Question: Would it be a waste of a paramedics time to deliver Salbutamol through a BVM to an unconscious patient while setting up for Epi in the case of an Asthma or anaphylaxis? Would the OPA if used, not block the mist and prevent inhalation? To me, Epi administration (scenario dependent) would be the priority. Thanks

 In the setting of a patient who is unconscious with suspected asthma or anaphylaxis, and is requiring BVM, epinephrine is indicated as you correctly state. In the setting of anaphylaxis, epinephrine would be your first drug administration priority and should not be delayed. There are very few silver bullets in medicine and this is one of them.  After epinephrine has been administered, then other treatments can be prioritized including salbutamol. The concurrent administration of salbutamol (as long as it does not delay epinephrine administration) would still have some benefit in the situation you describe. We know that calls are dynamic, but in the case of anaphylaxis, airway management and epinephrine administration should be the two top priorities.  In the setting of an apneic patient with suspected asthma, then as per the directive, epinephrine should be the first medication administered.  Unlike anaphylaxis, epinephrine use in asthma has only some limited evidence showing its effectiveness. It is prudent to administer salbutamol as early as possible to begin reversing bronchoconstriction, especially those requiring BVM.

In regards to the use of an OPA while delivering salbutamol, it will likely allow for easier ventilation by helping maintain upper airway tone (ex. preventing the base of tongue from compressing epiglottis) and hence, allow for increased drug delivery to the lungs with each breath.   

Airway/Breathing,Bronchoconstriction

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