Portal Navigation Links (Level 1):
Residents | Government | Business | Culture

Portal Navigation Links (Level 2):
News | County Executive | County Council | Departments | Services (A to Z)   | Online Services
County Cable 6 | Transportation  |  Education  |  Careers | Volunteers | Contact Us

Fire & Rescue Navigation Links:

 

Prehospital Assessment &Care

This is NOT your 'normal' asthma attack! Your patient has had asthma attacks before... THIS one is DIFFERENT
A common reason for a 911 call is because the patient's 'normal' asthma is exacerbated by allergies, or by an infection, viral or bacterial.

Initial Assessment
(primary survey)
General impression: Look distressed? Tripod position? Using accessory muscles? Anxious? Scared? Lethargic? Skin color?

Assess LOC using AVPU. Is the patient able to communicate?

Patients unable to communicate are not moving much air.

Does the patient have an adequate airway?

Is the patient breathing? Approximate rate? Audible wheezes or other abnormal sounds? Effort of breathing? Coughing?

Asthma in children often presents as coughing rather than wheezing.

Is breathing adequate?
Yes: Administer oxygen
No: Ventilate with Bag-Valve-Mask and 100% oxygen

Circulation: Pulses present? Tachycardia/bradycardia? strong/normal/weak? Capillary refill? Bradycardia in children = pre-code condition

Patient
History
S
Signs & Symptoms presenting

A
Allergies: ALL allergies - nothing is unimportant

M
What medications does the patient take? What have they taken today? Both prescription and over-the-counter medications. Don't forget birth control, estrogen supplements and Viagra-type drugs.

P
Past Illnesses: Does the patient have asthma? What other medical conditions are present? Any surgeries? Has the patient ever been hospitalized for asthma? If so, were they intubated? On a respirator? What did it take to stop your last attack?

History RED FLAGS:
- Previously hospitalized for asthma
- Previously needed to be intubated for asthma
- Previously needed to be on a ventilator for asthma

L
Last oral intake x3: Food, Liquids & Medications

E
Events Prior: History of the current illness using a modified O-P-Q-R-S-T-U format:

O
Onset: What were you doing when the attack started? Do you know what triggered the attack?

P
Pain: Do you have any pain anywhere

S
Severity: Compared to previous asthma attacks, how severe is this one?

T
Time: When did it first begin?

U
You did what? What interventions has the patient taken to mitigate the attack? Have they taken their rescue inhaler? How many puffs? How long ago?

Listen to the chest: Non-wheezing asthmatics may be so tight that they are moving almost no air.

Remember the progression of signs:
Expiratory wheezes -> Inspiratory & expiratory wheezes ->quiet chest = No air movement

- Take measures to reduce emotional stress
- Assess & obtain history, but DO NOT DELAY ADMINISTERING MEDICATIONS!
- Remove restrictive clothing
- Comfortable position to breathe
- Administer oxygen: Pulse Ox readings helpful before & after O2 & medications.
- Administer albuterol or epinephrine as per protocol
- Vital signs q5 minutes if patient is unstable (requires medication)
- Consider ALS
- Consult medical control if priority 1 or if symptoms do not resolve. Consider consulting for patients over 45 years of age and all asthma patients with a cardiac history
- Transport

BLS Consider ALS Assistance

ALS Consider Intubation

- Altered sensorium/diminished LOC?
- Extreme respiratory effort and/or evidence of tiring?
- Inaudible chest sounds on auscultation? (quiet chest)
- Inability to speak or speaking in 2-3 word phrases?
- Abnormal skin color, temperature and/or moisture?
- Medications then and now: What has the patient taken? What have you given? What is left in your war chest?

 - All BLS care listed PLUS:
- Consider Continuous Positive Airway Pressure (CPAP) if so equipped.
- Establish IV of Lactated Ringers if priority 1 or 2, or if cardiac history.
NOTE: Starting an IV in a pediatric asthma patient will increase anxiety, increase oxygen demand and exacerbate ALL asthma symptoms, and may therefore be counter-productive unless absolutely necessary.
- Consider albuterol, epinephrine or terbutaline. Consult Maryland Medical Protocols for indications and use of these medications