In addition to oxygen, which bronchodilator is commonly administered via nebulizer under ICEMA standing orders for bronchospasm?

• A. Levalbuterol
• B. Ipratropium bromide
• C. Epinephrine
• D. Albuterol

Answer: (D)

In EMS standing orders for bronchospasm, the quick-acting nebulized bronchodilator most commonly used after providing oxygen is albuterol. Albuterol is a beta-2 adrenergic agonist that relaxes airway smooth muscle by increasing cyclic AMP, producing rapid bronchodilation within minutes. Its proven efficacy in acute asthma and other bronchospastic conditions, plus widespread availability and familiarity in prehospital care, makes it the standard first-line choice in many ICEMA protocols.

Levalbuterol works similarly and can be used in some settings, but it’s less universally stocked or indicated as the default in many standing orders, so it’s not the common default choice. Ipratropium bromide is an anticholinergic bronchodilator often used as an adjunct to albuterol or in specific conditions (like COPD), rather than as the primary nebulized agent for routine bronchospasm in standing orders. Epinephrine has a role in severe allergic reactions or specific rescue indications but is not the typical nebulized option for general bronchospasm in ICEMA protocols.