Respiratory-Asthma/COPD Administrative Guideline

Question 1

History

Answer 1

- Asthma; COPD -- chronic bronchitis, 
emphysema, 
- Congestive heart failure
- Home treatment (oxygen, nebulizer)
- Medications (theophylline, steroids, 
inhalers)
- Toxic exposure, smoke inhalation

Question 2

Signs and symptoms

Answer 2

• Shortness of breath
• Decreased ability to speak
• Increased work of breathing/accessory
  muscle use
• Wheezing, rhonchi
• Fever, cough
• Tachycardia

Question 3

Differential

Answer 3

• Asthma
• Anaphylaxis
• Aspiration
• COPD (Emphysema, Bronchitis)
• Pneumonia
• Pulmonary embolus
• Pneumothorax
• Cardiac (MI or CHF)
• Pericardial tamponade
• Hyperventilation
• Inhaled toxin (Carbon monoxide, etc.)

Question 4

Respiratory

Distress/Wheezing

Answer 4

Consider Anaphylaxis/Allergic Reaction AG
Administer oxygen and titrate to SaO 2 of ? 94%
Place in position of comfort

Question 5

Wheezing on lung examination, history of asthma/COPD

Answer 5

IV/IO access, EtCO 2 monitoring
Administer albuterol SVN if available
Administer albuterol 2.5 mg SVN
Administer ipratropium (Atrovent) 0.5 mg nebulized with albuterol
May repeat albuterol x 2
Administer methylprednisolone 2 mg/kg IV/IM
(max dose 125 mg)
For severe respiratory distress consider administration of magnesium sulfate 25 mg/kg (max dose 2 g) IV over 20 minutes.

Question 6

NO clinical improvement, improved saturation and lung sounds

Answer 6

CPAP: Continuous positive pressure ventilation as blood pressure allows, with inline albuterol nebulization
Consider administration of epinephrine (1 mg/mL) 0.01
mg/kg, max dose=0.3 mg IM

Question 7

Administer epinephrine for suspected allergic reaction/anaphylaxis or impending respiratory failure related
to asthma

Answer 7

Administer with caution in patients with history of CAD/MI/stents, as epinephrine may precipitate
myocardial ischemia in these patients