4. MEDICAL EMERGENCIES
4.4 BRONCHOSPASM
Bronchospasm is defined as spasmodic narrowing (contraction) of the lumen (bronchial muscle) of a bronchus for whatever reason resulting in restricted airflow. This results in hypoventilation of the alveoli leading to hypoxemia. The causes of acute bronchospasm may not always be easily discernible. Asthma is the most common disorder to present with bronchospasm. However, there are many other conditions that may present with bronchospasm. Other causes include: allergic reaction, respiratory infection, changes in environmental conditions (humidity or temperature), inhalation of caustic gases (smoke, chlorine gas etc.), emotional stress, exercise, and medications (aspirin or similar non-steroidal anti-inflammatory agents). Patients may present with mild to severe distress and management is based upon severity.
ASSESSMENT / TREATMENT PRIORITIES
1. Maintain universal blood and body fluid precautions.
2. Maintain open airway and assist ventilation as needed.
3. Administer high concentration of oxygen by non-rebreather mask.
4. Determine patient's hemodynamic stability and symptoms. Continually assess Level of Consciousness, ABCs and vital signs.
5. Obtain appropriate history related to event, including Past Medical History (prior asthma, anaphylaxis, allergies), Medications, Drug Allergies and Substance Abuse. NOTE: exposures to foreign body, foods, medicines, chemicals or envenomation.
6. Determine if patient is in mild or severe distress:
a. Mild Distress: Slight wheezing and/or mild cough. Able to move air without difficulty.
b. Severe Distress: Evidenced by poor air movement, speech dyspnea, use of accessory muscles, tachypnea and tachycardia.
NOTE: Severe bronchospasms may present without wheezes indicating minimal air movement.
TREATMENT
BASIC PROCEDURES
1. Maintain universal blood and body fluid precautions.
2. Maintain an open airway. This may include repositioning of the airway, suctioning or use of airway adjuncts (oropharyngeal airway / nasopharyngeal airway) as indicated. Assist ventilations as needed.
3. Administer high concentration of oxygen by non-rebreather mask. (humidified O2 is acceptable)
4. Encourage and/or assist patient to self administer their own prescribed inhaler medication if indicated or if not already done.
5. Activate ALS intercept, if deemed necessary and if available.
6. Initiate transport as soon as possible with or without ALS.
7. Notify receiving hospital.
INTERMEDIATE PROCEDURES
1. Maintain universal blood and body fluid precautions.
2. Maintain an open airway. This may include repositioning of the airway, suctioning or use of airway adjuncts (oropharyngeal airway / nasopharyngeal airway) as indicated. Assist ventilations as needed.
3. Administer high concentration of oxygen by non-rebreather mask. (humidified O2 is acceptable)
4. Encourage and/or assist patient to self administer their own prescribed inhaler medication if indicated or if not already done.
5. Activate Paramedic intercept, if deemed necessary and if available.
6. ALS STANDING ORDERS
a. Provide advanced airway management if indicated.
b. Consider IV Normal Saline (while enroute) if in severe distress.
7. Initiate Transport as soon as possible with or with out Paramedics.
8. Notify receiving hospital / Medical Control.
PARAMEDIC PROCEDURES
1. Maintain universal blood and body fluid precautions.
2. Maintain an open airway. This may include repositioning of the airway, suctioning or use of airway adjuncts (oropharyngeal airway / nasopharyngeal airway) as indicated. Assist ventilations as needed.
3. Administer high concentration of oxygen by non-rebreather mask. (humidified O2 is acceptable)
4. Cardiac monitoring / dysrhythmia recognition
5. ALS STANDING ORDERS
a. Mild Distress:
- Administer Albuterol 0.5% 0.5 ml mixed with 3 ml of Normal Saline via nebulizer.
b. Severe Distress:
- Advanced Airway management if indicated.
- Administer Albuterol 0.5% 0.5 ml mixed with 3 ml of Normal Saline via nebulizer. Additional Albuterol treatments may be administered as necessary.
- Initiate Saline lock or IV Normal Saline if indicated.
6. Initiate transport as soon as possible.
7. Contact MEDICAL CONTROL. The following may be ordered:
a. Repeat Albuterol Sulfate 0.5% nebulizer treatment.
b. Atrovent Inhalation Aerosol (2 puffs) via metered dose inhaler with or without spacer device (e.g. - aerochamber).
c. Atrovent 0.02% nebulizer treatment (may be combined with Albuterol 0.5% treatment)
d. Epinephrine 1:1,000 0.3 mg-0.5 mg subcutaneously*. (may be repeated q 15 min.)
e. Epinephrine 1:10,000 0.1 mg-0.5 mg IV push*
f. For patients with known cardiac disease: Terbutaline Sulfate 0.25 mg subcutaneous (SC). A second dose may be required.
8. Notify receiving hospital.
*CAUTION: The use of Epinephrine in patients over the age of 40 and patients who have already taken high dosage of inhalant bronchodilator medications may result in cardiac complications.
MoonDragon's EMS Index Page
HELPFUL PRODUCTS & FURTHER EDUCATION
-- by Phyllis A. Balch, James F. Balch - 2nd Edition
-- by Phyllis A. Balch, James F. Balch - 4th Edition
-- by Phyllis A. Balch
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