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.

*Updated* I wanted to clarify, which drugs/treatments are contraindicated after the patient is found to be hypotensive, even if the BP normalizes either with or without IV bolus therapy?