Don’t forget about dexamethasone as a treatment option
in your bronchoconstriction medical directive
- Dexamethasone is a steroid utilized for its potent anti-inflammatory effect & long duration of action
- Benefits of administering dexamethasone:
| In Acute Asthma Exacerbations | In COPD Exacerbations |
|---|---|
|
|
Dexamethasone for Bronchoconstriction
- Dexamethasone is indicated for patients with respiratory distress AND suspected bronchoconstriction AND history of asthma/COPD/20 pack-year history of smoking
- Dexamethasone can be used in conjunction with salbutamol, epinephrine, and CPAP
- Salbutamol, epinephrine, & CPAP are still priority treatments
- PO is the preferred route of administration
- Dexamethasone should be utilized even if your patient shows improvement after salbutamol or epinephrine
- Dexamethasone’s effect will not be seen by paramedics
- The contraindication to steroids applies to systemic steroids (PO or parenteral) NOT inhaled or topical steroids
*Dexamethasone has different indications, conditions, contraindications, & route of administration in the Croup medical directive*
Case
Called Code 4 to a park for a 23 year old male complaining of SOB. On arrival you are directed to your patient and acquire the following information:
Symptoms
| General Impression | Sitting upright, learning forward. Moderate respiratory distress |
| Head/Neck | Unremarkable |
| Chest | Wheeze bilateral apex to base |
| Abdomen | Unremarkable |
| Extremities | Good radial pulses, cap refill < 2 seconds |
Vitals
| LOC | Unaltered |
| RR | 32 |
| SpO2 | 92% |
| HR | 116 |
| BP | 138/92 |
| Temp | 37.5 |
Patient Information
| History | Asthma |
| Medications | Flovent, salbutamol |
| Allergies | None |
Patient reports relief of dyspnea after 800mcg of salbutamol. What are the next steps in treatment?
A) Transport code 4 CTAS 2 and continue to monitor
B) Administer another 800mcg salbutamol 5-15 minutes PRN
C) Administer 8mg dexamethasone PO
Case Highlight
Although this patient reports relief after 1 dose of salbutamol, dexamethasone is still beneficial due to its long lasting anti-inflammatory properties.
Although this patient reports relief after 1 dose of salbutamol, dexamethasone is still beneficial due to its long lasting anti-inflammatory properties.
