You start a primary survey; no cat haem, Airway is clear, lots of wheezing bilaterally in all fields on auscultation, radial pulse present but tachycardic with some clamminess to his skin. Temperature and blood sugars are in normal parameters (36.8⁰c and 5.4). Observations; Resps 28, HR 115, BP 119/83, O2 saturations 93%, 3 lead ECG NSR, 15 GCS. You do a peak flow, he blows 300 l/min on the tube, his normal range is around 640 l/min

Given all the information, what level of severity is his asthma classed as

What medication would you look to start with in his treatment

What is the initial dosage of Salbutamol nebulised in this scenario

You start the nebuliser and confirm the blue light response required from the back up Ambulance, they inform you they are 10 minutes away. You auscultate his chest after the nebuliser but note there is little change to the audible wheeze and his breathing still feels the same. What following nebulisation drug can you administer

What is the dosage of the Ipratropium Bromide

The Ipratropium Bromide is set up and being administered to the patient. You cannulate the patient and continue doing observations. The nebuliser starts coming to its end and the patients’ breathing seems to have worsened. If there is ever a change in a patients’ condition what should be reviewed

You quickly re-assess the patient and note that his effort of breathing is more laboured and his resps have increased. You contact control for an update on the back up but they explain the crew has been diverted to a cardiac arrest and another ambulance is on route to you but they will be a further 15 minutes. With IV access, what drug could you consider giving to help the patient

You draw up the Hydrocortisone, what is the dosage for IV administration in Severe Asthma

You slowly administer the IV Hydrocortisone, explaining it may give a burning sensation. From the medications you’ve administered so far, what could you repeat every 5 minutes

What further medication in the Paramedic scope could be administered to help the patient where available

You re-apply a new dose of salbutamol, but you take note that you have been on scene for a short while now and the patients’ condition has continued to slowly deteriorate in front of you. You ask for a further update from control and they can only say the ambulance is still 15 minutes away. You do another primary survey and set of observations. As you work your way through the patient slumps back saying he is tired and with this is breathing becomes remarkably worse. His resps are now around 35 and it is very shallow. You attempt to sit him up using pillows but he says he is too weak to hold himself. The defibrillator screen starts flashing that his O2 sats have dropped to 89% although he is on a nebuliser. What has his severity of asthma changed to

What further medications would you consider giving now to help the patients’ condition

What initial dose of Adrenaline 1:1000 IM will you give

You administer the Magnesium Sulfate and IM Adrenaline, updating control that your patient is deteriorating and you need a crew asap. The nebuliser is still running but the patients’ condition doesn’t seem to respond to the treatment given so far. A further 5 minutes passes, can you repeat the IM Adrenaline

You give another 500 mcg of Adrenaline but on reviewing the patient again, his respirations are now rapid and pretty much ineffective, his O2 sats have dropped further to 86%, his consciousness level is dropping. You can hear outside that the crew has arrived. What action can you do to try and assist his breathing