About
Section 1: General Patient Care
Section 2: Medical Protocols
2.01 - Adrenal Insufficiency / Crisis (Adult & Pediatric)2.02A - Allergic Reaction / Anaphylaxis2.02P - Allergic Reaction / Anaphylaxis2.03A - Altered Mental / Neurological Status / Diabetic Emergencies / Coma - Adult2.03P - Altered Mental / Neurological Status / Diabetic Emergencies / Coma - Pediatric2.04 - Behaviorial Emergencies (Adult & Pediatric)2.05 - Behaviorial Emergencies - Restraints (Adult & Pediatric)2.06A - Bronchospasm / Respiratory Distress (Adult)2.06P - Bronchospasm / Respiratory Distress (Pediatric)2.07 - Hyperthermia (Environmental - Adult & Pediatric)2.08 - Hypothermia (Environmental - Adult & Pediatric)2.09 - Nerve Agent / Organophosphate Poisoning2.10 - Obstetrical Emergencies2.11 - Newly Born Care2.12 - Resuscitation of the Newly born2.13 - Pain and Nausea Management2.14 - Poisoning / Substance Abuse / Overdose2.15A - Seizures2.15P - Seizures2.16A - Shock2.16P - Shock2.17A - Sepsis2.17P - Sepsis2.18 - Stroke2.19 - Hyperkalemia2.20 - Home Hemodialysis Emergency Disconnect
Section 3: Cardiac Emergencies
Section 4: Trauma Protocols
Section 5: Airway Protocols & Procedures
Section 6: Medical Director Options
Section 7: Medical Policies & Procedures
Section 8: Special Operations Principles
Appendices
2.06A - Bronchospasm / Respiratory Distress (Adult)
EMT-Basic (Standing Orders)
- 1.0 Routine Patient Care
- IF the patient has not taken the prescribed maximum dose of their own inhaler prior to the arrival of EMS, AND the inhaler is present:
- Encourage and/or assist patient to self-administer their own prescribed inhaler medication if indicated.
- If patient is unable to self-administer their prescribed inhaler, administer patient’s prescribed inhaler.
- The maximum dose has been administered prior to the arrival of the EMT. the patient cannot physically use the device properly. (Patient cannot receive inhalation properly.)
- The device has not specifically been prescribed for the patient.
- **If properly trained and authorized, use6.01 BLS Albuterol.
- CPAP in accordance with:Protocol 6.9 Continuous Positive Airway Pressure (CPAP) by EMT-Basic and/or Advanced EMT.
EMT-Basic (Medical Control)
- Additional doses of above medications, if prescribed to patient or authorized, and if maximum dose has not been administered.
- Epinephrine 0.3 mg via auto-injector. If approved underProtocol 6.6 Check and inject Epinephrine by EMT Basicepinephrine 0.3 mg IM.
EMT-Advanced (Standing Orders)
- Albuterol 2.5-3 mg via nebulizer. Ipratropium Bromide 0.5mg may be combined with the albuterol treatment.
Additional albuterol treatments may be administered as necessary with or without ipratropium bromide. - Note that a multi-dose inhaler may be used to give albuterol or ipratropium (instead of nebulizer) if infection control is an issue (e.g. influenza-like-illness).
- If approved, epinephrine 1:1,000 0.3mg IM-ONLY.
- Must be administered in accordance with criteria listed inA1 Adult Medication Reference.
- CPAP in accordance withProtocol 6.9 Continuous Positive Airway Pressure (CPAP) by EMT-Basic and/or Advanced EMT.
EMT-Paramedic (Standing Orders)
- In a patient with a known diagnosis of asthma or COPD, who does not have history or findings concerning for congestive heart failure, consider hydrocortisone 100 mg. IV/IO/IM or methylprednisolone 125 mg. IV/IO/IM.
- In patients ≤40 years old, epinephrine 0.3 mg IM as a one time dose.
- Continuous positive airway pressure (CPAP) assistance, if not contraindicated, and if nebulizer therapy can be continued with the CPAP device.
- For Asthma only, consider magnesium sulfate 2-4 grams IV/IO over 20 minutes.
EMT-Paramedic (Medical Control)
- Additional doses of above medications.
- Epinephrine 1:10,000, 0.1-0. 5 mg IV/IO very slowly
Caution:
The use of Epinephrine in patients over the age of 40 or with known cardiac disease and patients who have already taken high dosage of inhalant bronchodilator medications may result in cardiac complications.
Caution:
Epinephrine for bronchospasm must be administered by Auto-Injector ONLY, except by medical control order or department authorization.