508 CHRONIC OBSTRUCTIVE PULMONARY DISEASE

In patients in acute respiratory distress with central cyanosis due to chronic obstructive pulmonary disease:

1. Begin Basic Life Support Respiratory Distress procedures.

2. Begin Cardiac Monitoring, record and evaluate EKG strip.

3. 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.

4. Contact Medical Control for implementation of one or more of the following options:

MEDICAL CONTROL OPTIONS

OPTION A:

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.

OPTION B:

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 C:

Transportation decision.

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