Bronchoconstriction Medical Directive

Question 1

Bronchoconstriction

What are the indications for the bronchoconstriction MD?

Answer 1

Respiratory distress;
AND
Suspected bronchoconstriction.

Question 2

Bronchoconstriction

What are the conditions for salbutamol administration?

Answer 2

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

Question 3

Bronchoconstriction

What are the conditions for epi administration?

Answer 3

RR: BVM ventilation required
Other: Hx of asthma

Question 4

Bronchoconstriction

What are the indications for dexamethasone administration?

Answer 4

Other: Hx of asthma OR
COPD OR
20 pack-year history of
smoking

Question 5

Bronchoconstriction

What are the contraindications to salbutamol administration?

Answer 5

Allergy or sensitivity to salbutamol.

Question 6

Bronchoconstriction

What are the contraindications to epinephrine administration?

Answer 6

Allergy or sensitivity to EPINEPHrine.

Question 7

Bronchoconstriction

What are the contraindications to dexamethasone administration?

Answer 7

• Allergy or sensitivity to steroids
• Currently on PO or parenteral steroids

Question 8

Bronchoconstriction

What is the dose of salbutamol for patients who are <25kg?

Answer 8

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

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

Question 9

Bronchoconstriction

What is the dose of salbutamol for patients who are ≥25kg?

Answer 9

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

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

Question 10

Bronchoconstriction

How many mcg are there in 1 puff of salbutamol?

Answer 10

100mcg

Question 11

Bronchoconstriction

What is the dosing info for epinephrine?

Answer 11

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 12

Bronchoconstriction

What is the dose for dexamethasone administration?

Answer 12

Route: PO/IM/IV
Dose: 0.5mg/kg
Max. single dose: 8mg
Dosing interval: N/A
Max. # of doses: 1

Question 13

Bronchoconstriction

What are the clinical considerations of the bronchoconstriction MD?

Answer 13

• 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 of 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.