Hello!
Fantastic question, This is a patient you need to be very aggressive with in your treatments. Remember your systematic approach... Use your senses, Listen to their lungs, See their work of breathing, Feel their pulse are they anxious and tachycardic? If they are in FAILURE then we need to jump ahead of this 8-ball. You have confirmed asthma complications and your basic treatments are not working (Albuterol, Atrovent, Xopenex, etc,) and they are status asthmaticus- Now its time to be a Paramedic... Open up that drug box and break out the stethoscope... Status Asthmaticus.... Tight lung sounds, everything is inflamed and irritated and You will hear your stridors and your wheezes, note tripoding, accessory muscle useage, cyanosis, Sp02 in the dumps, etc. Its time to open them up. IV access is a must, I would start with adrenalin IV and Solu-medrol (Steroid) IV and watch and see, of course they are on 100% hi-flow right now as a given. If that doesnt work you can also try Magnesium Sulfate as it has great bronchiodilation and anti-inflammatory properties. However, if no success noted then its time to break out the Etomidate and the Succs cuz this patient is buying a tube. Airway control is a MUST. Just keep in mind treat your patient not your monitor, judge by their condition how aggressive your treatment will be.
Mark,
EMT-P
