|
Prehospital
Assessment &Care
|
Assessing
the Asthma Patient |
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? |
| Physical
Examination |
Examine
the chest: Any retractions? Any signs of rash? |
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 |
| Look
for cyanosis |
| EMERGENCY
EMS CARE for ASTHMA |
|
EMTB
Emergency
Care |
-
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? |
|
ALS
Emergency
Care |
-
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 |
| |
| |
|
Seniors
