Question is regarding dexamethasone in anaphylaxis. Scenario of a 50s M stung by a bee, known anaphylaxis reactions in past, no epi pen called EMS. Pt had angioedema, hives, and signs of bronchoconstriction. Pt treated with epi, followed by benadryl and some salbutamol for his bronchoconstriction. Pt has a history of asthma. Causative factor of bronchoconstriction likely being from anaphylaxic reaction to the bee sting, which the bronchoconstriction quickly resolved with epi, benadryl and salbutamol. Could this pt benefit from dexamethasone? Is this part of the expectation if you have anaphylaxis and the pt also has bronchostriction, with indications as described in protocol, that we should follow the protocol including dexamethasone? And while I’m on the topic, thoughts on dexamethasone in anaphylaxis in general, often steroids are given in hospital, could dexamethasone be beneficial?

If we have an asthmatic patient that is refusing transport to the hospital after administering salbutamol, should we still proceed with dexamethasone administration?

Are we still withholding EPI in bronchoconstriction for greater than 50 year old patients? It’s not in the protocols to but I remember the memo from Feb 2021 saying to withhold it.

Is there a pharmacological benefit to administering dexamethasone PO vs IV/IM or is it the preferred route simply to avoid unnecessary sharp use? 

Why do the pandemic guidelines allow for the administration of 2 doses of epinephrine (<50y) in bronchoconstriction (asthma exacerbation) vs the ALS PCS allowing only a single dose (without age guideline)?

Does wheezing have to be present in the patient assessment to administer Ventolin?