Directives

• Indications for Bronchoconstriction: Respiratory distress and suspected bronchoconstriction
• For bronchoconstriction, Salbutamol has no relevant conditions for administration
• For bronchoconstriction, Epinephrine has BVM ventilation required in the "RR" section and Hx of asthma in "Other"
• For bronchoconstriction, dexamethasone has Hx of Asthma or COPD or 20-pack year hx of smoking in other
• Contraindications for Salbutamol and EPI in the bronchoconstriction directive are just an allergy to them
• Contraindications for Dexamethasone in the Bronchoconstriction directive are: allergy or sensitivity to steroids and currently on PO/parenteral steroids
• For salbutamol under bronchoconstriction, if the PT weighs less than 25 kg and the route is MDI, the dose is 600 mcg/6 puffs.
• For salbutamol under bronchoconstriction, if the PT weighs 25 kg or greater and the route is MDI, the dose is 800 mcg/8 puffs.
• For salbutamol under bronchoconstriction, if the PT weighs 25 kg or greater and the route is NEB, the dose is 5 mg(comes in 2.5 mg per NEB so you'd use 2)
• For salbutamol under bronchoconstriction, if the PT weighs less than 25 kg and the route is NEB, the dose is 2.5 mg(comes in 2.5 mg per NEB so you'd use 1)
• For salbutamol under bronchoconstriction, if the PT weighs 25 kg or greater and the route is MDI, the dose is 800 mcg/8 puffs
• For salbutamol under bronchoconstriction, the max # of doses are 3 and the dosing interval is 5 to 15 minutes and PRN
• Under bronchoconstriction, EPI is given the same way it is for anaphylaxis. The only difference is the dosing interval as you can only give a max dose of 1
• For Dexamethasone under bronchoconstriction, the route is PO/IM/IV. The dose is 0.5 mg/kg and the max single dose is 8 mg(If they're greater than 16 kg, you're nuking them with full dose). You could only give a max of 1 dose. It's concentration is 10 mg per mL
• Under bronchoconstriction, Clinical considerations state that if the PT is apneic, EPI is the first medication you should be administering. You can follow up with salbutamol MDI using BVM adaptor
• Under bronchoconstriction, Clinical considerations state that nebulization is contraindicated in PTs with a known or suspected fever or in the setting of a declared febrile respiratory illness outbreak by the local medical officer of health(Wtf does this mean)
• Under bronchoconstriction, Clinical considerations states that when administering MDI, the rate of admin should be 100 mcg/1 puff every 4 breaths(meaning it takes at least a minute to deliver the full adult dose)
• Under bronchoconstriction, Clinical considerations states that a spacer should be used when administering salbutamol MDI
• Symptoms of bronchoconstriction includes wheezing, coughing, dyspnea, decreased air entry and a silent chest
• EPI is indicated for bronchoconstriction when the PT is asthmatic and BVM ventilation is required. This is usually after salbutamol has had no effect but salbutamol could be bypassed and EPI could be given directly bcuz of PT's severity. The indication to administer EPI is independent to the ability to administer Salbutamol
• You must shake the MDI between intervals of breaths
• MDI administration is preferred over nebulization for salbutamol. Nebulization is considered if PT is unable to accept MDI
• You must use PPE before administering salbutamol via NEB
• Dexamethasone administered for IV/IM use can still be administered PO
• Dexamethasone should be given PO. It is only given IV/IM if the PT is extremely SOB in suspected respiratory failure and all other care has been provided
• Dexamethasone can be used in conjunction with salbutamol, EPI and CPAP
• The contraindication for steroids for Dexamethasone only applies to systemic steroids and not inhaled or topically applied ones
• If you smoked a pack a day for the last 20 years or 2 packs a day for the last 10 years, you'd have 20 pack-years
• Indications for Croup Medical Directive: Current history of URTI and barking cough or recent history of barking cough
• Under the croup directive, for EPI the age must be 6 months or older and under 8 years old
• Under the croup directive, for EPI, they must have a HR of less than 200 BPM and in "other" they must have Stridor at rest
• Under the croup directive, for Dexamethasone, the age must be 6 months or older to less than 8 years. They also must be unaltered for LOAs and in "other" its used for mild, moderate and severe croup
• The contraindications for EPI under Croup are allergy/sensitivity to EPI
• The contraindications for Dexamethasone under Croup are: allergy or sensitivity to steroids, steroids received within the last 48 hours and unable to tolerate oral medications
• For croup, if you're giving EPI and the PT is under 10 kg, the route is NEB and the dose is 2.5 mg and a max of a single dose.
• For croup, if you're giving EPI and the PT is 10 kg or greater, the route is NEB and the dose is 5 mg and a max of a single dose.
• For severe presentations of croup, EPI should be your priority treatment with dexamethasone being considered. For mild to moderate presentations, only dexamethasone should be considered.
• Start CPR on a PED if they have a heart rate of below 60
• Joule settings for PEDs are: initial is 2 J/kJ and subsequent are 4 J/kJ