Patients exhibiting signs and symptoms of moderate to severe respiratory distress and a history consistent with asthma. All that wheezes is not asthma, particularly new onset in adults.

1. Perform patient assessment and ABC's.
2. Administer oxygen via a device which will insure adequate oxygenation. If the patient presents with acute respiratory distress and poor tidal volume, be prepared to assist ventilations via BVM.
3. Apply pulse oximetry device and record reading.
4. Monitor vital signs in accordance with S.O.P. protocol.
5. Transport all patients treated for asthma.
6. After attempting to contact On-line Medical Control you may administer 2.5 mg/3m. Albuterol via small volume nebulizer.
7. Request ALS Intercept as soon as possible.

INTERMEDIATE LIFE SUPPORT

1. Administer Albuterol 2.5 mg/3cc via small volume nebulizer (1.25 mg/3cc for pediatrics).
2. If patient not responding to Albuterol, contact Medical Control request Epinephrine 1:1,000 0.3 mg SQ. (0.01 mg/kg max 0.3mg for pediatrics).
3. Establish IV access using an isotonic solution. Consider fluid bolus for patients without cardiovascular disease, otherwise run TKO.

1. Other therapies appropriate in this setting:
   1. May repeat Albuterol Nebulizer therapy 'back to back' up to X 3.
   2. May repeat 2nd Dose Epineprhine 1:1,000 0.3 mg SQ.
   3. If response to Albuterol and Epinephrine is determined inappropriate, contact Medical Control for orders to administer Magnesium Sulfate 1 gm/100cc IV drip over 20min. (Carefully monitor LOC as well as BP for signs of toxicity. Have Calcium Gluconate readily available [Caclium Gluconate 10% dosage: 20 mg/kg slow IVP over 10 min.] Consult with Medical Control prior to administration of Calcium Gluconate for guidance).
   4. Endotracheal intubation if respiratory arrest appears imminent or occurs.
   5. Reassess if poor response for alternative diagnosis.