Bronchoconstriction Medical Directive

Question 1

Bronchoconstriction Medical Directive

Answer 1

A Primary Care Paramedic may provide the treatment prescribed in this Medical Directive if authorized.

Question 2

Indications

Answer 2

Respiratory distress:
AND
Suspected bronchoconstriction.

Question 3

Conditions - Salbutamol

Answer 3

Age: N/A
LOA: N/A
HR: N/A
RR: N/A
SBP: N/A
Other: N/A

Question 4

Conditions - Epinephrine

Answer 4

Age: N/A
Weight: N/A
LOA: N/A
HR: N/A
RR: BVM ventilation required
SBP: N/A
Other: Hx of asthma

Question 5

Contraindications - Salbutamol

Answer 5

Allergy or sensitivity to salbutamol

Question 6

Contraindications - Epinephrine

Answer 6

Allergy or sensitivity to epinephrine

Question 7

Treatment

Answer 7

• Consider salbutamol

- Consider epinephrine

Question 8

Consider salbutamol

Answer 8

Weight <25 kg
Route: MDI*
Dose: Up to 600 mcg (6 puffs)
Max. single dose: 600 mcg
Dosing interval: 5-15 min PRN
Max. # of doses: 3 

Weight <25 kg
Route: NEB
Dose: 2.5 mg
Max. single dose: 2.5 mg
Dosing interval: 5-15 min PRN
Max. # of doses: 3

Weight ≥25 kg
Route: MDI*
Dose: Up to 800 mcg (8 puffs)
Max. single dose: 800 mcg
Dosing interval: 5-15 min PRN
Max. # of doses: 3

Weight ≥25 kg
Route: NEB
Dose: 5 mg
Max. single dose: 5 mg
Dosing interval: 5-15 min PRN
Max. # of doses: 3

*1 puff = 100mcg.

Question 9

Consider epinephrine

Answer 9

Route: IM
Concentration: 1 mg/mL = 1:1,000
Dose: 0.01 mg/kg*
Max. single dose: 0.5 mg
Dosing interval: N/A
Max. # of doses: 1
*The epinephrine dose may be rounded to the nearest 0.05 mg.

Question 10

Clinical considerations

Answer 10

Epinephrine should be the 1st medication administered if the patient is apneic. Salbutamol MDI may be administered subsequently using a BVM MDI adapter.
Nebulization is contraindicated in patients with a known or suspected fever or in the setting or a declared febrile respiratory illness outbreak by the local medical officer of health.
When administering salbutamol MDI, the rate of administration should be 100 mcg approximately every 4 breaths.
A spacer should be used when administering salbutamol MDI.