Administering Dex With a Prescribed Steroid
With patients who are already taking PO Dexamethasone who have yet to take their PO Dex, and are having an acute COPD exacerbation or another ailment that causes them to meet the directive for Dex, would Dex be contraindicated due to the current use of steroids (even though it’s the same we are providing)?
This is where a really good history gathering comes into play on top of a physical assessment and knowing the pharmacology of Dex. If a patient has been recently discharged from hospital lets say and they have been prescribed Dexamethasone, or any other steroid for that matter, it would be reasonable to administer it if they have not yet started taking their prescription. Of course, you should document this along with your reasonings for administering it, as you mentioned it is a contraindication to be using other steroids. If you don't believe they self administered correctly or took the appropriate dose, you can of course always consult with a base hospital physician to determine risks/benefits.
Medical Directive Category
Please reference the MOST RECENT ALS PCS for updates and changes to these directives.