BreathLife

We use the Zoll M Series on our mainline trucks; our units are paddle equipped but also pad capable. I prefer to use the paddles initially for quick look and first 3 shocks (if needed), then I try to get my pads on as I put the patient on a backboard. I find that the pads just make for a simpler transport. You gotta admit there is a certain coolness factor involved with paddles.

Albuterol is used in acute exacerbations of COPD due to its characteristics as a beta 2 agonist, as you yourself stated COPD is most commonly diagnosed as emphysema and a chronic obstructive/ restrictive respiratory complication. In an acute exacerbation thereof the beta 2 effect is not directed at the emphysema as much as it is directed to asthma, bronchitis, or another obstructive/ restrictive disease, thus hopefully alleviating the resulting bronchconstriction and improving FEV1, peak flow, and VT. It should also be considered that diminished BS does not only mean emphysema as it is commonly seen in status asthmaticus where the bronchioles have constricted to a point where there is little to no airflow, in cases such as these bronchodilators are much more than just a placebo, they are immediately necessary.

I am sort of on the fence here, as are several others. I feel that ALS practitioners should have a strong collegiate health science background as well as a strong BLS and precepted ALS patient care background. As ALS providers we are no longer practicing strictly "cookbook" medicine, we now take a patient's pathophysiology into account as we choose our treatments and to correctly do so is quite difficult without both experience and education.