Page 191 - ATP-P 11th Ed

ASTHMA PROTOCOL
(REACTIVE AIRWAY DISEASE)

SPECIAL CONSIDERATIONS
1. Other disorders to consider: anaphylactic reaction, spontaneous pneumothorax,
HAPE, and pulmonary embolism.
2. Exposure to nerve agents, vesicants, and Toxic Industrial Chemicals (TICs) can
cause Reactive Airway disease (RAD) (bronchoconstriction). SECTION 2

Signs and Symptoms
1. Wheezing
2. Dyspnea
3. Difficulty with speaking in full sentences
Management
1. Albuterol (Ventolin ) metered dose inhaler – works best when used with spacer,
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2–3 puffs q5min, repeat up to 3 times.
2. IF THERE IS NO RESPONSE TO ALBUTEROL (Ventolin ), epinephrine
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0.5mg (0.5mL of 1:1000 solution) IM (DO NOT INJECT INTRAVENOUSLY). May
repeat one dose in 5–10 minutes.
3. Oxygen with pulse oximetry monitoring
4. IV access with saline lock
5. Dexamethasone (Decadron ) 10mg IV/IM/PO
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6. If there is fever, pleuritic chest pain and productive cough, treat per Bronchitis/
Pneumonia Protocol.
7. If bronchospasm due to nerve agent, primary treatment should be with atropine to re-
verse bronchospasm and bronchorrhea. Atropine should be given in 2–4mg doses until
airway distress resolves. See CBRN: Nerve Agent Poisoning Protocol

Disposition
1. Urgent evacuation if no response to treatment.
2. If the patient responds to management, observe for 4 hours.
a. Return to Duty if there is no wheezing or dyspnea and normal oxygen satu-
ration. Continue albuterol (Ventolin ) (2 puffs q6hr) and re-evaluate in 24
®
hours. Continue dexamethasone (Decadron ) 10mg IM daily for 4 days.
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b. Urgent evacuation if symptoms persist.
180 SECTION 2 TACTICAL MEDICAL EMERGENCY PROTOCOLS (TMEPs) ATP-P Handbook 11th Edition 181