Asthma / COPD — Life-Threatening

For the dyspneic patient in extremis, suspect Asthma / COPD Exacerbation if:

  • Wheezes, rhonchi, long expiratory phase
  • Signs of Severe Exacerbation:
    • Respiratory rate >30
    • Retractions (use of accessory muscles)
  • Signs of Life-Threatening exacerbation:
    • Cyanosis
    • Agitated
    • Somnolent
Stabilizing Measures (depends on available options, in order of preference):
  • Call 911.  Give O2.
  • Albuterol nebulizer (continuous)
  • Albuterol inhaler — 1 puff q 1 min.
  • If Deteriorates / Life-threatening:
    • Epinephrine 1:1000 (in 1 ml vial) 0.3 – 0.5 cc sub-cut. q5min x 3 doses; OR
    • EpiPen IM, repeat in 10 min.

See posting Acute Dyspnea – 1.