Date Published

July 30, 2013

Updated For

ALS PCS Version ALS PCS Version 5.2


Question: In regards to the bronchoconstriction protocol, in order to administer to Epi, the patient must require BVM ventilation and have a history of asthma. What if the patient is alone or they are so short of breath that a history of asthma cannot be obtained? Or possibly this could be their very first asthma attack without an actual diagnosis yet?

We were dispatched to an 8 year old with asthma experiencing SOB; on arrival no wheezing present, lungs clear, no obvious respiratory distress noted, sats at 95 RA; 100 on o2. Mom states he takes puffers but his doctor never actually told her that he has asthma. I found this odd since he is on ventolin and steroid rescue inhaler. If that scenario was different, and we did have to bag him, we absolutely can't give this patient Epi due to the fact that the doctor never confirmed he has asthma even though he is prescribed inhalers? Is this correct?

Would a BHP patch be appropriate for an order, knowing that his air entry is diminished and the probable cause is severe bronchoconstriction, most likely due to asthma but not confirmed by diagnosis according to parent?


 Interesting and difficult scenario. Most often if a patient is suffering from an extreme asthma exacerbation, some wheezing or other evidence of bronchoconstriction is present. In your case, your patient had no wheezes, lungs were clear and they were not in respiratory distress. You were correct to not administer epinephrine.

The challenge you are describing is that had you been required to use a BVM for this patient, how reliable is the communication to the parent from their physician that the patient's underlying condition is asthma. Many children are prescribed puffers for reactive ariways disease or viral illnesses but yet do not truly have asthma which could lead to confusion. Fortunately the situation you are describing would be rare.

We would suggest that a child who is on puffers as above prescribed from a physician who presents with respiratory distress and shows clear signs of bronchoconstriction and requires BVM ventilation most likely would benefit from epi as per the bronchoconstriction medical directive. If unsure, a patch to the BHP would also be reasonable.



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