RESPIRATORY Emergencies Flashcards
Mild to moderate Asthma management
Administer bronchodilators using one of the following:
Administer one puff of a short acting beta agonist (for example, salbutamol) via a metered dose inhaler (MDI) and spacer, followed by six breaths. Repeat this six times.
Or,
Administer 5 mg of nebulised salbutamol in combination with 0.5 mg of nebulised ipratropium using oxygen as the driving gas.
Administer an oral steroid:
40 mg of prednisone PO for an adult.
See the paediatric drug dose tables for a child.
Administer further doses of salbutamol as required.
Severe Asthma management
Administer 5 mg of nebulised salbutamol in combination with 0.5 mg of nebulised ipratropium using oxygen as the driving gas.
Administer continuous nebulised salbutamol until improvement occurs.
Administer adrenaline IM if the patient is not improving:
Administer 0.5 mg IM for an adult.
See the paediatric drug dose tables for a child.
Gain IV access.
Administer magnesium IV:
Administer 10 mmol (2.47 g) IV over approximately 15 minutes for an adult.
See the paediatric drug dose tables for a child and administer over approximately 15 minutes.
Administer a second dose if the patient is not improving and transport time is longer than 30 minutes.
Repeat adrenaline IM every ten minutes if the patient is deteriorating and adrenaline IV is not being administered.
Consider application of CPAP if the patient is not improving. See the ‘CPAP’ guideline.
The administration of an
oral steroid is not a priority but should occur if the patient is able to swallow, using the doses described above.
Immediate life threatening asthma
Administer an adrenaline infusion via an infusion pump. Start at a rate of
0.5 mg/hour and adjust the rate as required, or
Place 1 mg of adrenaline into a 1 litre bag of 0.9% sodium chloride (1:1,000,000 solution):
Administer as an infusion. Start at 2 drops/second and adjust the rate as required, or
Administer a bolus of 0.01 mg adrenaline (10 ml) IV every 1-2 minutes as required.
Adrenaline for a child aged 5-14 years:
Administer an adrenaline infusion via an infusion pump. Start at a rate of
0.25 mg/hour and adjust the rate as required, or
Place 1 mg of adrenaline into a 1 litre bag of 0.9% sodium chloride (1:1,000,000 solution):
Administer as an infusion. Start at 1 drop/second and adjust the rate as required, or
Administer IV boluses (see the paediatric drug dose tables) every 1-2 minutes as required.
Adrenaline for a child aged less than five years:
Do not administer adrenaline as an IV infusion.
Administer IV boluses (see the paediatric drug dose tables) every 1-2 minutes as required.
An ICP or CCP may administer ketamine if an adult patient is severely agitated and this is preventing the ability to safely provide treatment or transport:
Administer 0.5 mg/kg of ketamine IV, up to a maximum of 50 mg. This may be repeated every 10 minutes as required.
Consider commencing an infusion using service guidelines.
Mild to moderate COPD management
5mg Salbutamol and 500mcg Atrovent via air driven neb titrating SPO2 88-92%
40mg prednisone
Severe COPD management
5mg salbutamol and 500mcg atrovent via air driven neb SPO2 88-92%.
IV access 0.5mg Midazolam for anxiety only if patient is able to obey commands at all times
10mmol (2.4.7g) magnesium IV over 15 minutes. repeat dose if no pt improvement and transport time >30 minutes.
Consider CPAP if patient is not improving
Oral steroid not a priority but if the patient can swallow 40mg prednisone
COPD imminent respiratory arrest
Administer adrenaline IV in addition to the treatments for severe COPD:
Administer an adrenaline infusion via an infusion pump. Start at a rate of 0.5 mg/hour and adjust the rate to the patient’s condition, or
Place 1 mg of adrenaline into a 1 litre bag of 0.9% sodium chloride (1:1,000,000):
Administer as an infusion. Start at 2 drops/second and adjust the rate to the patient’s condition, or
Administer a bolus of 0.01 mg adrenaline (10 ml) IV every 1-2 minutes as required.
Do not administer midazolam.
FBAO management unconscious
If the patient is unconscious and ventilation is inadequate
Attempt to remove the foreign body under direct vision with a finger sweep and move sequentially through the steps below if the obstruction is not cleared:
Attempt to remove the foreign body using a laryngoscope and Magill forceps.
Perform five chest compressions and recheck the airway using a laryngoscope and Magill forceps.
Commence CPR and try to ventilate using a manual ventilation bag and mask.
Intubate with an endotracheal tube, inserting the tube as far as possible and then withdrawing the tube to the usual position.
Perform a cricothyroidotomy.
PEEP
If a manual ventilation bag is being used to provide ventilation:
For an adult:
Do not attach PEEP during cardiac arrest.
Apply PEEP at 5 cmH2O if the patient has traumatic brain injury (TBI), COPD, asthma or signs of shock.
Apply PEEP at 10 cmH2O for all other conditions.
For a child:
Do not attach PEEP during cardiac arrest.
Apply PEEP at 5 cmH2O for all other conditions.
For a neonate:
Apply PEEP at 5 cmH2O, including during cardiac arrest.
For an adult with cardiogenic pulmonary oedema if CPAP is indicated but unavailable:
Apply PEEP at 10 cmH2O. Focus on ensuring a tight seal with the mask and do not assist the patient’s breathing unless it is ineffective.
Consider increasing PEEP to 15cmH2O if the patient is not improving.
Use PEEP with caution if the patient has signs of shock.
Additional information
CPAP
CPAP is indicated if the patient has:
Cardiogenic pulmonary oedema with moderate to severe respiratory distress, or
Asthma, COPD, or undifferentiated respiratory problem with severe respiratory distress that is not improving with treatment, or
An SpO2 of less than 92% due to a respiratory problem despite treatment (less than 88% if COPD or known chronic hypoxia).
CPAP is contraindicated if the patient has:
Active vomiting, or
Ineffective breathing.
Use CPAP with caution if the patient has:
An altered level of consciousness, or
Signs of shock, or
Clinical suspicion of pneumothorax.
Application of CPAP
Commence at 5 cmH2O.
Increase to 10 cmH2O if it is being tolerated.
Consider increasing to 15 cmH2O if the patient is not improving.
Stridor management
Administer 5 mg of nebulised adrenaline if stridor is causing moderate or severe respiratory distress.
Repeat nebulised adrenaline as required every ten minutes.
Mild Croup
Administer prednisolone syrup PO.
Consider the likelihood that transport may not be required.
Croup moderate to severe
Administer 5 mg of nebulised adrenaline if stridor is causing moderate or severe respiratory distress.
Repeat nebulised adrenaline as required every ten minutes.
Administer prednisolone syrup PO if the patient can swallow.
