What are the initial steps for paramedic management of respiratory medical emergencies?

From the Guidelines

The initial steps for paramedic management of respiratory medical emergencies should focus on checking for responsiveness, shouting for nearby help, activating the emergency response system, and getting an AED and emergency equipment, as outlined in the 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care 1. The primary assessment should focus on airway, breathing, and circulation, with oxygen administration being crucial, typically starting with high-flow oxygen at 15 liters per minute via a non-rebreather mask for patients in respiratory distress. Some key points to consider in the management of respiratory medical emergencies include:

• Ensuring scene safety and performing a primary assessment
• Administering oxygen and positioning the patient upright at 45-90 degrees to ease breathing effort
• Monitoring vital signs, including oxygen saturation, respiratory rate, heart rate, blood pressure, and end-tidal CO2
• Considering the use of medications such as albuterol, ipratropium bromide, and epinephrine for specific conditions like bronchospasm and anaphylaxis
• Establishing IV access for medication administration and considering the use of CPAP ventilation for patients with adequate respiratory drive but poor oxygenation. It is also important to follow the principles of airway management, including preparation, team and individual preparation, creating a COVID-19 tracheal intubation trolley or pack, having a strategy, involving the smallest number of staff necessary, wearing appropriate PPE, avoiding aerosol-generating procedures, and focusing on promptness and reliability 1. In terms of specific interventions, the use of techniques such as videolaryngoscopy for tracheal intubation, a 2-person 2-handed mask ventilation with a VE-grip, and a second-generation supraglottic airway device for airway rescue may be considered 1. Overall, the goal of paramedic management of respiratory medical emergencies is to rapidly assess and intervene to stabilize the patient's breathing, while also preparing for potential complications and following established guidelines and principles of airway management.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION Adults and Children 2 to 12 Years of Age: The usual dosage for adults and for children weighing at least 15 kg is 2.5 mg of albuterol (one vial) administered three to four times daily by nebulization. The use of albuterol sulfate inhalation solution can be continued as medically indicated to control recurring bouts of bronchospasm Note: Use only as directed by your physician. More frequent administration or higher doses are not recommended.

The initial steps for paramedic management of respiratory medical emergencies involving albuterol administration are:

• Administer 2.5 mg of albuterol by nebulization, as directed by a physician 2
• Use one vial (3 mL of 0.083% inhalation solution) for adults and children weighing at least 15 kg 2
• Follow the instructions for use, including removing the vial from the foil pouch, twisting the cap off, and squeezing the contents into the nebulizer reservoir 2
• Key considerations:
  • Administer the medication as directed by a physician
  • Do not exceed recommended dosage or frequency
  • Monitor the patient's response to the medication and seek medical advice if the usual relief is not provided 2

From the Research

Initial Steps for Paramedic Management of Respiratory Medical Emergencies

The initial steps for paramedic management of respiratory medical emergencies involve several key considerations, including:

• Preoxygenation: This is a critical step in managing respiratory emergencies, as it helps to increase the patient's oxygen reserves and reduce the risk of hypoxia 3, 4.
• Airway management: Paramedics must be able to secure the patient's airway, either through endotracheal intubation or the use of alternative airway devices such as laryngeal masks or laryngeal tubes 5, 6.
• Ventilation: Once the airway is secured, paramedics must provide adequate ventilation to support the patient's respiratory needs 7, 6.

Preoxygenation Techniques

Preoxygenation can be achieved through various methods, including:

• Nonrebreather (NRB) mask with flush rate oxygen: This method has been shown to be noninferior to bag-valve-mask (BVM) preoxygenation in healthy volunteers 3, 4.
• BVM preoxygenation: This method is commonly used in emergency settings, but may be less effective than NRB mask preoxygenation in certain situations 3, 4.
• Simple mask with flush rate oxygen: This method has been shown to be less effective than NRB mask preoxygenation with flush rate oxygen 4.

Airway Management Options

Paramedics have several options for airway management, including:

• Endotracheal intubation: This is the most secure method of airway management, but may be challenging to perform in emergency settings 5.
• Laryngeal mask insertion: This method has been shown to be faster and more reliable than endotracheal intubation in certain situations 5.
• Laryngeal tube insertion: This method has been shown to be effective and safe for airway management in out-of-hospital cardiopulmonary arrest 6.