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Respiratory Distress Protocols
Im looking for ideas and experiences with the use of medications and interventions used with the treatment of bronchospasms. How many of you are including Mag Sulfate in your protocols for treating dyspnea and what point to do you begin this therapy. Is Capnometry being used and in your treatment plans? Our current protocol uses DuoNeb treatments (up to 3) and administration of Solumedrol. Please feel free to share your ideas on any other medications and or procedures on this common problem.
Replies to This Discussion
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Permalink Reply by Trevor on -
Our reactive airway protocol enables us to give A/A nebs, Epi IM solumedrol and Mag. We do have ETCO2 on our LP 12s as well... the Mag is usually reserved for people in status
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Permalink Reply by Jeremy Welshans on -
DuoNeb or albuterol SVN
SoluMedrol
Epi
Mag
I have personnaly used Mag for asthma several times with excellent results. In one case IV epi did not do the fix, but once the mag was pushed saw immediate results
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Permalink Reply by Jasen Adam on -
Albuterol
Brethine
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Permalink Reply by Tracey Baker on -
bronchospasms:
The old OXYGEN and CAPNOGRAPHY..12 lead: a beautiful tool and a huge fan I am!..Often forgotten!
Albuterol.
Albuterol and Atrovent.
Repeat Albuterol and Atrovrent
EPI: SQ: 1:10000
Solumedrol: ALWAYS to inhibit secondary reaction.
Mag sulfate if justified...Must get MD APPROVAL
Glucagon does assist Bronchospasms, though few areas use for such...
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Permalink Reply by Brian Wiegand on -
Albuterol
Atrovent
Epi. sq
Brethine sq
Solumederol
"Consider" Mag.
Been using capno. for about 5 years now. Never realized what a great tool it was.
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Permalink Reply by Matthew RJ Siko on -
Our Medical Director is a big advocate of Mag and uses it often as well as encourages us to use it when appropriate. I am here to tell you that Mag Sulfate works and is a good option. I have used it many times and have had nothing but success with it. Typically I will use 1-2g in a mini drip with a macro.
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Permalink Reply by Jasen Adam on
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I have been begging for our region to take a look our resp protocol and keep getting shut down. From what I am reading we are waaaaaaaaaay behind in times as usual. Maybe after reading all the options on here I'll try to bring it back up again.
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Permalink Reply by Brian Wiegand on
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You will probably be getting a new medical director. Isn't his group out 12/29?
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Permalink Reply by Jasen Adam on
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Yeah Ellis is gone and we don't know who we are getting yet. I hope it is someone who gives a damn about EMS and flight teams also.
I know they are suppose to be done sometime at the end of the month.
It looks as though the EmCare Physicians site has links to these
http://www.airaasi.com/
http://www.amr.net/
http://www.gmr.net/
I don't know if it is a professional association or not.
Sorry for the hijack of the forum
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Permalink Reply by Brian Wiegand on
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Don't know anything about them. I wonder where they are from. AMR? Haven't seen them around here. The air ambulance link is for fixed wing only. Won't affect us. We don't have our Indiana fixed wing yet.
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Permalink Reply by Tracey Baker on
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Jasen said:I have been begging for our region to take a look our resp protocol and keep getting shut down. From what I am reading we are waaaaaaaaaay behind in times as usual. Maybe after reading all the options on here I'll try to bring it back up again.
What is your protocal Jasen? Where?
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Permalink Reply by Cory T. Spankowski, NREMT-P, LP on -
Bronchospasm...absolutely a scary episode for the pt, especially the pt in respiratory failure (on hands and knees, breathing like a fish out of water). A good respiratory assessment is paramount in every situation, as there can be different etiologies.
Let's look at bronchospasm secondary from "true" restrictive airway disease and bronchospasm secondary to cardiac etiologies (aka "cardiac asthma"). If the clinician treats the respiratory patient who is dyspneic secondary to cardiac asthma "blindly" w/Beta agonists (Albuterol, Atrovent), Terbutaline, and Sub-Q/IM Epi (NO!!!!), that could very well be the demise of that patient. Cardiac asthma must be treated w/Lasix, MSO4, etc. I've been fooled by that once, and like to share this info, as this occurs more often than we tend to believe.
"True" restrictive airway disease can be treated with the usual tools, Albuterol, Atrovent (usually one time dose), Terbutaline, SQ Epi. Secondary treatments can include Solumedrol, and yes...MgSO4. MgSO4 does have good smooth muscle relaxing properties, which makes it a good intervention for bronchospasm. Most SOPs require that MD approval be obtained prior to use, so be sure to read through yours! Remember...Albuterol loses its Beta-1 effects and gains Beta-2 effects after around 3 doses, so be sure to monitor your patient with subsequent Albuterol dosing.
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