Edited by Arctickat, 14 November 2012 - 02:38 PM.
CPAP and administeration of oral medications
Posted 15 November 2012 - 12:42 AM
The question was asked whether I would now treat with Ventolin... I first said I would switch my patient from a nasal at 3lpm to an NRB at 15 lpm and see how my patient tolerated it and whether the histamine relased by the morphine would resolve in a few minutes...My main reasons for not giving ventolin to an AMI patient was because I wanted the heart to have to work as little as possible, and the beta 1 properties of ventolin would increase peripheral vascular resistance and increase heart rate, potentially causing more damage to the myocardial tissues.
Thoughts? I'm still not sold on administering a drug with beta 1 agonist properties to a new onset, unresponsive to nitro, unstable chest pain.
Posted 15 November 2012 - 06:26 PM
Posted 15 November 2012 - 11:10 PM
J306, as far as briefly removing CPAP and patient compliance with CPAP, all my recent CHF calls have required intensive efforts to get the patient to keep the mask ON. It's quite uncomfortable, and I can understand why patients feel the large CPAP arrangement (filter, ETCO2, Boussignac valve, facemask, headstraps) is even more smothering than an NRB can seem to some anxious, hypoxic patient. Not to mention the unaccustomed positive pressure itself.
Posted 16 November 2012 - 12:48 PM
Great question Jack. Have you checked your protocols? Specifically CP2.
Sure did, even quoted it in my scenario, to which the response was that it was contraindicated in Pulmonary Edema not in AMI... Two intructors have now said that since it was under the Pulmonary Edema protocol it does not apply to the CP1 protocol... Interesting.. I'm still not convinced, but regardless, my thoughts are that we should be striving to "do no harm" so it all comes down to the greatest benefit to the patient.
Posted 17 November 2012 - 12:16 AM
Therefore, if the patient develops bronchospasm during an AMI then protocol CP2 trumps CP1 and we can't give ventolin.
Have I ever mentioned how I F---ing hate how our protocols have turned us into cookbook medics?
However, I am not your instructor...perhaps you should seek direction from the College, considering they're the ones who'll be raking you over the coals if they find an issue with it.
Posted 17 November 2012 - 05:37 PM
Posted 29 November 2012 - 03:03 AM
When I asked about the situation above, he said that since it was a relative contraindication that it was a cost/benefit situation and patient dependant, so we wouldn't get nailed to the cross for making an informed, intelligent decision given the situation and acting in the best interest of the patient.
In conclusion, another grey area. I was relieved to learn that the college is making steps in the right direction and empowering the providers to make those tough decisions in the field without having to worry about loosing their licence for it.
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