Awesome, that was just what I needed to know. According to your protocols (and this is just my read on it) you should be unequivocally running these as medical arrests. The FBAO code protocol is in no way indicated. The medic instructors teaching you this are totally in the wrong.

They are applying a cookbook level of medical understanding and trying to make decisions based on it.

They think that you should follow the FBAO protocol because they don't understand the pathophysiology of either FBAO or a hypoxic code secondary to hypoxia from a sever anaphylactic reaction resulting in edematous closure of the ariway.

The reason FBAO emphasizes epi. in your protocols is for it's smooth muscle relaxation properties. The same reason that Glucagon can be indicated in FBAO. The theory would be that often in FBAO objects of a size that could pass down into the lungs are stuck along with muscle spasms of the larynx, epiglottis, hypo-pharynx, and even visibly out to the superficial strap muscles of the neck. In rare cases you can relax these muscles with a sympathomimetic enough to subsiquently pass the FB down into a main stem through PPV. Obviously in FBAO we aren't looking for bronchospasm relief. Now, I would argue that again, once a PT codes it's a mute point. With luck we hope code drugs have enough pressure to push them into coronary circulation which is the first branch off the aorta, so it get's the benefit of all the pressure CPR generates. Epi. or glucagon in FBAO, at least as far as I know is not for post code. My overall assessment of your protocol is that the PT condition indicates cricothyrotomy, this is the only life saving measure. It feels like they wrote that protocol to make it look like they had a plan other than "We don't trust our medics with cricothyrotomies (needle even), but want to look like the plan is something other than let the PT die, which is essentially what this protocol says.

I don't in any way see how it could be defended to run the FBAO on a hypoxic code secondary edematous airway closure. The argument that the epi. in the FBAO could perfuse to the muscular level and be effective is just not pharmacokinetically probable. And what sounds like them trying to be clever to apply a treatment they think will work better they are actually making up some weird and confusing justification.

You are right that your protocols have no plan for an anaphylactic code specifically you should just run a medical code per ACLS and during your H's and T's consider Hypoxia as the cause. Again your protocols do not give you the tools to help this patient and there is just no reason to think you should be running a FBAO, according to your protocols, or physiologically.

That's just my interpretation and I've seen medics with really good intentions get carried away in this type of thing. Unfortunately we have to recognize that the average medic doesn't have the basic science knowledge to really understand how their drugs are working. they know WHAT epi does but they clearly don't know why or how to a level that they should be making these kinds of decisions.

I think your protocols are clear about what to do, this would be a medical code all the way. Your medical director simply doesn't want you to be able to do what the patient needs, surgical intervention of the airway, and out of feeling helpless these guys are trying to figure out something other than "so we just let them die and pretend to do CPR like it's going to work." But that's literally what the protocol means.