Rescue Prednisone vs. Dexamethasone
Question #24
Prior to our arrival on scene of a short of breath call, a clinic doctor gave a dose of prednisone for the acute reaction. The pt required full utilization of the bronchoconstriction medical directive, however because the prednisone was not prescribed and just given as an emergency dose, we were unclear if that was a valid contraindication for dexamethasone. As we were 4 minute transport time we decided to withhold due to uncertainty.
Answer:
Since prednisone and dexamethasone are both corticosteroids with similar mechanisms of action, the prior administration of prednisone by the clinic physician would meet the contraindication for dexamethasone under the bronchoconstriction medical directive. No additional dose of corticosteroid would be required, as the anti-inflammatory effect has already been initiated. Withholding dexamethasone in this scenario was appropriate, as administering another corticosteroid would not provide added benefit.
Medical Directive Category
Bronchoconstriction
Published
13 February 2025
ALSPCS Version
5.4
Views
37
Please reference the MOST RECENT ALS PCS for updates and changes to these directives.