Page 108 - 2022 Ranger Medic Handbook

Asthma
(Reactive Airway Disease)
DEFINITION: Inflammatory disorder of the airway with bronchiolar hyperresponsiveness and narrowing of the distal
airways; acute exacerbation seen with change in environment or level of allergen or irritant.
S/Sx: Wheezing, dyspnea, difficulty with speaking in full sentences, chest tightness, decreased oxygen saturation,
respiratory distress
MANAGEMENT:
1. Initiate pulse oximetry monitoring.
2. Albuterol (metered dose inhaler – works best when used with spacer), 2–3 puffs q5min, up to 3 times and assess.
3. If there is no response to albuterol, initiate urgent evacuation and continue albuterol MDI 4 puff q10min AND/OR
SECTION 3 4. May repeat one dose in 5–10 minutes.
consider epinephrine 0.5mg (0.5mL of 1:1,000 solution) IM (DO NOT INJECT INTRAVENOUSLY).
5. Initiate IV access with saline lock.
6. Dexamethasone 10mg IV/IM OR methylprednisolone 125mg IV/IM.
7. Administer oxygen if SpO 2 < 92%.
8. If there is fever, pleuritic chest pain and productive cough, treat per Bronchitis/Pneumonia Protocol.
9. If airway compromise, refer to Airway Management Protocol.
10. If available, administer medications via nebulizer (albuterol 2.5mg tid over 5–15 minutes).
DISPOSITION: If the patient responds to management, observe for 4 hours. Return-to-duty if there is no wheezing or
dyspnea and normal oxygen saturation. Continue albuterol (2 puffs q6hr) and reevaluate in 24 hours. Continue predni-
sone 60mg qd × 4 days.
Consider fluticasone 250mg/salmeterol 50mg (Advair) 1 puff bid × 14 days. Urgent evacuation if no response to treat-
ment. Urgent evacuation if symptoms persist.
SPECIAL CONSIDERATIONS: Other disorders to consider: anaphylactic reaction, spontaneous pneumothorax, HAPE,
and pulmonary embolism.

Barotrauma
DEFINITION: Physical damage to body tissues caused by difference in pressure between an air space inside or beside
the body and surrounding fluid.
S/Sx: Pain/pressure in the ear(s), sinuses, teeth; pulmonary overinflation syndrome may present with chest pain, dys-
pnea, mediastinal emphysema, subcutaneous emphysema, pneumothorax, and arterial gas embolism (AGE).
MANAGEMENT: Middle ear – If a tympanic membrane rupture is present or suspected:
1. Protect the ear from water, diving, flying, or further trauma, DO NOT use ear drops.
2. Pseudoephedrine 60mg PO q4–6hr prn AND/OR oxymetazoline 2–3 sprays each nostril bid (no longer than 3 days).
Refer to higher level of care when feasible. Consider moxifloxacin 400mg PO qd only if gross contamination is sus-
pected. Paranasal sinus barotraumas – pseudoephedrine 60mg PO q4–6hr prn.
3. Pulmonary barotraumas to include subcutaneous emphysema – If no respiratory distress, monitor patient closely.
Use pulse oximetry if available. If respiratory distress occurs – Treat per Spontaneous Pneumothorax Protocol.
4. If arterial gas embolus is suspected, administer 100% oxygen and 1L normal saline IV 150mL/hr. Urgent evacuation
to recompression chamber. If an unpressurized airframe is used, avoid altitude exposure greater than 1,000 ft.
5. Treat per Pain Management Protocol. (Avoid narcotics if recompression is anticipated.)
DISPOSITION: Urgent evacuation for cerebral arterial gas embolus or pneumothorax with respiratory distress. Mild to
moderate middle ear, sinus, or pulmonary barotraumas without respiratory distress, observation and Routine evacua-
tion. Routine evacuation for consultation for tympanic membrane rupture.
SPECIAL CONSIDERATIONS:
1. Pulmonary overinflation syndrome (POIS) may occur from ascent from depth if compressed air was used or exposure
to blast overpressure.
2. The most commonly affected site is the middle ear and tympanic membrane, but paranasal sinuses and teeth may
be affected.
3. Pulmonary barotrauma occurs when compressed air is breathed at depth followed by ascending with a closed airway
(i.e., breath-holding) and can cause pneumothorax or arterial gas embolism.
94 SECTION 3 TACTICAL MEDICAL EMERGENCY PROTOCOLS (TMEPs) & SICK CALL