CHF and albuterol

[46Young]

For me, the only reason I'd give albuterol is if there was significantly diminished L/S. If there is little to no O2 exchange, the pt's condition will only worsen. If you can hear the rales quite well, the pt's L/S aren't diminished, at least not enough to warrant an albuterol neb. That isn't their main problem. The albuterol will be given via an in-line neb w/ CPAP, and nitrates (we are allowed to double dose, 0.8mg, if SBP is above 180, until therapeutic endpoint is reached or adverse affects manifest). As mentioned earlier, many APE events have a concurrent COPD exacerbation. If a COPD exacerbation was believed to contribute to the APE event, anticholinergics would not be contraindicated. I also like to use ETCO2 capnography/capnometry. If you see that shark fin waveform, you can infer that they're air trapping. Both albuterol and CPAP will help with that.