respiratory Flashcards
Management of Mild/moderate adult asthma
4-12 puff via PDMI salbutamol repeat after 20/60, 4 breaths between each puff
If PDMI salbutamol not available for adults, how do you Manage the pt?
5mg of Nebulised salbutamol repeat after 20/60
Severe asthma Management in adults
Nebulise 10mg Salbutamol with 500mcg Atrovent. repeat salbutamol 5mg every 5/60 dexamethasone 8mg (iv, oral)
When do you manage an asthma pt with adrenaline
- Pt in acute life threat
- Pt not responding to nebulised treatment
- Speaking single words
How often do you give adrenaline in asthma pt
adrenaline 500mcg repeat 500mcg 5-10/60 to max 3 doses
IV adrenaline dose
consult with clinician 20mcg repeat 2/6
draw up 1ml dilute with 9ml normal saline
discard 9ml
draw up 9ml, diluting 1ml,
admin 2ml (20mcg every 2/60)
If pt become unconscious with poor or no ventilation
Ventilate 5-8 breaths per minute, @ 6-7ml/kg, allowing for prolonged expiration
If pt loses cardiac output
1min of apnoea
Criteria to suspect COPD
Pt over Age 40yrs Phx of smoking chronic cough chronic suptum production chronic Shortness of breath family Hx
Exacerbation of COPD can be expected when
Increase cough
increase sputum production
increase SOB
complete removal of wheeze may not occur due to chronic nature
Management of COPD
10mg salbutamol with 500mcg Atrovent (single)
8mg Iv/oral dexamethasone
if after 10/60 pt deteriorates or no improvement
MICA
consult for CPAP
Contraindications for CPAP
GCS <13 facial trauma pt requiring airway management actively vomiting Pneumothorax hypoventilation life threatening arrhythmia
Indication for removal of CPAP
Ineffective - cardiac/respiratory arrest - mask intolerance/pt agitation - nil improvement after 1 hr treatment Vital signs - HR <50bpm or BP<90mmHg - loss of consciousness or GCS <13 - decreasing SPO2 Active risk to patient - Loss of airway control - Copious secretions - Actively vomiting - Paramedic judgement of clinical deterioration
What Spo2 range do we aim for in Pt’s with COPD
88-92%
Management of choking pt
Position pt upright If partial obstruction - encourage cough - 5 back blows alternating - 5 chest thrusts if pt becomes unconscious - Laryngoscope - Magill's - suction Loss of cardiac output - Mx as per cardiac arrest
