Respiratory

Question 1

1. What is the Rx for Mild/Moderate Asthma?

Answer 1

Salbutamol pMDI + spacer - 4-12 doses at 20min intervals, pt to take 4 breaths for each dose
(if pMDI not available can nebulise 5mg at 20min intervals)

Question 2

2. What is the Rx for Severe Asthma?

Answer 2

• Salbutamol 10mg (5mL) and IB 500mcg (2mL) nebulised - repeat salbutamol 5mg at 5min intervals
• Dexamethasone 8mg IV/Oral

Question 3

3. What is the Rx for inadequate response to treatment for severe asthma?

Answer 3

No response to nebulised therapy, speaking single words/acute life threat - Adrenaline 500mcg IM, repeat at 5-10mins (max 1.5mg)
- No response to IM Adrenaline, consult for IV if thunderstorm asthma 20mcg at 2min intervals.

Question 4

4. What is the Rx for Unconscious asthma, with poor or no ventilation but still CO?

Answer 4

Requires immediate assisted ventilation

• Ventilate at 6-7mL/kg @ 5-8vents/min
• Moderately high respiratory pressures
• Allow for prolonged respiratory phase

Question 5

5. What is the Rx unconscious asthma that loses CO?

Answer 5

Apnoea 1min and prep for resus

Question 6

6. When should COPD be suspected?

Answer 6

Any pt over 40 who has:

1. Smoking Hx
2. Dyspnoea that is progressive, persistent and worse with exercise
3. Chronic cough
4. Chronic sputum production
5. Fam Hx of COPD

Question 7

7. How is exacerbation of COPD defined?

Answer 7

1. Increased dyspnoea
2. Increased cough
3. Increased sputum production
   Complete removal of wheeze may not be possible due to chronic airway disease

Question 8

8. What is the indication for CPAP in COPD?

Answer 8

SpO2 <90% RA or <95% on supplemental O2

Question 9

9. What are the indications for the removal of CPAP?

Answer 9

• Ineffective: 1. cardiac/respiratory arrest 2. mask intolerance/pt agitation 3. nil improvement after 1hr
• Vital signs: 1. HR <50 or SBP <90 2. LOC or GCS <13 3. Decreasing sats
• Active risk to pt: 1. Loss of airway control 2. Copious secretions 3. Active vomiting 4. Paramedic judgment of clinical deterioration

Question 10

10. What is the Rx for exacerbation of COPD?

Answer 10

• Salbutamol 10mg + IB 500mcg
• Dexamethasone 8mg IV/Oral
  Titrate O2 to 88-92%

Question 11

11. What is the Rx for UAO with stridor?

Answer 11

Pt at imminent risk of life-threatening airway obstruction, MICA must be called - guideline NOT for stridor assoc with anaphylaxis

• Stridor: Adrenaline 5mg nebulised - consult for repeat dose, notify receiving hospital
• Dexamethasone 8mg IV/IM