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I just wanted to emphasise a few points. For example, oxygen will not be all that helpful. In fact, in some cases, we may administer a mixture of 20-30% mixture Oxygen and 70-80% Helium while we try to decrease obstruction with other methods. Also, the absence of wheezing is not always this disastrous silent chest everybody assumes. A person can present with relatively milld symptoms and no wheezing, only to have significant airflow obstruction. This may not even be appreciated until you assess the PEFR and even perform bedside spirometry and you note a significant ice-cream scoop on the flow/volume loop. Asthma is much more complicated and subtle than many assume. My post was not necessarily related to the topic at hand. If somebody is having trouble with their asthma and I just happen to be a first aider, I will most likely call an ambulance, provide emotional support, obtain a history and transfer my findings to the EMS crew. All this craziness about giving this MDI or that MDI to a patient is not all that relevant as you have pretty much stated. Perhaps, it would apply in some rural situations or outlandish disaster scenarios, but for the most part, I'll wait for EMS. ERDoc, I am not a huge fan of cancelling orders. While I do believe inhaled bronchodilators are over utilised in the hospital and outside of the hospital, I would need to present a solid case before cancelling an order and I don't believe in going behind a physicians back. What I am not keen on is arbitrarily ordering scheduled bronchodilators on patients. However, I don't necessarily use the absence of wheezing to determine the absence of obstruction. For example, I have mild to moderate obstruction and had likely gone 30+ years with asthma until I was diagnosed a few years back during a PFT. I had crap peak flows and air trapping without any wheezing, but for years I would cough and often clear my throat. I didn't really know how bad I felt until I was treated.

If somebody improves on oxygen, I will still assess their PEFR. If it is low, I will treat regardless of an "improvement" on oxygen since oxygen does not reverse airflow obstruction. Also, using an MDI with a spacer may have similar efficacy to low volume nebulised delivery. Since albuterol is considered a rescue medication, it may be life saving in that it can potentially prevent further exacerbation. Remember, a patient can present with an unremarkable physical exam only to have a critically low PEFR and significant airflow obstruction.

As a first aider I can administer ventoline by using a puffer which we carry on all three of our jump kits. We have a medical director and when I first started by boss paid for me to go over to Vancouver and take a 1 day course which gave me certification to administer ventoline via inhaler. We can alos administer other meds. as well through this 1 day course. Does your company have a medical director? Is there any courses where you live that you can take which give you the certification to administer certain medications as a first aider? When it comes to using another persons puffer I would probably not use it as it does not follow the 6 R of medication use ( if I was a first aider in town and I knew that an ambulance could be there within minutes.) When you are an hour and a bit from town sometimes you have to go outside of the lines and if that means using some other person's medication to help this person, than I guess I would possibly loose my license. I know that if we did not carry inhalers and someone was suffereing from Asthma and somebody offered their inhaler and I said " No" I am not allowed to use other peoples meds. and this person died! I could not look myself in the mirror knowing I could have done something to help but didn't because of some Rules and Regulations! I am a strong believer in helping people in need no matter what the outcome could mean for me! Brian

Jeez crotch. The one sensible thing youve said in a fortnight and you're worried about sounding like a jerk? I whole heartledly agree with what you have said though, its good advice.