DuoNeb

[emsbrian]

I once sat at a conference for a 2 hour lecture by a nice MD who made many great arguments why we done even need a stethoscope. Changed my views greatly on EMS... Still like my stethoscope though. It was more of a jab at the over treatment and over thought that happens we paramedics forget that one major step: Transport decision.

[OzMedic]

I once sat at a conference for a 2 hour lecture by a nice MD who made many great arguments why we done even need a stethoscope. Changed my views greatly on EMS... Still like my stethoscope though. It was more of a jab at the over treatment and over thought that happens we paramedics forget that one major step: Transport decision.

Could not agree more! The first lecture in my medic class was about not getting all excited about our new toys and remembering our primary function "TRANSPORT MEDICINE".

[ffmedic9588]

We have both atrovent and ventolin nebs. We only have ventolin in MDI form. Not sure why that is, they only thing I can think of is and I am not 100% sure how this goes so please correct me if I am wrong but I remember reading somewheres of a case with a pt in severe respiratory distress and exhibiting s/s of anaphylaxis and the medics used MDI atrovent with BVM and pt kept getting worst and come to find out pt had an allergy to peanuts and appearently there is a peanut base in the MDI to propel the medication. Does this sound right? Please correct me if I am wrong or way of but explain. I love to learn.

[akroeze]

We have both atrovent and ventolin nebs. We only have ventolin in MDI form. Not sure why that is, they only thing I can think of is and I am not 100% sure how this goes so please correct me if I am wrong but I remember reading somewheres of a case with a pt in severe respiratory distress and exhibiting s/s of anaphylaxis and the medics used MDI atrovent with BVM and pt kept getting worst and come to find out pt had an allergy to peanuts and appearently there is a peanut base in the MDI to propel the medication. Does this sound right? Please correct me if I am wrong or way of but explain. I love to learn.

:shock:

I want to know too because I'm anaphylactic to peanuts!

[tniuqs]

1EMT-P"]I have treated several patients who have had asthma & been on beta blockers. If the patient does not respond to oxygen therapy & nebulized Albuterol then I add Ipratropium bromide, if they still do not respond then I usually move on to

Epinephrine 1:1,000 0.3mg IM/SC & Fluids.

Firstly edited for your reading enjoyment, please google on.

1EMT-P: This use of EPI really concerns me, if one had a Cardiac PMHX (with or without Beta Blockers) then add EPI to an already stressed heart your asking for trouble, this has lost favour in Kanukistan for the most case with Respirologists.

OzMedic mate: Ok I have my camera ready smile :shock:

Kevkie: You said "Albuterol" LMFAO......... are you ok man?

Your right about Mag Sulfate, the studies are anywhere but conclusive, but, just on spec if ones PMHX of poor diet or alcholism go for it, as there has really been no lifethreatning side affects have been reported, that I have come across. I can't really understand why EMS has jumped on that Bandwagon.

Note: Current "trends" may indicate that inhaled steroids are acting faster than previously thought, and early implimentation of BIPAP is gaining popularity...ps this is where I would put my money, and why can't anyone make an improved Nebulizer one that increases the Volume of "Salbutamol or Atrovent" inhaled per breath? is is believed that only 10 to 15% is actually delivered to the terminole bronchus. as for the term bronchospasm....this is not plural ! :roll:

Agreed.......EMT = Ed's Moving and Transport.

Rid: Can we get these guys a s/s ETCO2, it can't hurt, I don't know if it will make any difference to outcome but maybe some education in the use of this diagnostic tool.

akroeze: Peanut propellant? in MDI I don't think so, hell they stopped putting Peanuts in MARS bars thanks to you!

But go with the neb till you find out for sure and touch my Snikers bar and there will be a WAR east vs west! :shock:

EMSBrian: Last but not least......did that Lecturer ever have a patient with breast ROT, I think NOT, use your PPE. :twisted:

[AZCEP]

:shock:

I want to know too because I'm anaphylactic to peanuts!

Atrovent is prepared with a SOY-based preservative. If your patient is allergic to soy, they can be allergic to atrovent. The cross reactivity concerning peanuts is enough to consider not using the atrovent if you know that your patient is allergic. It is also a reason to consider withholding it from pediatrics. The anti-cholinergic effect is a better one, but we don't want to be inducing anaphylaxis if we don't have to.

[tniuqs]

Well learn something every day! thanks AZCEP.

I guess Glacoma should be mentioned in passing for completeness, and Fluids for increased insensitive water losses.

cheers

[1EMT-P]

Tniuqs, Please re-read the post... I did not say that I gave epinephrine to the patient... I did however give a list of treatment options, including epinephrine...

[tniuqs]

Tniuqs, Please re-read the post... I did not say that I gave epinephrine to the patient... I did however give a list of treatment options, including epinephrine...

Hey man not trying to say you did not putting words in your mouth at all, just friendly exchange of ideas is all.

I just find that this option "is still an option" with many services as per local protocol (s) is all and risk vs benefit, should be weighed cautiously.

cheers

ps But I am still pissed that akroeze had peanuts taken out of my Mars Bars! :twisted:

[akroeze]

ps But I am still pissed that akroeze had peanuts taken out of my Mars Bars! :twisted:

Did Mars Bars ever actually HAVE peanuts in them? I mean, other than "may contain traces"?

And for the record, it wasn't me as I find Mars disgusting