
What are crackles (rales)?
These are the indicators of 'severe/near-death' bronchospasm (name 3/4)
- Distant wheezing or silent chest
- Single word responses or mute
- Tachypnea greater than 40.min; labored or fatigued respiratory effort to apnea
- Confused or unresponsive
On a unconscious choking victim, we will perform this for 2 minutes while continuing to clear the airway, attempting to ventilate, and setting up our airway management equipment.
What are chest compressions?
These are the contraindications for epinephrine in an emergent situation.
There are no contraindications for Epi in an emergency situation.
This is the criteria that needs to be met by a patient to be considered in anaphylaxis.
Acute onset of illness with skin or mucosal signs and symptoms AND 1 of the following:
- Sudden respiratory signs and symptoms
- Sudden systolic BP less than 90mmHg or signs of end-organ dysfunction/poor perfusion
OR
Likely or known exposure for that patient with 2 or more of the following:
- sudden skin or mucosal s/s
- persistent GI symptoms
- Sudden respiratory signs and symptoms
- Sudden systolic BP <90mmHg/ signs of poor perfusion
This absence or significant reduction of breath sounds on one side, combined with respiratory distress and hypotension, raises concern for a life-threatening condition requiring possible needle decompression.
What is a tension pneuomothorax? (relates to absent lung sounds)
Name 2 of the 4 treatments that an ACP can provide to a bronchospasm patient.
CPAP @ 5cm H2O
Prednisone 50mg OR dexamenthasone 10mg
Magnesium sulfate 2g IV/IO
Epinephrine 0.3mg IM
ACPs are only to attempt this technique a single time to clear the airway obstruction.
What is an intubation attempt (to push the obstruction into the mainstem bronchus)?
This medication is provided by ACPs in the presence of bronchospasm. It's main purpose is to assist with smooth muscle relaxation within the lungs.
What is magnesium sulfate?
After providing the maximum dose of epinephrine IM, OLMC would need to be contacted to provide what medication?
This harsh, low-pitched lung sound that may improve after coughing is often caused by secretions in larger airways and may indicate the need for suctioning or airway clearance.
What are rhonchi?
When perfoming any AGMP (aerosol generating medical procedures), what MUST all practitioners participating in the the procedure be doing/wearing?
(Name 3/5)
- Perform hand hygiene
- Wear a gown
- Wear safety glasses or face shield
- Wear an N95 respirator
- Wear gloves
This procedure is a 'last ditch effort' and borderline surgical skill that an ACP will use when an obstruction cannot be cleared.
What is a Cricothyrotomy