Question: In the Bronchoconstriction Medical Directive, would a patient ever receive salbutamol followed by epinephrine? Is epi there in case that the patient does not respond to salbutamol and instead gets worse after salbutamol administration? If the patient does not require epi at first, but instead is given salbutamol, then gets worse requiring epi, could that epi administration follow with salbutamol again?
Great question. You absolutely can have an asthma patient who is tiring out, and you could be giving
salbutamol via MDI (8 adult sprays), who worsens and now requires BVM ventilation.
As you begin ventilating the patient, your partner can prepare the epinephrine 1:1000, perform an independent double check and administer the 60 Kg patient an IM injection of 0.5 mg epinephrine.
While ventilating with BVM, you can continue to administer salbutamol via MDI adapter (if available) on the BVM.
If, lets say, in 5 minutes the patient improves and no longer requires BVM ventilation but is still wheezy, go ahead and consider another dose of MDI (8 adult sprays is given) salbutamol provided the maximum number of doses hasnt been reached.