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(Adapted from an evidence-based guideline using the National Prehospital Care Process Model Guide).
Asthma, respiratory distress, wheezing, respiratory failure, bronchospasm, chronic obstructive pulmonary disease (COPD), salbutamol, nebulizer, inhaler.
Respiratory failure with wheezing and wheezing in children 2 years of age or older, potentially caused by bronchospasm due to reactive airway disease, asthma, or COPD. These patients may have a history of recurrent wheezing that was relieved by nebulizer/inhaler beta-agonists such as salbutamol.
1. Symptoms/signs include:
a) wheezing – the presence of wheezing (whistling) during exhalation, which will last as long as there is air flow;
b) may have signs of a respiratory infection ( fever, nasal congestion, cough, sore throat);
c) an acute onset may occur after inhalation of an irritant.
2. This includes:
a) exacerbation of asthma;
b) exacerbation of COPD;
c) wheezing due to a suspected lung infection (for example, pneumonia, acute bronchitis).
Respiratory failure due to one of the following reasons:
a) anaphylaxis;
b) bronchiolitis (wheezing in children younger than 2 years);
c) croup;
d) epiglottitis;< br />e) aspiration of foreign objects;
e) immersion/drowning;
e) congestive heart failure;
e) injury.
1. Anamnesis:
a) the onset of symptoms;
b) the simultaneous presence of several symptoms (fever, cough, rhinorrhea, swelling of the lips/tongue, rash, difficulty breathing, aspiration of foreign objects) ;
c) typical triggers of symptoms (cigarette smoke, change of weather, upper respiratory tract infection;
d) contact with other patients;
e) previous treatment;
e) intubation in anamnesis;
e) number of visits to the emergency department during the last year;
e) number of hospital stays during the last year;
g) number of stays in the intensive care unit; >h) did any of the relatives suffer from asthma, eczema or allergies.
2. Examination:
a) a full spectrum of vital signs (temperature, pulse, BH, BP, saturation) – the waveform of capnography is a useful addition and shows the shape of the “shark fin” signal in conditions of obstructive physiology;
b) lumen of the larynx (normal or narrowed, prolonged exhalation phase);
c) respiratory noises (whistling, rattling, wheezing, muffled, clear);
d) signs of respiratory insufficiency (cracking, swelling of the wings of the nose, retraction, stridor);
e) inability to speak in full sentences (sign of shortness of breath);
e) skin color (pale, cyanotic, normal);
e) state of consciousness (conscious) , in, listless, sleepy, unconscious);
j) signs of respiratory distress include:
1. Monitoring:
a) pulse oximetry and resting end-expiratory CO2 (ETCO2) should be routinely used as an adjunct to other forms of respiratory monitoring;
b) take an ECG if there is no improvement after respiratory therapy deficiencies.
2. Respiratory tract:
a) carry out oxygen therapy – start with the use of a nasal cannula and, if necessary, switch to a regular mask and a non-reversible mask to maintain a normal level of oxygenation;
b) carry out sanitation of the nasal and/ or oral cavity (using aspiration
th catheter) in the presence of excessive secretion.
3. Aerosol medicines:
a) salbutamol 5 mg in the form of a spray through a nebulizer (6 standard breaths using an inhaler) should be administered to children with severe respiratory distress and signs of bronchospasm (eg, history of asthma, minor wheezing ) EMD specialists with basic or professional life support skills – re-introduction of the drug in the same dose with unlimited frequency if symptoms of insufficiency continue; p>
4. Usefulness of an IV catheter and fluids – IV catheters should be placed when there is clinical concern about dehydration for the purpose of fluid administration or when IV drugs are administered.
5. Steroids – methylprednisolone (2 mg/kg, maximum dose – 125 mg) IV or IV; or dexamethasone (0.6 mg/kg, maximum dose – 16 mg) IV, IV or orally can be used at the pre-hospital stage. Other steroid drugs in equivalent doses can be administered as an alternative.
6. Magnesium sulfate (40 mg/kg IV, maximum dose – 2 g) for 10-15 minutes in severe bronchospasm and in case of concern about increasing respiratory failure.
7. Epinephrine (0.01 mg/kg in 1 mg, max. dose – 0.3 mg) should be used only in increasing respiratory failure as adjunctive therapy in the absence of signs of clinical improvement.
8. Improvement of ventilation and/or saturation in respiratory failure using non-invasive assistive devices:
a) non-invasive ventilation with constant positive pressure using a PPTD or DPPTD device should be carried out in acute respiratory failure;
b) ventilation with an AMBU bag should be carried out in children with respiratory arrest.
9. The use of supralaryngeal devices should occur only if the AMBU bag does not give results – airway control should be performed by the least invasive methods.
In conditions of pronounced bronchoconstriction, wheezing may not be heard. Patients with a history of asthma who complain of chest pain or shortness of breath should receive appropriate care, even in the absence of wheezing.
Document all review details to assess change after each intervention: