Asthma

[raptor]

Hi guys,

New to the list. Just leaving Metropolitan Ambulance Service, Melbourne (MAS) for Western Australia Ambulance Service (WAAS). I am still amazed at how different we can all be at times.

MAS = Salbutamol 10mg initially, followed by 5mg top ups 5/60. If moderate to severe, or not responding after 10/60 salbutamol, then 500mcg ipratropium. If consciousness lost, then 0.3mg IM adrenaline (oops...you guys prefer epi) every 20/60 (NSW uses adrenaline 5/60, which would be better). Hydrocortisone 250mg IV and IV salbutamol for severe. Sedate to enable ETI in unconscious asthmatic. I think Tasmania use dexamethasone (ideal as it has a much faster onset than hydrocortisone).

WAAS = Salbutamol 5mg, repeated as needed. No ipratropium. Adrenaline 0.5mg IM repeated once only after 10/60. No corticosteroids. No sedate to intubate.

Cheers for now!

[primemedic01]

Consider Ipratropium 0.5mg with albuterol 2.5mg with 3mL NS via Neb p.r.n x1

Consider repeat Albuterol 2.5mg with 3mL NS via Neb p.r.n. q 5 min

Consider Levalbuterol 1.25mg via Neb

Consider Methylprednisolone 125mg IV

With no response to Neb treatments and "impending respiratory failure" consider 0.3mg (0.3mL) Epi 1:1000 SQ or IM

Magnesium Sulfate 2g in 100mL NS IV over 10 minutes

[Sasha]

Salbutamol 5mg nebulised with 6-8l/m O2, repeated as required until side effects become significant

In acute severe or life threatening asthma, nebulised Ipratropium 0.5mg should be given concurently with the first dose of Salbutamol. In acute asthma unresponsive to Salbutamol alone, a single 0.5mg dose of Ipratropium should be added to the second or later dose of Salbutamol.

Adrenaline 1:1000 for life threatening asthma with failing ventilations. 0.5mg IM initially, repeated after 5 mins if required.

Try to take best peak flow reading from three before and after treatment (easier said than done in some cases)

IN ADDITION TO THE ABOVE ALSO ADMINISTER Hydrocortisone ..... where call to hospital time is over 30 minutes .... which is every time!!!! Hydrocortisone is only used with the life threatning guidelines (I.V admin)

[Dustdevil]

IN ADDITION TO THE ABOVE ALSO ADMINISTER Hydrocortisone ..... where call to hospital time is over 30 minutes .... which is every time!!!! Hydrocortisone is only used with the life threatning guidelines (I.V admin)

Why all the screaming?? :?

[medic001918]

Our protocols currently allow us to use either an albuterol neb (2.5mg) or a combivent neb (2.5mg albuterol/0.5mg atrovent). We also have epi SQ available with medical control and Solumedrol available again with medical control.

There's rumors that our new protocols are going to allow us to use Mag in asthma cases. That's not set in stone yet.

Shane

NREMT-P

[theotherphil]

IN ADDITION TO THE ABOVE ALSO ADMINISTER Hydrocortisone ..... where call to hospital time is over 30 minutes .... which is every time!!!! Hydrocortisone is only used with the life threatning guidelines (I.V admin)

Yeah, our trust doesn't carry the Hydrocortisone yet but it is in the pipeline :wink:

[Sasha]

Yeah, our trust doesn't carry the Hydrocortisone yet but it is in the pipeline :wink:

Which Ambulance Trust do you work for .

We have carried Hydrocortisone for a long while ..... South East Coast Amb service

[tniuqs]

Why all the screaming??

Could it be he is seriously long way away from your "tourist attractions" ....just guessing?

cheers

[theotherphil]

Which Ambulance Trust do you work for .

We have carried Hydrocortisone for a long while ..... South East Coast Amb service

I work for North East Ambulance Service, previously TENYAS before the merger.