Would you treat a patient with COPD who is in severe respiratory distress, using accessory muscle use, cyanotic around the lips, no wheezes, but mild crackles in the bases with 1. Salbutamol, dexamethasone, and then CPAP? 2. Or just Dexamethasone and then CPAP? 3. Or just Salbutamol and CPAP? According to the companion Doc for CPAP it states that “CPAP should be considered as an additive therapy to the bronchoconstriction (specifically COPD exacerbation) or acute cardiogenic pulmonary edema medical directive, not a replacement.” Please clarify for me. Thanks!

Can I give a pediatric patient some juice, with their dexamethasone, to make it more palatable? I see this done in-hospital.

How long after someone took an oral steroid (example prednisone) would be contraindicated for giving dexamethasone within the Bronchoconstriction Medical Directive? The Croup Medical Directive is clear that steroids must not have been taken within the past 48 hours. But, the Bronchoconstriction Medical Directive only says, “Currently on PO or parenteral steroids”. What is considered Currently on – taken within the last 24 hours?

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?

With regard to the croup protocol, I am looking for clarification on the indication of “history of URTI.” Does this need to be diagnosed in hospital, or can recent symptoms of an URTI be enough? If the symptoms are enough, how long should the patient present with them for it to qualify as an URTI?

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

If my asthmatic patient has an anaphylactic reaction do they also get dexamethasone?