Podcast
Questions and Answers
What is the primary goal of pre-hospital care in acute respiratory distress?
What is the primary goal of pre-hospital care in acute respiratory distress?
Which of the following is NOT a medication used in the treatment of asthma?
Which of the following is NOT a medication used in the treatment of asthma?
In which condition is oxygen use carefully titrated to prescribed saturation levels?
In which condition is oxygen use carefully titrated to prescribed saturation levels?
What is a benefit of using a metered-dose inhaler during a respiratory emergency?
What is a benefit of using a metered-dose inhaler during a respiratory emergency?
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What type of mask is used for providing oxygen with controlled flow rates?
What type of mask is used for providing oxygen with controlled flow rates?
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What is the most common disease classified under Chronic Obstructive Pulmonary Disease (COPD)?
What is the most common disease classified under Chronic Obstructive Pulmonary Disease (COPD)?
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Why do chronic COPD patients require a mild degree of hypoxia to continue breathing?
Why do chronic COPD patients require a mild degree of hypoxia to continue breathing?
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What is an adequate SpO2 level for patients with COPD?
What is an adequate SpO2 level for patients with COPD?
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Which medications are commonly used to manage COPD?
Which medications are commonly used to manage COPD?
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What is a potential risk of administering too much oxygen to COPD patients?
What is a potential risk of administering too much oxygen to COPD patients?
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What primarily characterizes asthma?
What primarily characterizes asthma?
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Which phase is NOT a part of asthma?
Which phase is NOT a part of asthma?
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What is the main purpose of selective bronchodilators?
What is the main purpose of selective bronchodilators?
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What does a metered-dose inhaler (MDI) deliver?
What does a metered-dose inhaler (MDI) deliver?
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What can occur if an MDI is used improperly?
What can occur if an MDI is used improperly?
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What is the function of a spacer device when using an MDI?
What is the function of a spacer device when using an MDI?
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What is the most common inhaled drug used to treat reversible bronchospasm in asthma?
What is the most common inhaled drug used to treat reversible bronchospasm in asthma?
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Which type of nebulizer uses gas to drive medication conversion?
Which type of nebulizer uses gas to drive medication conversion?
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What condition may require the administration of Ipratropium bromide?
What condition may require the administration of Ipratropium bromide?
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What is a key factor in respiratory distress associated with asthma?
What is a key factor in respiratory distress associated with asthma?
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At what pressure is oxygen stored in green/aluminum cylinders?
At what pressure is oxygen stored in green/aluminum cylinders?
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What is the concentration of inspired oxygen (FiO2) in normal room air?
What is the concentration of inspired oxygen (FiO2) in normal room air?
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Which of the following is an intrinsic trigger for asthma?
Which of the following is an intrinsic trigger for asthma?
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Which oxygen delivery device can provide an oxygen concentration of 90%?
Which oxygen delivery device can provide an oxygen concentration of 90%?
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When should corticosteroids be considered during an acute exacerbation of asthma?
When should corticosteroids be considered during an acute exacerbation of asthma?
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What role does Adrenaline play in treating life-threatening asthma?
What role does Adrenaline play in treating life-threatening asthma?
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What is the flow rate range for a nasal cannula?
What is the flow rate range for a nasal cannula?
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How does a Venturi mask alter oxygen concentration?
How does a Venturi mask alter oxygen concentration?
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What are the indications for administering Hydrocortisone during an acute exacerbation of asthma?
What are the indications for administering Hydrocortisone during an acute exacerbation of asthma?
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What is a primary symptom indicating an acute exacerbation of asthma?
What is a primary symptom indicating an acute exacerbation of asthma?
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What percentage of oxygen can a simple/partial rebreather mask deliver?
What percentage of oxygen can a simple/partial rebreather mask deliver?
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How far should a metered-dose inhaler (MDI) be held from the mouth when it is not available?
How far should a metered-dose inhaler (MDI) be held from the mouth when it is not available?
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What type of mask is often used by COPD patients?
What type of mask is often used by COPD patients?
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What method do nebulisers use to deliver medication to the lungs?
What method do nebulisers use to deliver medication to the lungs?
