Not all dyspnea patients need or will be helped by a bronchodilator ... Remember, we do not have beta adrenergic receptors in our alveoli, contrary to what many people believe. Rather, the decision to use a dilator should be based on good evidence pointing to bronchospasm. Unfortunately, albuterol is not the scrubbing bubbles all purpose lung cleaner and general purpose respiratory cure all that people often make it out to be.
Hmm, can we nebulise dish soap then, will that clean that nasty icky puss and crap out of our patients lungs?
You touch on a very good point; not everybody needs salbutamol and like oxygen, IV fluid and one or two other things out there in the realm of prehospital medicine it is routinely dished out either a) to people who do not require it or
in concentrations above what is required.
I've known people to take upwards of 5 minutes to give an asthmatic patient some salbutamol because he had a temperature and the Technician was unsure if he could give nebules to a patient with a chest infection.
Not to diss the guy for not knowing but *facepalm, know thy medication!
Let's get back to the basics. Remember, Asthma, COPD, etc. do NOT need high flow O2.
Does anybody NEED "high flow" O2 (in the context of ambulance practice to mean fifteen litres on a non rebreather mask)?
If you have a long response time to a hospital and they are in COPD with CHF or Paracardial Tampanade, go with a diaretic, such as Lasix. If you have the ability insert a foley, but not absolutely needed, just easier. I know that might not be standard practice to do so, but when I was in the field that's one thing we could do.
If still SOB with cyanosis go ahead and increase O2, but be prepared to tube. I've had to do that on a few occassions. It's not recommended, just a last ditch effort.
Increasing O2 probably won't help for oxygenation and ventilation are not the same thing. You can crank that O2 regulator off the meter and cram a truck load of O2 down thier throat but if it's not able to reach the brain and vital organs it won't do much.
If anything it may be harmful; it's been drilled into us here in New Zealand that an asthmatic patient who requires manual ventilation should not be bagged more than six times a minute to avoid dynamic hyperinflation. Apparently there have been a few sparky people out there bagging the snot out of respiratory arrested asthmatics.
Now if there's a bigger controvesy out there than prehospital frusemide I'm yet to find it. I don't think it should be part of the standard kit of an Ambulance Officer and recent grumblings here in New Zealand show it's probably being slated for removal.
Actually, COPD patients often do require high flow modalities. Remember, high FiO2 and high flow are profoundly different concepts. Additionally, a NRM at 15 LPM is NOT a high flow modality. Simply stated, a high flow modality must meet or exceed the patient's flow requirements.
So how do you ensure a high FiO2 above what I can deliver with my ubiquidos black and white cylinder of oxygen?