Question: Case - Adult patient experiencing an asthma attack. Wheezing in all fields (air entry in all fields) and tachypnea. Historically, we've been taught to administer Epi in cases of 'silent chest', absent air entry in any fields or patient requiring BVM ventilation. The BVM ventilation has always been associated with diminished air entry/silent chest, but not really with hyperventilation. The old BLS stated to assist with BVM ventilation in any patient with a RR>28. Does this mean that if the patient has RR>28, therefore requiring BVM ventilation, he/she SHOULD receive Epi even if there is air entry (albeit wheezing) in all fields?
The Patient Care Standard does not answer your question. The Companion Document gives some guidance. On page 12 it states Epinephrine 1:1,000 IM is indicated when the patient is asthmatic and BVM ventilation is required. This is typically after salbutamol has had no effect, however salbutamol could be bypassed and epinephrine be administered immediately due to the severity of the patients condition. The indications to administer epinephrine do not change based on the ability to administer salbutamol. This is to be interpreted as meaning if the patient who is having an exacerbation of asthma and requires BVM support, then Epinephrine should be given if the other conditions are met.