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Study Notes
Respiratory Emergencies: Pharmacology for EMS
- Acute respiratory distress affects many people
- Pre-hospital care aims to treat reversible bronchial constriction (bronchospasm)
- The exception to this is acute pulmonary edema
- Advanced life support (ALS) interventions significantly reduce mortality in patients with respiratory distress
Learning Objectives
- Define nasal cannula, rebreather face mask, non-rebreather face mask, and venturi mask
- Discuss the use of oxygen in a respiratory emergency
- Describe bronchodilator agents
- Discuss the benefits of the metered-dose inhaler (MDI)
- Discuss medications used in the treatment of asthma: salbutamol (albuterol) and ipratropium bromide
- Discuss medications used as second-line therapy for acute asthma exacerbation
- Describe the key treatment for patients with chronic obstructive pulmonary disease (COPD)
Oxygen
- Oxygen is a common medication used in pre-hospital settings
- Provided to trauma and medical patients
- In situations like neonatal resuscitation, COPD exacerbations, and acute coronary/stroke patients, oxygen use is carefully titrated to prescribed saturation levels (rather than indiscriminately applied)
- Oxygen is stored in green/aluminum cylinders at 1,800-2,400 psi, decreasing to 60 psi as it passes through the regulator
Oxygen Cylinders: Capacity and Duration of Use
- Cylinder capacities and duration of use are tabulated (see slide 6 for specific values)
Oxygen
- Oxygen delivery is measured in terms of concentration of inspired oxygen (FiO2) and flow
- Normal room air is 21% FiO2
- Increasing administered FiO2 increases the oxygen content delivered to the body
Oxygen Delivery
- Oxygen delivery devices include nasal cannula, face masks (simple, partial rebreather, non-rebreather) and the venturi mask
- Deliver oxygen concentrations from 24-90% depending on device and settings
- Nasal cannula: low-flow; simple/partial rebreather masks do not have reservoir bags or one-directional side ports; non-rebreather masks have a reservoir bag and one-way valves prevent exhaled oxygen from re-entering the bag; venturi masks deliver specific FiO2 concentrations via changeable inserts
Nebulizer
- Nebulisers use oxygen, compressed air, or ultrasonic power to break up medication solutions and deliver aerosolized particles directly to the lungs
Management of Wheezing
- This section details the management of wheezing.
Bronchodilators
- Asthma involves: narrowing of airways, bronchial spasm, increased mucus production.
- Respiratory distress can also include edema of the respiratory tract mucosa which thickens the lining restricting airway diameter.
- Bronchodilators are split into selective and non-selective agents acting on alpha and beta adrenergic receptors.
- Bronchodilators act on bronchial smooth muscle and improve patients' conditions (side effects minimised)
Inhalation Delivery of Medications
- Beta2-specific medications can be delivered via nebulization, parenteral or oral administration.
- Nebulization involves conversion of liquid medication into a mist
- Various nebulizer types including pneumatic or ultrasonic types exist
- Metered-dose inhalers (MDIs) deliver medication in a propellant spray
Metered-Dose Inhaler (MDI)
- MDIs deliver a predetermined amount of medication in the correct particle size propelled by gas.
- Improper use may result in medication not reaching the lungs.
- A spacer device can help slow down the medication movement to improve delivery.
Asthma
- Asthma is caused by a trigger reaction (intrinsic/extrinsic).
- Intrinsic triggers are within the body (eg., exertion, anxiety).
- Extrinsic triggers are outside the body (eg., animal dander, dust, pollen, cleaning chemicals, animal droppings).
Asthma Management
- First-line treatment for asthma is inhaled beta2 drugs, followed by IV medications if inhaled drugs fail.
- Salbutamol (albuterol) is the most common inhaled drug used to treat reversible bronchospasm.
- Ipratropium bromide is used for severe asthma/COPD when salbutamol is ineffective
- It's a cholinergic receptor blocker that decreases smooth muscle contraction
Second-Line Therapy for Acute Exacerbation of Asthma
- Clinical picture of asthma or COPD (eg., gasping for breath, accessory muscle use, wheezing) indicates the need for treatment.
- Consider corticosteroids if transport time is prolonged
- A Peak Expiratory Flow Rate (PEFR) can indicate the severity of the exacerbation, response to therapy, and potential need for further intervention
- Severe/life-threatening asthma requires immediate administration of hydrocortisone IV or IM
- Adrenaline is used in severe cases to stimulate alpha/beta cells and relieve bronchospasm
COPD Management
- COPD is a classification of diseases that obstruct the pulmonary system.
- Common COPD diseases include emphysema and chronic bronchitis
- In severe COPD exacerbations, treatment focuses on oxygenation and ventilation.
- Chronic COPD patients breathe with a hypoxic drive
- Mild hypoxia is required for breathing
- SpO2 levels in the low 90s are often adequate
- Steroids and bronchodilators are used to manage COPD similar to asthma
Hypoxic Drive
- Discusses why COPD patients should not be given too much oxygen and the potential consequences and appropriate oxygen regimes for these patients.
Medication Review for Next Week's Quiz
- Salbutamol, Ipratropium bromide, Hydrocortisone, and Dexamethasone are listed for review.
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Description
This quiz covers essential pharmacology for managing respiratory emergencies in pre-hospital settings. Participants will learn about various oxygen delivery systems, bronchodilator agents, and specific medications used for treating conditions like asthma and COPD. Understanding these concepts can enhance the care provided to patients in acute respiratory distress.
