Notes – Bronchospasm (due to Asthma and Obstructive Lung Disease)

Bronchospasm (due to Asthma and Obstructive Lung Disease)

Patient Safety Considerations

  1. Routine use of lights and sirens is not recommended during transport
  2. Giving positive pressure in the setting of bronchoconstriction, either via an extraglottic airway or intubation, increases the risk of air trapping which can lead to pneumothorax and cardiovascular collapse. These interventions should be reserved for situations of respiratory failure

Notes/Educational Pearls

Key Considerations

  1. Inhaled magnesium sulfate should not be administered
  2. COPD patients not in respiratory distress should be given oxygen to maintain adequate oxygen saturation above 90%
  3. Nebulizer droplets can carry viral particles, so additional PPE should be considered, including placement of a surgical mask over the nebulizer to limit droplet spread
  4. In the asthmatic patient, pharmacologic intervention should take priority over CPAP and be given in line with CPAP

Pertinent Assessment Findings

  1. In the setting of severe bronchoconstriction, wheezing might not be heard. Patients with known asthma who complain of chest pain or shortness of breath should be empirically treated, even if wheezing is absent.

Quality Improvement

Associated NEMSIS Protocol(s) (eProtocol.01)

  • 9914139 – Respiratory Distress/Asthma/COPD/Croup/Reactive Airway

Key Documentation Elements

Document key aspects of the exam to assess for a change after each intervention:

  • Respiratory rate
  • Oxygen saturation
  • Use of accessory muscles
  • Breath sounds
  • Air entry
  • Mental status
  • Color

Performance Measures

  • CPAP utilization
  • Time to administration of specified interventions in the protocol
  • Rate of administration of accepted therapy (whether or not certain medications/interventions were given)
  • Change in vital signs (heart rate, blood pressure, temperature, respiratory rate, pulse oximeter, capnography values)
  • Time to administration of specified interventions in the protocol
  • Number of advanced airway attempts
  • Mortality

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