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Asthma attacks without an inhaler


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Good topic for sure, it makes you think. I am allowed to use my skills as PCP even if I am doing a First aider position like at the county fair I wouldn't go down to the level of Red Cross (which I have for work). And here we do this with our Ambulance so in therory Im not going to come across this as I have a ventolin protocol and can use it. Now if I'm off on Vacation and this happened Im pretty sure that the pt will be getting someone elses puffer (as long as it is the same) as these people can go down fast and furrious. If I did nothing and they died then not only would I feel bad but Im pretty sure I could be sued to some extent

Really in the states the only thing you can give is O2 and epi without Dr's orders. How can that be if you have the training for things like Ventolin etc. It amazes me that in the states if you help someone and it goes wrong you can be sued but if you stand there and watch someone die you cant.

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I would also use someone elses inhaler, like let's say my own. I have one for odd times when I get wheezy. It's not been used often. I would only use it for specific circumstances, such as lon

Ruff I like this statement. This AM I wasn't even thinking along the lines of On-Line MedCon. Perfect way to CYA and still get the job done. I will say if your in my area the Director will say

Say you're a first aider and you're called for an asthma attack case. You give the girl oxygen for now. But you have no inhalers in your bag and the patient forgot hers, but you have people offering t

I am allowed to use my skills as PCP even if I am doing a First aider position like at the county fair I wouldn't go down to the level of Red Cross (which I have for work). And here we do this with our Ambulance so in therory Im not going to come across this as I have a ventolin protocol and can use it. Now if I'm off on Vacation and this happened Im pretty sure that the pt will be getting someone elses puffer (as long as it is the same) as these people can go down fast and furrious. If I did nothing and they died then not only would I feel bad but Im pretty sure I could be sued to some extent

I am sure the delegated authority of your medical director permits for the administration of nebulised salbutamol, this does not mean you can dish them up somebody elses salbutamol.

Really in the states the only thing you can give is O2 and epi without Dr's orders. How can that be if you have the training for things like Ventolin etc. It amazes me that in the states if you help someone and it goes wrong you can be sued but if you stand there and watch someone die you cant.

Oxygen and adrenaline are both prescription medications.

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Say you're a first aider and you're called for an asthma attack case. You give the girl oxygen for now. But you have no inhalers in your bag and the patient forgot hers, but you have people offering to give her theirs.

Would you give her somebody else's inhaler to use? Or would you just wait for improvement and if condition doesn't improve-- call an ambulance? Seems like the latter makes more sense, but I guess using somebody else's inhaler isn't so detrimental-- particularly if the patient recognizes her medications. Right?

WRONG!

First off, even as a multimedia first aider (like they teach in Boy/Girl Scouts; you should already KNOW when to activate the 9-1-1 system. Giving a patient someone else’s medication simply based on ‘she recognized the name of her medication’ is akin to prescribing medications without a license. In GA and MI, even EMT-I can’t just raid the drug box because the patient recognizes the name. We can ASSIST the patient taking their own medications.

Sorry Matthew remember your Rs

Right Name

Right Experation

Right Perscription

Right Dose

I would never give someone someone else's perscription. The only exception to that rule is Epi Pen, we carry our own in the lock box incase of anaphalaxsis.

Look at it this way, do you want to lose your liscense over a mistake that could have been prevented? Just because it is the same medication that the patient takes doesn't mean everything is the same. One thing you could do while waiting for the rig is add water to the O2. Sometimes moisting the O2 will realive some of the symptoms of the attack. Yes its not medication and no it won't completely fix the situation but it will buy you time and releave the patient discomfort to a degree.

Your best bet is to put a rush on the rig, have ALS respond as well, and keep an eye on your patient because an asthma attack could decompansate into respitory failure if it goes to long.

Actually Ug, there are more ‘rights’ (you only mentioned 4). They are:

Right patient: This holds true, especially when assisting the patient who is taking their own medications. This also precludes the good Samaritan from offering up their medications.

Right medication: The general public usually can’t tell you WHY they’re taking a medication (other than “the doctor gave it to me.”), why would you trust “that sounds right”?

Right time: This doesn’t mean that since the next dose is to be taken at 1800… that we make sure it happens. This includes right indications, no contraindications and the right conditions (i.e.: no nitro after taking Viagra within the last 72 hours.

Right date: Is the medication expired? Is fluid medications like epi clear?

Right dose: I think this one is self explanatory.

