EMS Protocol of the Week - Asthma
From the perspective of an ED physician, Protocol 507 – Asthma (attached below) is one of the most frustrating ones to encounter. Not because it’s particularly complicated, but rather because it often doesn’t leave you with anything to do. The Standing Orders for 507 include almost everything you would do yourself for a patient coming through walk-in triage with an acute asthma exacerbation: albuterol/ipratropium nebs x3 followed by continuous albuterol, IV access, steroids, magnesium, and even IM epinephrine for severe exacerbations. Checking an EKG is also included for appropriate patients. The only MCO for these cases is for the patient that may benefit from a repeat dose of IM epi. Otherwise, everything else is done by the paramedics on their own. It’s not unusual to receive a patient who was in extremis on EMS arrival, got IM epi, multiple nebs, steroids, and magnesium, and who now feels entirely better on ED arrival and wants to go home. And maybe sometimes the patient can go home, but be extraordinarily careful in these instances that you’ve fully reviewed the patient’s prehospital course. Note that in this case, the patient in front of you is wildly different from the one EMS encountered, and consider that fact at length when determining the patient’s disposition. In any event, whether it’s admission, discharge, or observation, the only thing left for you to do at that point is order the chest x-ray and maybe labs.
See? Boring for us, fun for the medics. And good for the patient, which I GUESS is what really matters.
Questions, comments, concerns? Send an email! Otherwise keep checking www.nycremsco.organd the protocol binder for more fun stuff.
PS, while it doesn’t say so explicitly, this protocol is written for adults. What do we do with the kids? Stay tuned!
David Eng, MD
Assistant Medical Director, Emergency Medical Services
Attending Physician, Department of Emergency Medicine
Maimonides Medical Center