Respiratory

3-8-a. Bronchospasm

Respiratory distress with wheezing, not involving a foreign body.

1) Administer oxygen by mask

2) If in severe respiratory distress, give 0.01 mg/kg Epinephrine IM (use the 1 mg/1 ml form = 1:1,000): give the dose IM up to 0.3 mg maximum especially if the patient is very poorly or not inhaling the nebulized medication

3) Administer 1st inhalation updraft aerosol treatment with Albuterol 2.5 mg via nebulizer. If initially in severe bronchospasm or impending respiratory arrest, increase the dose in 1st updraft treatment to Albuterol 5 mg (2 vials), plus Ipratroprium dosed by age:

a) ½ vial / 0.25 mg for age < 6, and

b) 1 vial / 0.5 mg for age > 6 added to nebulizer

4) If not improving, do a 2nd inhalation updraft treatment with Albuterol 5 mg plus Atrovent 0.5 mg via nebulizer

5) If still not improving, consider Mag Sulfate IV dose 50 mg /kg (maximum 2 g dose) given slowly for one dose

6) If patient with severe bronchospasm requires intubation and is very hard to ventilate because of severe bronchospasm, consider use of ET Epinephrine using the dilute, 0.1 mg/ml form, (old labeling = 1:10,000) with the dose 0.1 ml/kg = 0.01 mg/kg syringe-misted/atomized down the endotracheal tube to reduce the bronchospasm

7) After intubation the patient’s lungs may remain “tight”/stiff, so you should use special BVM or ventilator settings for safety:

a) Use a slow rate of 8 per minute AND

b) Use a low tidal volume of 6 cc per Kg

8) Use the end-tidal (EtCO2) monitor

3-8 Respiratory P-3-8-b. Respiratory Arrest or Inadequate Airway Where a Pulse Exists:

1) Open airway and administer oxygen by BVM ventilation

2) If unable to ventilate with BVM consider Endotracheal intubation

3) If unable to intubate, continue assisted mask ventilations with very careful technique

4) Establish IV with Normal Saline at TKO rate