2. ASTHMA / BRONCHOSPASM
• This protocol is used for patients who are complaining of
dyspnea and who are wheezing.
• Whenever possible, allow these patients to assume
whatever position is comfortable (they may not tolerate
laying flat).
3. • A patient with a history of CHF that has wheezing on
auscultation of lung sounds should not be automatically
classified as an “asthma patient.”
• If the CHF patient does not have a history of asthma or
allergic reaction, the more prudent assessment would be
that of CHF (cardiac asthma) (See CHF/Pulmonary
Edema protocol 2.2.4)
4. Procedure:
BASIC LEVEL: EMT and PARAMEDIC
• Initial Patient Assessment Protocol 2.1.1
• Airway Assessment/Management Protocol 2.1.2
• If severe distress CPAP may or may not help (keep in
mind, it is the medications that will work best to break the
bronchospasm)
• Attach cardiac monitor and pulse oximeter.
• Transport to designated hospital.
5. ALS LEVEL 1: PARAMEDIC ONLY
• Administer Albuterol (Ventolin) 2.5mg (in 3 cc normal
saline) by nebulizer. May repeat twice PRN. DO NOT
GIVE ALBUTEROL OR IPRATROPIUM BROMIDE IF
THE HEART RATE IS > 140
• May add Ipratropium Bromide (Atrovent) 0.5 mg
(0.5ml) to the first Albuterol neb only.
6. ALS LEVEL 1: (con’t)
• If indicated, start IV of Lactated Ringer’s or Normal
Saline at TKO.
• For persistent respiratory distress, give
Methylprednisolone Sodium Succinate (Solu-Medrol)
125mg IV. (NOTE: If patient already on a steroid, give 80
mg of Solu-Medrol IV).
7. ALS LEVEL 1: (con’t)
• For severe dyspnea, Epinephrine (1:1000) 0.4 ml
subcutaneous Adult (Peds: 0.01 ml/kg.) Caution should
be used with administration of Epinephrine when the
patient has a history of hypertension or heart disease
(call med control if you have any concerns).
• Consider need for
endotracheal intubation.
8. ALS LEVEL 2: MEDICAL CONTROL
• Repeat Epinephrine (1:1000) 0.4 mg SubQ
• If patient still has dyspnea after:
- SubQ Epi
- 3 Albuterol nebs (first with Atrovent)
- and Solu-Medrol
• Med control may order
Magnesium Sulfate 2 gms IV
(mixed with 50ml of D5W given
over 10 – 15 minutes)
