Treatment for Asthmatics that are on MAOI's or TCA's

[captainstandup]

Sorry I have been away for a few days, family calamity. In any event I was referring to a fluid challenge in CHF patients being necessary to improve preload and subsequently cardiac output to a point that would allow treatment of the CHF with nitrates an other therapies. Ideally we would consider dopamine or dobutrex to accomplish this but it may be worth trying a small fluid challenge 200 to 300 ml. Perhaps this will accomplish the task and permit instant treatment without the toxic effects of the pressors including the risk of tissue necrosis with extravasation and of course the potential for increased myocardial oxygen demand with the pressors.

This was merely intended to draw a similarity between the benefit versus risk of treating chf with fluid and treating Acute asthma with bronchodialators such as albuterol while weighing the risk of hypertensive crisis and risk of death from the status asthmaticus.

Oxygen, comfort, transport for a status asthmaticus patient when you are 24 miles from the ER = Take them around back to the morgue entrance when you get there.

[rat115]

The point of this discussion is to; discuss what, if any, other therapies and medications are used by other providers in these situations and not a the ridiculous notion of not treating the patient.

On the original topic....My exhusband was on albuteral and an MAOI. He never had any problems with the two. You just have to watch, but don't with hold anything in an acute situation.

[captainstandup]

Which MAOI was he taking?

[Kaisu]

the cardiogenic patient gets the small fluid challenge in case he/she wasn't really cardiogenic - and was really hypovolemic... most of them will NOT respond positively to the fluid... then they start getting a very carefully titered dopamine drip to get a pressure up to about 90 or 100 systolic.. then I can begin CPAP to treat the pulmonary edema... 70% of cardiogenic shock is fatal.. but that's what I would do..

Same with MAOI patient in status asthmaticus.. gotta breathe... A & A, repeat A, 0.3 to 0.5 of epi sub Q - RSI intubation ready in case... and watching the BP and heart rate like a hawk.. ready to run interference on those as the situation unfolds... with 40 minute transports.. no- high flow O2, comfort and transport just doesn't cut it in either situation.

[captainstandup]

Dobutamine is less cardiotoxic than dopamine, especially in the setting of CHF (assuming the problem is not rate related) where the desired effect is inotropic rather than chronotropic. The obvious risk is increasing myocardial Oxygen demand and worsening an already decompensated patients condition.

Surely you dont think I was saying not to provide high flow oxygen, comfort and transport to a patient in this condition? I was referring to the posts that listed ONLY these three thing, which is completely inapproprate.

[Kaisu]

Surely you dont think I was saying not to provide high flow oxygen, comfort and transport to a patient in this condition? I was referring to the posts that listed ONLY these three thing, which is completely inapproprate.

Oh gosh no.. I sure didn't mean to leave the impression that I was inferring that that was what you were implying..

8)

No, I was actually responding to an earlier post where that is exactly what the respondent was stating.

That is very interesting about the dobutamine. I think we want the vasoconstriction as well as the beta 1 effects of the dopamine when dealing with the cardiogenic shock patient. I know that dobutamine is one of the drugs of choice for CHF. Not in our protocols tho.. I will check it out with the million people around that know more than me. Thanks