Albuterol in CHF?

[mshow00]

Thank you ERDoc I finally had a chance to check those links you posted. It's kinda funny that I have never heard of the adverse reactions to the use of morphine in these cases, yet almost everyone I talked to said they would push it. At any rate it was very helpfully, so thank you again.

[JPINFV]

Can someone tell me why there are different points of view on this.

Lots of reasons I can think of for disagreements:

1. Ignorance (e.g. "enlarging the wrong container" argument)

2. Putting theory to practice (stimulating a stressed heart with a medication that relaxes an area not where the problem is).

3. Research seemingly at odds with the theory (it happens, not everything follows the book. Thanks for the articles ER Doc).

[mobey]

do you not carry a bvm on the truck. if you do, you have a primitive form of cpap

I have used a BVM many times for P. edema. Sometimes I will even offer it to the patient to assist themselves, you may be surprised how many times they take me up on my offer.

This is something I learned off this forum and it works great!!

[jwraider]

do you not carry a bvm on the truck. if you do, you have a primitive form of cpap

the other night on a ride along an ambulance comes into the bay and they are bagging a concious woman. Apparently the fire engine (they carry the cpap units in that county) didn't have theirs when they showed up on the call. Such a stupid system for cpap.

As for albuterol for CHF I think every patient is different. If the patient needs their lungs dilated to breath they should get it (I know thats hard to tell sometimes in this situation).

but I think it's a good thing for someone who develops a reaction to the junk in their lungs and starts closing up. Do the CHF treatment first if possible.

I've watched a medic who was ruling out COPD excaserbation vs CHF try o2,albulterol,cpap,nitro in that order. The PT lung sounds were very diminished and he was complaining of mild chest pain (BP 160 ish I think) and a history of COPD.

[JPINFV]

As for albuterol for CHF I think every patient is different. If the patient needs their lungs dilated to breath they should get it (I know thats hard to tell sometimes in this situation).

Albuterol doesn't dilate the lungs, it dilates the bronchioles.

[AnthonyM83]

I heard a doctor order 2 breathing treatments for a pretty bad CHFer yesterday...but it was among a battery of other orders (80mg Lasix, 2inch Nitro, etc)...he said CHF'ers like that will often develop bronchospasms so he threw in the albuterol, but not that highlight of his treatment.

[ambodriver]

Jesus, I hope he isn't anybody's medical director.

My protocols say to "consider" albuterol "if the patient is wheezing." Problem is waaaaaay too many people who work in this state seem to completely ignore the "consider" part. They think it's mandatory, or at least act like it is.

Myself, besides the obvious pathophysiology issues, I've never had a wheezing CHF patient that didn't stop wheezing after nitro and Lasix.

no he was an old doc, very respectable. He had given lasix, nitro and the rest of the good stuff and was treating the wheezes with the albuterol. I specifically asked him about this and he said sometimes you just have to treat all the symptoms, and that sometimes the edema will cause bronchospams. Albuterol isn't going to cause the heart to do much more damage to itself. It's pretty specific to the lungs. This wasn't a very bad CHF'er. I had asked him why not cpap? He said he wanted to treat the wheezing first. Was interesting convo.

[ambodriver]

nm

[Novisen]

http://www.escardio.org/admin/GuidelinesRe...ines-AHF-FT.pdf

[CaliMedic209]

i think the albuterol should be given.. it takes 2 seconds and i HIGHLY doubt it will cause any harm.. the way i look at it is if the pt is having bronchospasms they will be having trouble getting air into the lungs, THEN they have to attempt to breath through the fluid filling them.. i just think its quick and does make a difference