[quote="Asysin2leads"So if you can scoop and run, treat w/ diesel" ??? Was there something I missed?
With all due respect, I think you must have missed my whole post, except for the last sentence. Ref: Before you intubate.....
We can agree to agree on this one. I think we're both saying the same thing, though we do have different ways of saying it. Bear with me.
If someone with status asthmaticus has a sat of less than 94% on 40% NRB, decreased or absent breath sounds despite the chest moving up and down, maximal accessory muscle use, and altered mental status/is obtunded, then, by all means....intubate. It sounds like the original poster's patient had all or most of the things that score a "2" on the asthma scale and he probably did need to be intubated.....AGREED. But, if a patient can speak a partial sentence, is moving air at all, and there is any way that he can have kitchen sink therapy...O2, non-invasive PPV, bronchodilators, corticosteroids, mag, terbutaline, etc and get to definitive care pretty quickly, intubation should be avoided if at all possible. Transport rapidly instead, after you've gotten the drugs started. (My comment on solumedrol was that, once you had decided to intubate the pt, it would come after the fluids and intubation, since you won't see immediate benefits from it like you will the fluids or the Mag.Yes, definitely give it. It works....just later.) The reason I advised to TWD is due to the terribly increased morbidity/mortality for these patients once they are intubated. They frequently die from pnuemonia or other complications and never make it back off the vent. We see this in the intensive care setting, whereas EMS providers don't always see the long term outcome (or lack of it) for their patients. I'm sure you have your pt's best interests at heart and want to take the best care of them that you can. I have the utmost respect for our medics and EMTs.
The original poster had a question about why her asthma patients kept coding after being intubated.
Specifically speaking about the asthma patient, they have probably been sick for hours or days before they call you. They are tachypneic, which contributes to dehydration from rapid and prolonged exhalation, and they probably haven't been drinking fluids well. Typically, these patients are already very hypovolemic. Add this to the fact that they aren't moving air well... they have air trapping, mucous plugging and bronchospasm. With the intubation procedure, intrathoracic pressure suddenly increases with the pressure from mechanical ventilation, which leads to decreased venous return and decreased cardiac output. Add that to a bronchospasm, and you're in alligators up to your elbows. This leads to a bradycardic patient (not from vagal stim), who may not recover from the event.
Bottom line: do the best for your pt. If you think this means intubation, so be it. It's your call. But, think about preload issues WHEN you intubate if you want your pt to make it to the hospital without CPR in progress.
My 0.02 for what it's worth.
Be safe.