Right documentation: Document the administration of the medications, and all pertinent positives and negatives (responses to the medication for which it was administered. i.e.: If you give albuterol, did it relieve the symptoms?)

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This is a great thread!! I wouldnt give the patient someone elses medication, for all the reasons mentioned above.

Mathew asked how oxygen could make it worse. ( sorry havent figured out the whole quote thing). If they are in acute and severe respiratory distress, 15 liters of oxygen by non rebreather can actually shut thier respiratory drive down. I've seen it happen...now you have a respiratory arrest on your hands.

In the short term, it will help some but they need the nebulized meds to actually help stop the attack. Our protocol is nebulized Albuterol/Ipatropium. Consider Epi 1:1000 0.3cc sq. Contact Med Control for additiional Albuterol/Ipatropium. Monitor respiratory status continuously and be prepared to deal with respiratory and cardiac arrest.

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This is a great thread!! I wouldnt give the patient someone elses medication, for all the reasons mentioned above.

Mathew asked how oxygen could make it worse. ( sorry havent figured out the whole quote thing). If they are in acute and severe respiratory distress, 15 liters of oxygen by non rebreather can actually shut thier respiratory drive down. I've seen it happen...now you have a respiratory arrest on your hands.

In the short term, it will help some but they need the nebulized meds to actually help stop the attack. Our protocol is nebulized Albuterol/Ipatropium. Consider Epi 1:1000 0.3cc sq. Contact Med Control for additiional Albuterol/Ipatropium. Monitor respiratory status continuously and be prepared to deal with respiratory and cardiac arrest.

No Mag. Sulfate in your protocol 39?

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It really depends on the situation, both sides are right. If the patient is just having a normal "textbook" asthma attack, where they are in low to moderate distress, and EMS is less than 15 minutes away, I would not advocate using someone else's (if for no other reason, not to pass cooties on to someone else). You said "girl" in your description which makes me think pediatrics, so an adult inhaler may be of a stronger dose than necessary.

On the other hand, if the patient is in severe distress and you let them go into respiratory arrest because of rules, then you should get out of healthcare. That would be similar to you being at a pond that has a "no swimming - keep out of pond" sign up, and there is a child drowning 10ft from shore, and you won't go in because swimming is not allowed.

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The standard adult dosage of albuterol is 2.5mg in 2.5ml of NS. The standard pedatric dose is 0.15mg in 2.5-3.0 ml of NS. This is about 1/17th of the adult dosage.

As far as the child in the pond in Crothity's senario, if the rescuer isn't trained or equipped for water rescue, they could end up making the situation worse. While it's noble to try to save the child, what good are you really doing if you end up drowning in the process of trying to save the child?

The same applies to the asthmatic in the original post. Howmany medics have we heard talking about cardiac drugs and make the statement "It was one of those 'A' drugs..."?

Was it Adenosine? Atropine? Amyl Nitrate? Amiodarone? Asa?

Part of the problem here is that the general public only knows what they see on television. They see cops solve major crimes in an hour and think that this is the way 'real life law enforcement' should operate. They see these action drama shows like "Trauma", "Third Watch" and "House" and think that we save every patient

Just be cause Mr. Smith has an albuterol MDI in his pocket, doesn't mean that little Jane Doe gets the same dosage. If an educated medic can confuse those 'A-drugs', how can we reasonably expect the general public to understand that just because the name sounds the same, it could turn out to be vastly different drugs and 'bad things happen despite good intentions'. Remeber, that the road to Hell is paved with good intentions, but it's still the road to Hell.....

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Jake.. nope no Mag. Sulfate in our protocols. And Crotchity just because we CAN give meds doesnt mean that we SHOULD give meds. Especially someone else's drugs. AND if it is a Combivent MDI then we couldnt use it anyway. Ipatropium is contraindicated in pediatric patients. Just sayin....

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Quick commentaries:

1) Someone is here from Israel. Do not Israeli EMS units have On Line Medical Control, even under a different name, say, "Medical Director"? Someone to ask, in effect, "Mommy/Daddy, May I?" within the agency?

2) Oxygen is a prescription item in NY, but usually, nobody cries "Foul" if given by a (CERTIFIED) First Responder, EMT or Paramedic, following protocols, as they are, again, usually, minimally under the licence of the service's Medical Director.

3) Protocols I work under, which may be different where (collectively) YOU work, state to the effect of "even if it is the same med, issued by the same doctor, on the same day, to both spouses (or domestic partners) from the same pharmacy, you cannot give the medicines of one person to another person, or suffer the consequences of the authorities".

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