507 ASTHMA

In patients with acute asthma and/or active wheezing:

1. Begin Basic Life Support Respiratory Distress procedures.

2. Administer Metaproterenol 5% (0.3 ml in 2.5-5.0 ml of 0.9% saline solution)
   OR
   Albuterol Sulfate 0.083% (one unit dose bottle of 3.0 ml), by nebulizer, at a flow rate that will deliver the solution over 5 to 15 minutes.

3. Begin Cardiac Monitoring in patients over 40 years of age or with history of arrhythmia, or cardiac disease.

4. In patients in severe respiratory distress, begin an IV infusion of Dextrose 5% in water (D5W) to keep vein open. If the patient is on a methylxanthine, draw a tube of blood for theophylline level determination.

5. Transportation decision.

6. If patient develops or remains in severe respiratory distress, contact Medical Control for implementation of one or more of the following options:

MEDICAL CONTROL OPTIONS

OPTION A:

Administer Epinephrine 0.3 mg (0.3 ml of a 1:1,000 solution), subcutaneously.

OPTION B:

Repeat Metaproterenol 5% (0.3 ml in 2.5-5.0 ml 0.9% saline solution) OR Albuterol Sulfate 0.083% tone unit dose bottle of 3.0 ml) by nebulizer, at a flow rate that will deliver the solution over 5 to 15 minutes.

OPTION C:

Administer Aminophylline* 5.0 mg/kg loading dose, IV drip, over 20 minutes. (Maximum dose is 400 mg.) If the patient has taken any methylxanthine within the last 12 hours, no Aminophylline is to be administered; if taken within the last 24 hours, administer a 2.5 mg/kg loading dose IV drip, over 20 minutes.

* Aminophylline is introduced into either a 50-100 ml container of Dextrose 5% in water (D5W) or a burette reservoir chamber with the fluid level adjusted to 100 ml by adding Dextrose 5% in water (D5W).

OPTION D:

Transportation decision.

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