Adult Bronchospasm

Question 1

Adult Bronchospasm - Condition not improved past initial management and pt has COPD?

Answer 1

Consider CPAP
500 ml bolus
Magnesium sulphate 2 g IV in 50 ml over 10 min

Question 2

Adult Bronchospasm - Condition not improved past initial management and pt does not have COPD?

Answer 2

500 ml bolus

Magnesium sulphate 2 g IV in 50 ml over 10 min

Question 3

Adult Bronchospasm - Condition not improved after magnesium sulphate?

Answer 3

Epi 0.3 mg IM q 20 to max of 0.9 mg

Question 4

Adult Bronchospasm - Condition not improved after IM Epi?

Answer 4

BVM or advanced airway with MDI Salbutamol and Ipratropium bromide

Question 5

Adult Bronchospasm - CPAP indications?

Answer 5

> 15 years
CHF
COPD
RR > 25/min
SpO2 < 94%

Question 6

Adult Bronchospasm - CPAP contraindications?

Answer 6

BP < 100 mmHg
Vomiting
Possible pneumothorax
Unable to maintain airway

Question 7

Adult Bronchospasm - Fluid administration in acute bronchospasm?

Answer 7

500 mL IV/IO bolus followed by a 250 mL/hr maintenance drip

Question 8

Adult Bronchospasm - salbutamol dose?

Answer 8

1 puff MDI with spacer 30-60 seconds prn to a maximum of 30 puffs
5 mg neb continuously

Question 9

Adult Bronchospasm - salbutamol contraindications?

Answer 9

Hypersensitivity

Tachydysrhythmias

Question 10

Adult Bronchospasm - salbutamol MDI + spacer administration?

Answer 10

Prime canister 3 times
1 puff into spacer
5 breaths by patient

Question 11

Adult Bronchospasm - ipratropium bromide dose?

Answer 11

1 puff MDI with spacer 30-60 seconds total max of 15 puffs MDI
500 mcg nebulized q 5 minutes 1500 mcg

Question 12

Adult Bronchospasm - ipratropium bromide contraindications?

Answer 12

Hypersensitivity

Question 13

Adult Bronchospasm - ipratropium bromide MDI + spacer administration?

Answer 13

Prime canister 3 times
1 puff into spacer
5 breaths by patient

Question 14

Adult Bronchospasm - epiNEPHrine (1mg/mL) indications?

Answer 14

Bronchospasm with impending respiratory failure

Question 15

Adult Bronchospasm - epiNEPHrine (1mg/mL) dose?

Answer 15

0.3 mg IM q 20 min total max of 0.9 mg

Question 16

Adult Bronchospasm - epiNEPHrine (1mg/mL) contraindications?

Answer 16

None when used in emergency situations
Hypersensitivity
Underlying cardiovascular disease

Question 17

Adult Bronchospasm - epiNEPHrine (1mg/mL) precautions?

Answer 17

Administer IM injections in the lateral quad

All patients receiving epiNEPHrine must be cardiac-monitored

Question 18

Adult Bronchospasm - predniSONE dose?

Answer 18

50 mg PO

Question 19

Adult Bronchospasm - predniSONE contraindications?

Answer 19

Patients with severe shortness of breath
Difficulty swallowing
Patients already taking prednisone
Patients with pneumonia and any symptoms of SIRS

Question 20

Adult Bronchospasm - predniSONE onset?

Answer 20

2 – 4 hours

Question 21

Adult Bronchospasm - dexamethasone dose?

Answer 21

10 mg IM/SIVP/IO/PO

Question 22

Adult Bronchospasm - dexamethasone contraindications?

Answer 22

Systemic fungal infections
Hypersensitivity to dexamethasone or other steroids
Hypersensitivity to benzyl alcohol or sodium sulfite
Patients with pneumonia and any symptoms of SIRS

Question 23

Adult Bronchospasm - dexamethasone onset?

Answer 23

2 – 4 hours

Question 24

Adult Bronchospasm - magnesium sulfate indications?

Answer 24

Severe bronchospasm refractory to nebulized medications

Question 25

Adult Bronchospasm - magnesium sulfate dose?

Answer 25

2 g IV/IO in 50 mL NS over 10 min

Question 26

Adult Bronchospasm - magnesium sulfate contraindications?

Answer 26

Any degree of heart block

Renal failure