Pneumoniua/Breathing Treatment

[tniuqs]

'nick Hoffman'

CPAP- Pressurize the lungs to free up the alveoli.

I think you did alright considering the O2 helped improve his breathing efforts.

But I deff would have hooked up the CPAP.

explenture

We have CPAP, but this guy was not close to CPAP per our protocol.

Vent ... is it just me that is overly concerned with these statments ?

Any SpO2 pre O2/post O2 ... ?

Is ETCO2 available ?

Did anyone think of doing a Temp ?

Uptake of nebulized medication ??? I believe is called "Side Stream" delivery.

Urine frequency is not a good indicator of Ins/Outs, Colour is a better indicator (clinically0

Stutum color and production always helpful ... ask them to cough then spit into a klenex.

Fluids are not a bad idea if your looking @ possible Pnemonia, tachcardia is compensatory mechanism when patients are dry.

Oh and its damn hard to kill the vast majority of patients with Albuterol +/- Atrovent, in this situation from the pmhx provided ... listen to your partner.

cheers

Edited April 21, 2009 by tniuqs

[FL_Medic]

'nick Hoffman'

explenture

Vent ... is it just me that is overly concerned with these statments ?

Any SpO2 pre O2/post O2 ... ?

Is ETCO2 available ?

Did anyone think of doing a Temp ?

Uptake of nebulized medication ??? I believe is called "Side Stream" delivery.

Urine frequency is not a good indicator of Ins/Outs, Colour is a better indicator (clinically0

Stutum color and production always helpful ... ask them to cough then spit into a klenex.

Fluids are not a bad idea if your looking @ possible Pnemonia, tachcardia is compensatory mechanism when patients are dry.

Oh and its damn hard to kill the vast majority of patients with Albuterol +/- Atrovent, in this situation from the pmhx provided ... listen to your partner.

cheers

I was wondering about the Temp, O2 saturation and ETCO2.

This would help to determine the patient's oxygenation and ventilation status. It would also help determine if the tachycardia was due to dehydration from infection. The urine output could also be causing dehydration.

I would hold off on the Lasix, seeing how research is showing less and less of a need for this med prehospital. Like Vent said a BNP( brain-type natruetic peptide) and chest x-ray are needed to truly Dx CHF.

CPAP may be a little much, but as stated O2 sat, and ETCO2 would help determine this.

Consider the patient's Hx, emphysema. This could lead to pulmonary HTN, then RVF via cor pulmonale, then consequently LVF (or BVF if you may). But as stated the crackles could be lung infection. I don't see a problem with an updraft to open them up. The tachycardia is most likely from the increased effort, or dehydration.

I pretty much agree with Vent's take on this.

Tough call. If someone has pneumonia, you may actually thicken up their secretions with albuterol, as you would with a diuretic and make things worse. CPAP would be a good idea if available. The tachycardia could be from hypoxemia or from the infectious process. Unless you are working with the patient long term, I wouldn't worry about knocking out their respiratory drive- that generally takes far longer than we ever spend with a patient. Crank up the o2 and like you said, it was helping.

An updraft is commonly given in the hospital with CPAP/BIPAP to patient's with pulmonary edema, or as you put it, secretions. "Cranking up" the O2 on an Emphysema patient isn't always the best treatment if low-flow O2 is improving the patient's condition. You're right about the respiratory drive, depending on what there current effort is. Where are you in the pulmonary toilet at this point though? This patient would probably benefit from some broncho-dilation with the supplemental O2. Of coarse, there are some questions still unasnwered, and I wasn't there.

Edited April 21, 2009 by FL_Medic

[explenture]

SP02 92-95 ETCO2 we don;t have

I was wondering about the Temp, O2 saturation and ETCO2.

This would help to determine the patient's oxygenation and ventilation status. It would also help determine if the tachycardia was due to dehydration from infection. The urine output could also be causing dehydration.

I would hold off on the Lasix, seeing how research is showing less and less of a need for this med prehospital. Like Vent said a BNP( brain-type natruetic peptide) and chest x-ray are needed to truly Dx CHF.

CPAP may be a little much, but as stated O2 sat, and ETCO2 would help determine this.

Consider the patient's Hx, emphysema. This could lead to pulmonary HTN, then RVF via cor pulmonale, then consequently LVF (or BVF if you may). But as stated the crackles could be lung infection. I don't see a problem with an updraft to open them up. The tachycardia is most likely from the increased effort, or dehydration.

I pretty much agree with Vent's take on this.

An updraft is commonly given in the hospital with CPAP/BIPAP to patient's with pulmonary edema, or as you put it, secretions. "Cranking up" the O2 on an Emphysema patient isn't always the best treatment if low-flow O2 is improving the patient's condition. You're right about the respiratory drive, depending on what there current effort is. Where are you in the pulmonary toilet at this point though? This patient would probably benefit from some broncho-dilation with the supplemental O2. Of coarse, there are some questions still unasnwered, and I wasn't there.

[fiznat]

These are tough patients to deal with. Though there are a few other assessments that could/can be done here (ETCO2 especially), in the end it is probably impossible to know the exact cause of this patient's condition in the prehospital arena. He is a COPD/CHF/Pneumonia/ACS mess that we can't do a whole lot to definitively sort out.

That said, I think you did okay. You monitored the vital signs, got a 12 lead, and kept an eye on the guy's ventilatory status. I think the decision to do or not to do a nebulizer tx in this situation depends entirely on how the patient looks to you, and whether you think he is maintaining on his own without it. The differential indicates that beta agonists may in fact worsen this patient's condition, so I don't think you were wrong in thinking twice about using them. ...Especially in a tachycardic, elderly patient that was not in extremis.

It is never a good thing to give knee-jerk treatments. Just because the guy has COPD and is complaining of SOB does not mean he immediately gets a neb. You need to look at the whole picture, and I think you did a good job doing that.

Edited April 22, 2009 by fiznat