MSDeltaFlt

My pleasure.

So long as their VS can handle it.

As far as therapeutic levels go, you'll know you're getting therapeutic when VS, breath sounds, and overall pt status improve. When you hear more air exchanging, respirations are less labored, and pt states they're breathing better, you're getting there. When lungs are clear, and there's no SOB, then you're therapeutic. Odds are you might not make it THAT far by the time you get to the hospital. Just get them on the road to recovery is all you can do most of the time.

It's redundant because of its length of duration. It will still be working at its peak 4hrs after you give it. That's why. So just give it once with albuterol and then you don't need to give it again until 4hrs later at the earliest; sometimes 6hrs later. However you CAN keep giving albuterol only back to back and even continuously for an hour or two to get the effect you need; so long as pt's VS will tolerate it (Heart Rate, BP, cardiac O2 demand, etc).

Atrovent any more frequent than Q4-6hrs is redundant. Give it once with albuterol and then keep giving albuterol continuously.

Chronic asthma and chronic pain in which he has acquired a tolerance of all kinds of things and is allergic to what you carry. In 40 mins you're not going to fix this guys pain. I doubt you'll even be able to take the edge off. Also pain is not mentioned in the primary survey. You are stuck on "B", my friend. Stick with the nebs. You'll be fine. So will the patient.

Late in the game here. I apologize. I like the way CH thinks. He brings up some good points. Regardless of which meds you have at your disposal, there is something that needs to be made intimately aware of. There is a difference between "giving sedatives" and "sedating your patient". There is also a difference between "giving pain meds" and "treating pain". I, myself, was once on a Fentanyl drip in the ICU with an unstable C2 Fx and extubated myself. Thought I was dreaming. Apparently not. Know the difference. Just my thoughts.

So far this year I'm 100% for ETI, however there were 2 pts where it took 2 attempts to get the tube.

Generally speaking all of the electrode wires are color coded. They are also labeled. RA means Right Arm. LA means Left Arm and so on. Place them in the proper places and you'll get an accurate ECG. http://library.med.utah.edu/kw/ecg/ecg_outline/Lesson1/lead_dia.html V1: right 4th intercostal space V2: left 4th intercostal space V3: halfway between V2 and V4 V4: left 5th intercostal space, mid-clavicular line V5: horizontal to V4, anterior axillary line V6: horizontal to V5, mid-axillary line Generally start placing V1 & V2, then V4, then V6. Then you place V3 between V2 and V4 and V5 between V4 and V6.

It depends on the amount of chest pain and the kind of chest pain the pt complains of. Some pts' complaints of chest pain just as you described will get the full workup. Then again, some pts' complaints of chest pain just as you described will get absolutely nothing at all except maybe a trip to ED. It depends on what the assessment shows.

Get a manikin and practice it that way, and imagine the way it'd look like on a real patient in a real scenario. that way you'll have a little better understanding of just how difficult it can be. Some right handed people may try to tube with the blade in the right hand because they say they have more power and control with the blade in the right hand. If that's the case then they're doing it wrong. ETI is all technique; not power.