Hôpital régional de Sudbury Regional Hospital
SHORTNESS OF BREATH – MILD/MODERATE CARE MAP
ASTHMA and/or MILD COPD
INCLUSION CRITERIA:
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Mild/Moderate Shortness of Breath
Oxygen saturations greater than/equal to 90% unless known COPD
Known Asthmatic
Audible wheezing
Dyspnea at rest, cough, congestion
EXCLUSION CRITERIA:
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Severe Shortness of Breath
Oxygen saturations less than 90% unless known COPD
Laboured respirations
Tachycardic
Agitated, diaphoretic, cyanotic
Difficulty speaking
Exhausted, confused
TESTS (Medical Directive # EDOS01, EDOS02)
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Bloodwork: CBCD, Electrolytes, Urea, Creatinine, Random Glucose, Calcium, ECG
Peak flows (pre & post X 3)
Outpatient Chest X-ray
ASSESSMENT
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Vital Signs (temperature, pulse, blood pressure, respiration, oxygen saturation)
Postural Vitals – Lying down for full 5 minutes and Standing (High Fowler’s if unable to stand) for full
2 minutes
Mental Status including any changes from baseline
Hydration Status (mucus membranes)
Degree of dyspnea
Chest sounds, air entry, respiratory effort
C/O pain, type and location
Caution in patients with known active tuberculosis or underlying chronic suppurative lung disease
(bronchiesctasis, cystic fibrosis) as potential risk for increased complications
Caution in patients with immunosuppressed state (HIV, immunosuppressive or antineoplastic drugs,
haematologic malignancy, organ transplant recipient) as potential risk for increased complications
TREATMENT OPTIONS (Medical Directive # EDOS04)
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Oxygen therapy ***if known CO2 retainer titrate O2 to maintain between 88-92%***
Saline lock
Hôpital régional de Sudbury Regional Hospital
MEDICATIONS *******CHECK ALLERGIES & MEDICATION COMPATIBILITY******
(Medical Directive # EDOS03)
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Salbutamol (Ventolin) inhaler (100mcg/puff) with spacer and mask- 4 to 8 puffs inhaled q15-20 minutes
for
3 doses OR
Salbutamol (Ventolin) nebulizer (5mg/ml) – use 1ml in 3ml 0.9% normal saline q15-20 minutes for
3 doses
AND
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Ipratropium (Atrovent) inhaler (20mcg/puff) with spacer and mask – 4 to 8 puffs inhaled q15-20
minutes for
3 doses OR
Ipratropium (Atrovent) nebulizer (250mcg/ml) use (1 to 2ml) in 3ml 0.9% normal saline q 15-20
minutes for 3 doses
AND
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Prednisone 50mg tablet X 1 dose OR
Methylprednisolone (Solu-Medrol) 40 to 125mg IV; dilute in 50mL D5W or 0.9% normal saline X 1
dose over 15-30 minutes.
ONGOING MEASURES
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Nutrition – Regular diet or as tolerated (encourage fluids unless contraindicated)
Activity as tolerated – if non-ambulatory patient unsure repositioning q2hrs
Physiotherapy
Occupational Therapy
Spirometry
REFERENCES
Beveridge, R., Grunfeld, A., Hodder, R., & Verbeek, P. (1996). Guidelines for the emergency management of
asthma in adults. Canadian Medical Association Journal, 155(1), 25-37.
Lozano, P., Schaefer, J., Stout, J., Wagner, E., & Weiss, K. (2003). Interventions to improve the management of
asthma in primary care settings. Cochrane Database of Systematic Reviews, 4, 1-6.
Mackey, D., Myles, M., Spooner, C., Lari, H., Tyler, L., Blitz, S., et al. (2007). Changing the process of care and
practice in acute asthma in the emergency department: experience with an asthma care map in a regional
hospital. Canadian Journal of Emergency Medicine, 9(5), 353-365.
Ontario Lung Association Emergency Department Asthma Pathway. (2009). Medication Guidelines for
Emergency Management of Adult Asthma. Retrieved October 14, 2009, from
http://www.on.lung.ca/Health-Care-Professionals/EDACP/resources/medication_guidlines.pdf
RNAO Nursing Best Practice Guideline. (2007). Adult Asthma Care Guidelines for Nurses: Promoting Control
of Asthma. Retrieved October 14, 2009, from
http://www.rnao.org/Storage/27/2207_Asthma_Supplement_-_FINAL.pdf
Hôpital régional de Sudbury Regional Hospital
To, T., Cicutto, L., Degani, N., McLimont, S., & Beyene, J. (2008). Can a Community Evidence-based Asthma
Care Program Improve Clinical Outcomes. Medical Care, 46(12), 1257-1266.