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Questions and Answers
What is a common issue patients experience with the long-term use of nasal cannulas at night?
What is a common issue patients experience with the long-term use of nasal cannulas at night?
Which condition is characterized by reversible airway obstruction?
Which condition is characterized by reversible airway obstruction?
Which factor contributes to respiratory distress by reducing airway diameter?
Which factor contributes to respiratory distress by reducing airway diameter?
What is the effect of bronchospasm on an airways' radius?
What is the effect of bronchospasm on an airways' radius?
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What type of bronchodilators act preferentially on bronchial smooth muscle?
What type of bronchodilators act preferentially on bronchial smooth muscle?
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Which medication type targets beta2 receptors to relax bronchial smooth muscle?
Which medication type targets beta2 receptors to relax bronchial smooth muscle?
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What is the primary objective of prehospital interventions for respiratory distress?
What is the primary objective of prehospital interventions for respiratory distress?
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What common symptom do patients with asthma and COPD report during respiratory distress?
What common symptom do patients with asthma and COPD report during respiratory distress?
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What is the impact of increased secretions on patients with respiratory conditions?
What is the impact of increased secretions on patients with respiratory conditions?
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Which medication is the most commonly used in the prehospital setting for respiratory issues?
Which medication is the most commonly used in the prehospital setting for respiratory issues?
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In what context has the use of oxygen become controversial?
In what context has the use of oxygen become controversial?
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What is a common ongoing change for EMS providers regarding oxygen delivery?
What is a common ongoing change for EMS providers regarding oxygen delivery?
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What type of catheter may be required for patients needing continuous oxygen therapy at home?
What type of catheter may be required for patients needing continuous oxygen therapy at home?
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What is a significant benefit of advanced life support (ALS) interventions in respiratory distress?
What is a significant benefit of advanced life support (ALS) interventions in respiratory distress?
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Which group of patients is commonly encountered with a need for continuous oxygen at home?
Which group of patients is commonly encountered with a need for continuous oxygen at home?
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What is one risk associated with the administration of oxygen?
What is one risk associated with the administration of oxygen?
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What is the primary receptor that beta2 agonists are selective for?
What is the primary receptor that beta2 agonists are selective for?
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Which of the following is a potential side effect of excessive dosage of beta2 agonists?
Which of the following is a potential side effect of excessive dosage of beta2 agonists?
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Why should beta2 agonists be used cautiously in patients with a history of heart disease?
Why should beta2 agonists be used cautiously in patients with a history of heart disease?
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Racemic epinephrine is classified as which type of bronchodilator?
Racemic epinephrine is classified as which type of bronchodilator?
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Which kind of triggers can cause acute asthma attacks?
Which kind of triggers can cause acute asthma attacks?
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Which receptor stimulation is primarily responsible for increasing heart rate?
Which receptor stimulation is primarily responsible for increasing heart rate?
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What effect does stimulation of beta2 receptors have in the lungs?
What effect does stimulation of beta2 receptors have in the lungs?
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Which of the following is NOT an example of an intrinsic trigger for asthma?
Which of the following is NOT an example of an intrinsic trigger for asthma?
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What is indicated when the initial PEFR is less than 50% of predicted?
What is indicated when the initial PEFR is less than 50% of predicted?
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What should be considered if the PEFR does not improve by at least 10% after bronchodilator therapy?
What should be considered if the PEFR does not improve by at least 10% after bronchodilator therapy?
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What is the role of aminophylline in the treatment of acute asthma exacerbations?
What is the role of aminophylline in the treatment of acute asthma exacerbations?
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Which of the following is a potential risk of using methylxanthines in asthma treatment?
Which of the following is a potential risk of using methylxanthines in asthma treatment?
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What effect does magnesium sulfate have on patients with asthma?
What effect does magnesium sulfate have on patients with asthma?
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What is a potential consequence of not monitoring methylxanthine levels?
What is a potential consequence of not monitoring methylxanthine levels?
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When should corticosteroids be administered for acute exacerbations of asthma?
When should corticosteroids be administered for acute exacerbations of asthma?
