Bronchoconstriction Medical Directive

Question 1

What are the indications?

Answer 1

• Respiratory distress; AND Suspected bronchoconstriction

Question 2

What 3 medications are under this directive?

Answer 2

• Salbutamol & Epinephrine & Dexamethasone

Question 3

What are the conditions for salbutamol?

Answer 3

none

Question 4

What are the conditions for epinephrine?

Answer 4

• Age= n/a
• Weight= n/a
• LOA= n/a
• HR= n/a
• RR= BVM ventilation required
• SBP= n/a
• Other= Hx of asthma

Question 5

What are the conditions for Dexamethasone?

Answer 5

• Other= Hx of asthma OR COPD OR 20 pack-year hx of smoking

Question 6

What are the contraindications for salbutamol?

Answer 6

• Allergy or sensitivity to salbutamol

Question 7

What are the contraindications for epinephrine?

Answer 7

• Allergy or sensitivity to epinephrine

Question 8

What are the contraindications for Dexamethasone?

Answer 8

• Allergy or sensitivity to steroids
• Currently on PO on parenteral steroids

Question 9

What is the treatment for salbutamol MDI? (Weight <25 kg)

Answer 9

• Route= MDI
• Dose= up to 600 mcg (6 puffs)
• Max. single dose= 600 mcg
• Dosing interval= 5-15 min PRN
• Max. # of doses= 3

Question 10

What is the treatment for salbutamol NEB? (Weight <25 kg)

Answer 10

• Route= NEB
• Dose= 2.5mg
• Max. single dose= 2.5mg
• Dosing interval= 5-15 min PRN
• Max. # of doses= 3

Question 11

What is the treatment for salbutamol MDI? (Weight >25 kg)

Answer 11

• Route= MDI
• Dose= Up to 800 mcg (8 puffs)
• Max. single dose= 800 mcg
• Dosing interval= 5-15 min PRN
• Max. # of doses= 3

Question 12

What is the treatment for salbutamol neb? (Weight >25 kg)

Answer 12

• Route= NEB
• Dose= 5mg
• Max. single dose= 5mg
• Dosing interval= 5-15 min PRN
• Max. # of doses= 3

Question 13

What is the treatment for epinephrine?

Answer 13

• Route= IM
• Concentration= 1:1000
• Dose= 0.01mg/kg
• Max. single dose= 0.5mg
• Dosing interval= n/a
• Max. # of doses= 1
• The epi dose may be rounded to the nearest 0.05mg

Question 14

What is the treatment for Dexamethasone?

Answer 14

• Route= PO/ IM/ IV
• Dose= 0.5mg/kg
• Max. single dose= 8mg
• Dosing interval= n/a
• Max. # of doses= 1

Question 15

What are the clinical considerations?

Answer 15

• Epinephrine should be the 1st medication administered if the pt is apneic. Salbutamol MDI may be administered subsequently using BVM MDI adapter
• Nebulization is contraindicated in pts with a known or suspected fever in the setting of declared febrile respiratory illness outbreak by the local medical officer of health
• When administering salbutamol MDI, the rate of administration should be 100 mcg approx. every 4 breaths
• A spacer should be used when administering salbutamol MDI