Bronchospasm  

Patient Care Goals

Alleviate respiratory distress due to bronchospasm. Deliver appropriate therapy by differentiating other causes of respiratory distress.

Assessment

Pediatric Pearls: Signs & Symptoms: Differential: 
□ Pediatric hypotension is defined as SBP < 70 + (age in years x 2) mmHg

□ Wheezing in <2yo is often bronchiolitis and not asthma (unless they have a diagnosis of asthma).
 
□ Work of breathing is important. Pediatric patients will not start to desaturate until they are in respiratory failure		□ Shortness of breath 
□ Pursed lip breathing 
□ Decreased ability to speak 
□ Increased respiratory rate and effort 
□ Wheezing, rhonchi, rales, stridor 
□ Use of accessory muscles 
□ Fever, cough 
□ Tachycardia 
□ Anxious appearance
□ Shark-wave appearance on ETCO2		□ Asthma / COPD (Emphysema, Bronchitis) 
□ Anaphylaxis 
□ Aspiration 
□ Pleural effusion 
□ Pneumonia 
□ Pulmonary embolus 
□ Pneumothorax 
□ Cardiac (MI or CHF) 
□ Pericardial tamponade 
□ Hyperventilation 
□ Inhaled toxin (CO, etc.) 
□ Croup / Epiglottitis 
□ Congenital heart disease 
Trauma 
□ Hydrocarbon ingestion

Clinical Management Options

EMT-B
• Oxygen target SpO2 92% – 96%  
• Blood Glucose Level Assessment 
• Basic Airway Management as needed
Paramedic
• Vascular access as appropriate for patient condition 
• Monitor and interpretation of ECG & EtCO2 
• If wheezing (non-cardiac), consider Albuterol with Ipratropium
• Dexamethasone
• Consider early CPAP with PEEP in distressed patients
• For severe bronchospasm, consider Magnesium Sulfate and/or IM epinephrine
• Use caution in patient’s who are 65yo and older
• Advance Airway Management as Needed  
Consult Online Medical Control as Needed

Pearls

  • EtCO2 and SpO2 must be monitored continuously if either are abnormal or decline in patient’s mental status/condition. 
  • Normalization of ETCO2 can mean improvement of the patient OR failure to compensate with impending death. Monitor the ETCO2 wave and mental status of the patient closely.
  • Consider other reasons for respiratory distress such as pneumothorax or CHF (CHF can also wheeze, consider the entire patient history and exam).
  • A silent chest in respiratory distress is a sign for pre-respiratory arrest. 
  • Chronic COPD may have elevated CO2 at baseline. Patient respiratory status must be reassessed after each nebulizer or medication administration to determine need for additional dosing. 
  • Chronic COPD may have lower O2 at baseline and have increased mortality with hyper-oxygenation. The O2 goal is above 90% (not 100%).
  • Children less than 2yo are likely bronchiolitis, not asthma. Suctioning and oxygen is the first line treatment for bronchiolitis.
  • A history of intubations and ICU stay can be a poor prognostic sign in some patients.
  • Consider early CPAP in patients with respiratory distress. 
  • Magnesium may cause hypotension. Treat with fluid bolus.

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