DuoNeb

[1EMT-P]

Are any of you currently using DuoNeb (Ipratropium Bromide/Albuterol Sulfate) in the field for the treatment of Asthma/COPD/Shortness of Breath?

[medic001918]

We have it but we have to mix it ourselves. We don't get the pre mixed doses of it. It tends to work rather well. I will often use it as my first neb, and then follow up with straight albuterol. I won't use this for patients with suspected pneumonia's though, the atrovent has an anticholinergic effect and we want to mobilize the secretions to allow them to breathe better, not dry them out.

Shane

NREMT-P

[Ridryder 911]

Ditto .. We have the premix of each and mix them together. I personally rather use Xopenex, as well I have found albuterol first then combo.. works somewhat better. But, I have to call to deviate from the protocol...

R/r 911

[emsbrian]

We have been using combivent or self mixing for years, it works well. We follow the same thing as above, start with a combo, the just albuterol. This is pretty much standard around here, some still just run with Albuterol, bust only for cost reasons, most of those are just transfer services.

[akroeze]

Do you folks find that the ipratropium bromide makes THAT much of a difference?

[WelshMedic]

With Combivent you'll never really know, will you? I suspect it's effect will be more in teh long-term.

WM

[canuckEMT]

We have both Ipratropium and Salbutamol in single nebs as well as Combivent. We have choice to use either. If the pt is on home Salbutamol, I will go straight to combivent.

[OzMedic]

Do you folks find that the ipratropium bromide makes THAT much of a difference?

Salbutamol (albuterol) by itself is more effective that Ipratropium by itself, however, when the two drugs are combined they are synergistic in their effect. That means combined effect is greater than the sum of the two individual responses. This is due to the combined inhibition of the parasympathetic (ipratropium) and stimulation of the sympathetic (salbutamol) nervous system. There are many quality studies documenting this effect.

[akroeze]

Salbutamol (albuterol) by itself is more effective that Ipratropium by itself, however, when the two drugs are combined they are synergistic in their effect. That means combined effect is greater than the sum of the two individual responses. This is due to the combined inhibition of the parasympathetic (ipratropium) and stimulation of the sympathetic (salbutamol) nervous system. There are many quality studies documenting this effect.

Ok

Thank you for clarifying this to me

I wonder why our system doesn't use it...

I suppose, other than having to carry both combivent AND ventolin puffers as well as atrovent AND ventolin nebs which would be more costly

[northernmedic]

We carry both and mix up our own if we need it. We have both MDI's as well as nebules and we use the AMBU spur bags where you can sideport the MDI for severely dyspneic or intubated patients. Generally I give the first neb with atrovent/ventolin and then repeat the ventolin once or twice depending on the patient's response and the transport time.