Blakes Username

So it sounds like steroids would be an option, but more as a prophylaxis - although if they aren't contraindicated and we have time it looks like a good component to consider... will check out the parmacokinetics there. And if they are already in rep. arrest - 1:10,000 Adrenaline IVP and a drip for continuous infusion en-route would be a good basis for resuscitation (in combination w/ ventilation and compression's if it deteriorates into cardiac) - at least at the first point following arrest. Guidelines decree that I can only focus on one pharmacological intervention but now my asthma management plans are gonna ROCK! Would administering adrenaline/epi pre-cardiac arrest - (e.g the phase of respiratory arrest before cardiac) - possibly be of some benefit for resuscitation or defibrillation if needed and therefore act as a sort of therapy and precaution? I think magnesium looks like quite an interesting intervention, I remained quite skeptical until now as it is in an natural occurring mineral (or less pharmacuetic than most) and my assumption was that it hasn't been pharmacologically targeted in the same way as most medicines, but then again I suppose adrenaline is quite similar in that respect - It would be interesting to see if magnesium has an analogue by now like salbutamol and adrenaline. Is this due to Ketamine's ability to cause respiratory depression?

Awesome! Thanks heaps for all the reply's, I hadn't even considered "I.V." Salbutamol, will go and check that out. CPAP is a cool idea, the study's appear to take a bit of looking for but I can see how it would be beneficial in an asthmatic so will look for some more info on that too - It would be interesting to see if the use of CPAP in combination w/ bronchodilators has been recorded.

Awesome, Yeah - have been doing a bit more research on Adrenaline, just at this point determining why it is not used instead of Salbutamol 'exactly' as far as I can tell its to be used is Salbutamol has no effect because it has a greater affinity for b2 receptors and is something like 95x more effective at binding (am still in the process of researching though, feel free to correct me on that one). Helicopter = next step for RSI (my logic was they are the peeps with the suxamethonium), the main reason I am even looking at things like RSI is that its a pharmacology assignment and is only loosely based on things like qualification level and regional protocol - its more about analysing an effective agent for the situation used by paramedics. Yeah, was looking at the WFA guidelines when I mentioned the corticosteroids, seems like they would do more harm though - depending on the bacteria it could even speed up the process of something like meningitis (is what I now understand), actually I was wondering about the use of Ceftriaxone in such a situation... I think I will stick to the basics and look at Adrenaline some more. Thanks for the Tips!

Hey chbare, Thanks for the clarification, have only had a very brief look at bronchospasm and inflammatory stages at school, l wonder if the bronchspasm stage is where mast cell degranuation occurs and inflammatory mediators are released - and if so, the spasm is a manifestation related to the inflammatory cascade? I will have a look at magnesium some more and have got a few articles on ketamine - will check terbutaline out too, although I am not familiar with fluid bolus - does that mean a drink? or IV fluids? Interesting about the ventilation, by allowing permissive hypercapnia do you mean attaching high flow O2 to the BVM and maintaining a slower resp. rate? Interestingly, I had recently read that it was the expiration stifled by asthma and have been discussing/debating with class collegues weather in a cardiac arrest secondary to asthma; an altered ratio (such as 30:2) would be more appropriate than the 15:2 suggested by the guidelines for a cardiac arrest secondary to a respiratory arrest, what do you think? Thanks again.

Hi, have been a member for a while (post study even) and now I feel I can actually contribute to the forums! - Appologies for my absence btw, I have been focusing on tech 100% (and I have a 9mth old kid which makes it a mission) So, I am currently doing a case study and need to look at a medicine for the situation of respiratory arrest.secondary to asthma (when initial treatments such as salbutamol [b2 agonist] and ipratropium [choinergic antagonist] have had no effect) As far as I have read adrenaline [epinephrine] is a good next step to take in this situation, but some sources have mentioned that the effect is little more than the other sympathomemetic and therefore the best option is a corticosteroid (we have hydrocortisone in NZ). So just wondering, in a situation of respiratory arrest where IPPV is being given and we are on route to hospital - what is the most important thing to focus on, and is it perhaps worth considering intubation or even starting induction with ketamine and calling the helicopter? I can look at any medicine at any skill level used in paramedicine anywhere that is appropriate for this situation, oh and pt has a chest infection - so I am thinking maybe steroids are contra-indicated? Anyway, just looking for an opinion - or possibly a bit of direction to focus my referencing in; let me know what you think, Thanks for your time, - Blake.

Ha, Duly noted - we do ski on an active volcano to relax... The good news is great to hear! That was going to be one of my first questions... Will be getting my response from from Polytech soon (2-maybe 3 weeks), so hopefully i'll be coming out one degree wiser and relatively un-warped; (maybe i'll make some friends in the psychology department just in case) Appreciate the heads up, Peace.

Hi, I'm Blake, Just came across the city in my search to find a paramedic forum to gain a bit of insight into paramedic practice/EMT, etc; But now that i'm here... cool. At the start of this year I did a undergrad in A&P which furthered my interest in emergency medicine - so now currently volunteering with St John's ambulance in NZ, and recently applied to study my bachelor of health science (paramedic) for 2012. But I have heaps to learn yet, so I look forward to typo-speaking to everybody. Cheers.