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Asthma attacks without an inhaler


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Under our Medical Direction we are not allowed to give Ipatropium to pediatric patients. The Doc always tells us Albuterol only. I am not sure why it is this way. I stand corrected ERDoc. I was wrong...wow...how often do you here that!!???

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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

Under our Medical Direction we are not allowed to give Ipatropium to pediatric patients. The Doc always tells us Albuterol only. I am not sure why it is this way. I stand corrected ERDoc. I was wrong...wow...how often do you here that!!???

Lol. Around here, not too often. I won't try to guess why your medical director feels that way. Never trust a doctor, just because it's not in your protocols, doesn't mean it's contraindicated.

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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".

Dunno Richard, I'd have a really tough time standing around with my thumb up my ass while somebody dies, when I could have helped them. I think I'd rather face the wrath of the authorities and be able to sleep at night.

Regardless of what the protocol states, it s ethically wrong to fade to black and do nothing. It is against everything I have been educated to do and my own personal values. If you kept this pt. alive long enough so they could be tended to by ALS (I hate using that term!) by using something as simple as a MDI, then you've done your job. The authorities can blow me.

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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.

How exactly does oxygen shut down the respiratory drive in acute, severe respiratory distress? Also, how are you quantifying and qualifying the statement that you've "seen this happen?"

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No Mag. Sulfate in your protocol 39?

http://www.jppt.org/archive/v8n1/JPPTv8n1ms7.pdf

Seeing as this thread is morphing into treating asthma, can you explain the actions of mag sulfate, especially in the paediatric population.

I will bet after chbare's query, that someone is madly using Google to explain (exactly how oxygen shut's down the respiratory drive in acute, severe respiratory distress)

I have always wondered why EMS has jumped onto this mag sulfate band wagon with such vigour, as in most ER (that I have worked) we rarely used mag sulfate. Studies and because of the multiple pharmacological interventions of beta agonist and anticholinergics plus mag sulf, its very difficult to make any real conclusions, although I have heard from a few paramedics that swear that suddenly, after 15 minutes post administration of the triple treatment their patient rapidly improved ? My following question is what is peak efficacy of beta agonist ... then that deer in the headlights stare.

That said; It could be that that the risks are so low as a trace element at the 40 mg/kg suggested dosage and very little documented negative effects, then again this could be yet another EMS myth soon to be busted by Bledsoe ? Do I use it in the field ..sure why not as it (mag sulf) is so benign but really is it making any difference in outcome's or admission rates ? I say nope.

What's odd in my guidelines in EMS that CPAP is not advised (in the field) yet in ER its used very frequently, more than curious really. I can say that when committing an asthmatic to life support (ventilator) or even a flow diverter and spring valve PEEP gauge on a BVM when titrating PEEP up, use a stethoscope as well as watching all other 'notable' parameters like BP, SpO2, ETCO2, ABGs if you have them as one will at (qualifier) some point will note a decrease in bronchospam. best look to your protocols if so driven/ restricted.

Still waiting to hear about how humidity (estimated @ 2% increase in relative humidity from the typical wash bottle) which is highly prone to leaks (decreasing accuracy of delivery of O2) and then the infection rate with tap water (far more common than most would believe) may complicate ?

Which leads to another question in anyone's service, do any have an IDC guideline for noting when the "fluid" is changed ?

As I reflect on what I just wrote (off the top of balding head).. I believe if in the OP scenario and I was in a court room to defend my actions and why I "allowed a bystander" to share an MDI to a patient. I feel quite confident that I would be able to justify my actions under our "reasonable man" basis of law ... just saying your mileage may differ but I could NEVER stand back, deny or turn away any beta agonist volunteered to treat a child in distress, ps besides Pirate Hunters are known to be renegades.

cheers

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http://www.jppt.org/...JPPTv8n1ms7.pdf

Seeing as this thread is morphing into treating asthma, can you explain the actions of mag sulfate, especially in the paediatric population.

cheers

First, my bad for forgetting we were talking about a paediatric. I went back and read the OP. While the benefits of MgSO2 probably will never been seen in the field, why do it right? Pre-hospital medicine. I do believe it does benefit the pt. The same can be said for administering Solumedrol in the field. It takes hours for it to work and yet it is probably every EMS systems protocol. The Mag works great when the standard nebulized treatments are helping but not to the extent we would like to see. Only when this is the case will I hang the mag drip. It's another one of the medications that is nice to have but don't use all the time. CPAP is another "tool" for the the treatment of the Asthmatic pt. Do I have to explain this too?

http://www.medscape....warticle/498382

http://jama.ama-assn...62/9/1210.short

I couldn't find a lot of studies to support the use of mag in paediatrics, there aren't an abundance of studies to support either side.

I did find this one though.

http://emj.bmj.com/c.../24/12/823.full

Edited by JakeEMTP
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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.....

He said 10 ft from shore in a POND, not raging river. Are you really gonna let the kid die, how is letting the kid die making things WORSE

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He said 10 ft from shore in a POND, not raging river. Are you really gonna let the kid die, how is letting the kid die making things WORSE

Obviously, you've never seen how a drowning person will try to climb up their rescuer. I don't have statistics to prove my point, but what good is a drowned rescuer? People trained in water rescue are trained to deal with this sort of occurrance, I am not.

Just because they're ten feet from the shore, doesn't tell you how deep that pond is......for all you know, that 'pond' was part of an old rock quarry, and it just happens to be 60' deep.

*edited to add last paragraph.

Edited by Lone Star
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This discussion seems to be based on the ever popular "How far would you go to save a life" principle, i.e. would you bend or break the rules if it was to save a life. This is a philosophical discussion that involves ethical dilemmas that transcend medical, legal, and political philosophy. Its a sticky situation, along the lines of jailing a man for stealing a loaf bread to feed his family etc. etc. etc.

Luckily, in this case, it is not at all relevant. At all. The reason being is because as my post mentioned before, MDI's are NOT a life saving intervention, but rather for therapeutic relief of mild asthma symptoms. In other words, if you have an asthmatic who is wheezing and improves on oxygen, they don't need an MDI immediately. On the other hand, if you have an asthmatic who is not improving on oxygen and is barely moving air, they don't need an MDI, they need a BVM and immediate transport. This should render the entire premise of this argument null and void.

Unless someone can provide literature detailing the deterioration of an asthmatic on a timeline that reasonably exceeds standard transport times with only an MDI as the mediator, again, I say, this is a non-argument.

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