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The Valley Hospital Mobile ICU
Standing Orders / Communications Failure Orders
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8.41-7.17 Standing orders for respiratory distress with wheezing due to Asthma,
COPD or bronchoconstriction
(a) The following standing orders are authorized in the event that an adult patient presents with
dyspnea where the signs and symptoms are consistent with asthma, COPD or any other dyspnea
associated with wheezing or suspected bronchospasm:
1. Assess and secure airway; administer oxygen as needed, or via nebulizer;
2. Mix 2.5 mg Albuterol and Ipratropium Bromide 0.5 mg into normal saline and administer via
nebulizer;
3. Establish vascular access;
i. If patient presents with signs and symptoms of pulmonary edema/congestive follow
standing orders for pulmonary edema/congestive heart failure as outlined in N.J.A.C.
8:41-7.10.
4. Reassess the patient and if patient condition requires administer a maximum of two
additional treatments of 2.5 mg/3 mL normal saline solution via nebulizer;
5. Contact medical command.
Communications Failure Orders for respiratory distress with wheezing due to
COPD or bronchoconstriction
(a) The following Communications Failure Orders are authorized in the event that the patient is
presenting with an exacerbation of Asthma or other unspecified bronchoconstriction:
1. Administer Methylprednisolone Sodium Succinate 125 mg or Dexamethasone Sodium
Phosphate 10 mg IV/IO over one to two minutes.
2. If the patient has not responded to front line therapy and present with severe, ongoing
exacerbation, administer Magnesium Sulfate 2 grams IV/IO drip over ten minutes.
3. Administer Normal Saline 500 mL IV/IO bolus. This may be repeated one time to a
maximum of one liter.
4. If the patient presents in respiratory failure as defined by altered mental status, fatigued
and/or shallow respirations or absent lung sounds, or the patient is in respiratory arrest:
a. Age < 40 without significant cardiac history: Administer Epinephrine 1:1000 0.3 mg
IM