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What is the primary function of beta2 agonists in managing acute asthma exacerbations?
What is the primary function of beta2 agonists in managing acute asthma exacerbations?
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Under what condition should magnesium sulfate be considered for patients experiencing an asthmatic attack?
Under what condition should magnesium sulfate be considered for patients experiencing an asthmatic attack?
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What is one significant risk associated with the administration of epinephrine for asthma attacks?
What is one significant risk associated with the administration of epinephrine for asthma attacks?
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Why should epinephrine be used cautiously in adult patients with asthma?
Why should epinephrine be used cautiously in adult patients with asthma?
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What is the primary focus of initial treatment for mild to moderate COPD exacerbation?
What is the primary focus of initial treatment for mild to moderate COPD exacerbation?
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What is the primary purpose of bronchodilators in the management of asthma and COPD?
What is the primary purpose of bronchodilators in the management of asthma and COPD?
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What respiratory drive do COPD patients typically rely on for breathing?
What respiratory drive do COPD patients typically rely on for breathing?
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Which corticosteroids are most commonly used in managing moderate or severe asthma symptoms?
Which corticosteroids are most commonly used in managing moderate or severe asthma symptoms?
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In what scenario should systemic corticosteroids be considered during an asthma exacerbation?
In what scenario should systemic corticosteroids be considered during an asthma exacerbation?
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What can happen if a COPD patient is administered excessive oxygen?
What can happen if a COPD patient is administered excessive oxygen?
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What is a common clinical presentation of a patient experiencing an asthma exacerbation?
What is a common clinical presentation of a patient experiencing an asthma exacerbation?
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What is a potential complication of epinephrine used in treating asthma?
What is a potential complication of epinephrine used in treating asthma?
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What is a possible reason for choosing to administer a single dose of dexamethasone over a longer oral course of another corticosteroid?
What is a possible reason for choosing to administer a single dose of dexamethasone over a longer oral course of another corticosteroid?
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Which of the following is NOT a common classification of COPD?
Which of the following is NOT a common classification of COPD?
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What is the main role of corticosteroids in asthma and COPD management?
What is the main role of corticosteroids in asthma and COPD management?
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Which of the following statements regarding corticosteroids used for asthma is true?
Which of the following statements regarding corticosteroids used for asthma is true?
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Which of the following is NOT a symptom characterizing an asthma exacerbation?
Which of the following is NOT a symptom characterizing an asthma exacerbation?
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Study Notes
Respiratory Emergency Medications
- Respiratory distress is a common presentation in prehospital settings, affecting people across all demographics.
- Prehospital care often focuses on treating reversible bronchial constriction (bronchospasm), except in cases of acute pulmonary edema.
- Advanced life support interventions, including medication administration, significantly reduce mortality in respiratory distress cases.
Oxygen
- Oxygen is a frequently used prehospital medication.
- Oxygen use carries both benefits and risks.
- Oxygen use is becoming more nuanced, with careful titration to specific oxygen saturation ranges instead of indiscriminate application in situations like neonatal resuscitation, COPD exacerbations, and acute coronary syndrome.
- Ongoing research and guidelines updates are expected to change prehospital oxygen delivery methods.
- Some patients with COPD receive continuous oxygen therapy at home, often via transtracheal catheters for long-term use, which are surgically inserted.
Bronchodilators
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Asthma and COPD, characterized by reversible airway obstruction, cause respiratory distress through functional narrowing of airways.
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Bronchospasm (smooth muscle spasm) decreases airway diameter, while mucosal edema thickens the airways.
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Increased secretions also contribute to respiratory distress.
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Bronchodilators treat these conditions, categorized as selective or nonselective.
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Selective agents act preferentially on bronchial smooth muscle, minimizing side effects.
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Beta2 agonists, like albuterol, relax bronchial muscles without significant tachycardia or hypertension.
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Nonselective agents, like racemic epinephrine, act on multiple receptors including alpha, beta 1 & beta 2. Alpha receptor stimulation causes blood vessel constriction leading to higher blood pressure. Beta 1 receptors, found mostly in the heart, lead to an increase in heart rate and contractility. Beta2 receptor stimulation causes bronchodilation.
