NREMT Paramedic Cognitive ExamOperationsMedium
A paramedic is dispatched to a residence for a 5-year-old child experiencing a severe asthma exacerbation. The child is in severe respiratory distress, with audible wheezing, retractions, and an SpO2 of 88% on room air. After administering oxygen and assisting ventilations, what is the MOST appropriate next pharmacological intervention?
- ASubcutaneous Epinephrine
- BIntramuscular Glucagon
- CInhaled Albuterol and Ipratropium
- DIntravenous Dexamethasone
Show answer & explanationAnswer & explanation
Correct answer: C. Inhaled Albuterol and Ipratropium
For a severe asthma exacerbation, bronchodilators are the primary pharmacological intervention to open the airways. A combination of inhaled Albuterol (a short-acting beta-agonist) and Ipratropium (an anticholinergic) provides synergistic bronchodilation and is highly effective in pediatric asthma.
Why the other options are wrong
- A. Subcutaneous epinephrine can be used for severe, refractory bronchospasm, especially if associated with anaphylaxis, but inhaled bronchodilators are typically preferred as the first step for asthma.
- B. Glucagon is used for hypoglycemia or beta-blocker overdose, not for asthma exacerbation.
- D. Dexamethasone (a corticosteroid) is important for reducing inflammation but has a delayed onset and is not the immediate bronchodilator needed for acute severe distress.
Pediatric Asthma Exacerbation Tx
Emergency management of acute worsening of asthma symptoms in children, focusing on rapid bronchodilation, oxygenation, and reducing airway inflammation.
- Oxygen administration is crucial.
- Inhaled short-acting beta-agonists (e.g., Albuterol) are first-line.
- Ipratropium bromide can be added for synergistic effect.
- Corticosteroids (e.g., Dexamethasone) reduce inflammation but have delayed onset.
Memory trick: Oxygen, Bronchodilate, Inflame-Reduce, Repeat.