Asthma Patient Management

Management of Adequate and Inadequate Respiration

       A. Respiratory Compromise

       ​​​​​​​       1. Assure an adequate airway

​​​​​​​       ​​​​​​​       2. Review supplemental oxygen therapy

​​​​​​​       ​​​​​​​       3. Continuous Positive Airway Pressure (CPAP)/Bi-Level Positive Airway Pressure (BiPAP)

​​​​​​​       ​​​​​​​       ​​​​​​​       a. Definitions/Purpose

​​​​​​​       ​​​​​​​       ​​​​​​​       ​​​​​​​       i. CPAP – device to provide continuous positive airway pressure in the spontaneously breathing patient

​​​​​​​       ​​​​​​​       ​​​​​​​       ​​​​​​​       ii. BiPAP – device to provide differential positive airway pressure in the spontaneously breathing patient.

​​​​​​​       ​​​​​​​       ​​​​​​​       ​​​​​​​       ​​​​​​​       a) higher positive pressure during inspiration (e.g., 10 cm water pressure)

​​​​​​​       ​​​​​​​       ​​​​​​​       ​​​​​​​       ​​​​​​​       b) lower positive pressure during expiration (e.g., 5 cm water pressure)

​​​​​​​       ​​​​​​​       ​​​​​​​       ​​​​​​​       ​​​​​​​       c) Augments patient’s spontaneous breathing with positive pressure ventilation during inspiration

​​​​​​​       ​​​​​​​       ​​​​​​​       ​​​​​​​       iii. increase lung compliance

​​​​​​​       ​​​​​​​       ​​​​​​​       ​​​​​​​       iv. reduce alveolar collapse

​​​​​​​       ​​​​​​​       ​​​​​​​       ​​​​​​​       v. increase laminar airflow

​​​​​​​       ​​​​​​​       ​​​​​​​       ​​​​​​​       vi. decrease intubation rates

​​​​​​​       ​​​​​​​       ​​​​​​​       b. Indications

​​​​​​​       ​​​​​​​       ​​​​​​​       ​​​​​​​       i. CHF/Acute pulmonary edema

​​​​​​​       ​​​​​​​       ​​​​​​​       ​​​​​​​       ii. COPD/Asthma

​​​​​​​       ​​​​​​​       ​​​​​​​       ​​​​​​​       iii. near drowning

​​​​​​​       ​​​​​​​       ​​​​​​​       ​​​​​​​       iv. similar equipment may be used for home treatment of sleep apnea

​​​​​​​       ​​​​​​​       ​​​​​​​       c. Contraindications

​​​​​​​       ​​​​​​​       ​​​​​​​       ​​​​​​​       i. inability to tolerate the mask

​​​​​​​       ​​​​​​​       ​​​​​​​       d. Complications

​​​​​​​       ​​​​​​​       ​​​​​​​       ​​​​​​​       i. requires adequate tidal volume

​​​​​​​       ​​​​​​​       ​​​​​​​       ​​​​​​​       ii. patient must be alert and follow instructions

​​​​​​​       ​​​​​​​       ​​​​​​​       ​​​​​​​       iii. patient must tolerate mask

​​​​​​​       ​​​​​​​       ​​​​​​​       ​​​​​​​       iv. gastric insufflation

​​​​​​​       ​​​​​​​       ​​​​​​​       ​​​​​​​       v. vomiting and aspiration risk

​​​​​​​       ​​​​​​​       ​​​​​​​       ​​​​​​​       vi. barotrauma

​​​​​​​       ​​​​​​​       ​​​​​​​       ​​​​​​​       vii. facial hair

​​​​​​​       ​​​​​​​       ​​​​​​​       ​​​​​​​       viii. dysmorphic faces

​​​​​​​       ​​​​​​​       ​​​​​​​       e. Procedure

​​​​​​​       ​​​​​​​       4. Assisted positive pressure ventilations

​​​​​​​       ​​​​​​​       ​​​​​​​       a. Purpose/definition

​​​​​​​       ​​​​​​​       ​​​​​​​       b. Indications

​​​​​​​       ​​​​​​​       ​​​​​​​       c. Contraindications

​​​​​​​       ​​​​​​​       ​​​​​​​       d. Complications

Lower airway disease

​​​​​​​       a. Asthma

​​​​​​​       b. Bronchiolitis -- Respiratory Syncytial Virus (RSV) is common cause

​​​​​​​       ​​​​​​​       i. Highly contagious

​​​​​​​       ​​​​​​​       ii. Most common in infants under one year

​​​​​​​       ​​​​​​​       iii. Infections usually occur epidemically in the winter

Review of all medications used to treat asthma:

  • Albuterol
  • Duo-Neb
  • Corticosteroids
  • Epinephrine

Content Creator: Josh Renolds
CAPCE Course Number: 20-EMTP-F3-3206
Total CE Hours: 1
Level: Advanced
EMT-CE uses the NEMSES guidelines as the foundation for every course outline.