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Beta2 agonists should be used cautiously in patients with heart conditions. Continuous ECG monitoring is recommended.
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Examples of beta2 agonists include albuterol (Proventil, Ventolin), terbutaline (Brethine), formoterol (Foradil), and pirbuterol (Maxair).
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Ipratropium bromide (Atrovent) is an anticholinergic, not an adrenergic agent, used in severe asthma exacerbations or limited responses to albuterol. Its peripheral action is advantageous in COPD.
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A combined treatment of albuterol and ipratropium bromide (Combivent) is available to leverage both medications' different action mechanisms.
Management of Asthma
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Asthma triggers can be either intrinsic (within the body) or extrinsic (outside the body).
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Avoid triggers to prevent asthma attacks.
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First-line therapy for asthma includes inhaled beta2-specific drugs like albuterol.
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If the inhaled bronchodilators are unsuccessful, intravenous corticosteroids to treat inflammation are administered.
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Levalbuterol (Xopenex) is a newer, more beta-2 specific bronchodilator that was believed to cause fewer adverse effects than albuterol.
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Ipratropium bromide is used in severe cases, or with a limited response to albuterol.
Second-Line Therapy for Asthma Exacerbations
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Corticosteroids (methylprednisolone and dexamethasone) are used for severe asthma exacerbations with prolonged transport times, as they treat the underlying inflammatory process rather than simply treating symptoms.
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Peak expiratory flow rate (PEFR) measurement guides treatment decisions regarding exacerbation severity.
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When PEFR is less than 50% predicted, corticosteroids are recommended.
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Methylxanthines like aminophylline were once common, routine second-line agents for severe asthma exacerbations, but their use is now limited due to potential side effects and a narrow therapeutic window.
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Magnesium sulfate is a possible treatment for patients who do not respond adequately to beta2 agonist medications in suspected asthma exacerbations.
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Epinephrine should be used with caution in asthma treatment, primarily due to its strong and undesirable short-lived effects on the alpha and beta 1 receptors.
Chronic Obstructive Pulmonary Disease (COPD)
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COPD encompasses diseases causing pulmonary obstruction, specifically emphysema and chronic bronchitis.
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These conditions cause an increase in sputum production and bronchospasm, worsening with increased sputum.
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Initial treatment of mild-to-moderate COPD exacerbations focuses on reducing bronchospasm and clearing airways of secretions.
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Oxygen administration needs careful consideration, as COPD patients often have a hypoxic respiratory drive (a mild degree of hypoxia is necessary for triggering respiration).
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Supplemental oxygen may need to be titrated cautiously to avoid suppressing this natural respiratory stimulus.
Anaphylaxis
- Histamine is a chemical mediator found in body tissues, with higher concentrations in skin, lungs and GI tract.
- The body releases histamine when exposed to an antigen, resulting in increased blood flow, capillary permeability, tissue swelling bronchoconstriction, and urticaria..
- This reaction is called anaphylaxis.
Antihistamines
- There are two types of histamine receptors: H1 (acts on blood vessels and bronchioles) H2(acts on GI tract)
- Antihistamines are atropine-like with potentially unwanted side effects, including tachycardia, constipation, drowsiness, and sedation.
- Examples of antihistamines include dimenhydrinate (Dramamine), diphenhydramine, and Chlorphenamine.
Mucolytics
- Mucokinetic drugs alter respiratory secretion consistency, promoting easier clearance.
- Mucolytics thin mucus, making it less thick and sticky, improving expectoration.
Cough Suppressants
- Codeine, Benzonatate (Tessalon) are examples of antitussive cough suppressants.
Direct Respiratory Stimulants
- Direct respiratory stimulants, or analeptics, increase respiratory rate and depth, used for respiratory depression like from anesthesia.
- Doxapram (Dopram) is an example.
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Description
Explore the critical role of respiratory emergency medications in prehospital care. This quiz covers key interventions for managing respiratory distress, the use of oxygen, and emerging guidelines for its application. Test your knowledge on the latest practices and their impact on patient outcomes.
