Albuterol in CHF?

[Laura Anne]

OK, so I got some information, but not all out of a colleague of mine. He was saying how giving albuterol may cause the patient to 'dry up and have them go into V-fib or V-tach'. Unfortunately, I am at work and he had to go on a 911 call, leaving me hanging. I was attempting to look up on line some info on this, but have yet to understand what he's talking about.

My point of view on this topic was that giving albuterol would bronchiodilate and therefore supply more oxygenated blood to the cardiac tissue that is fatigued, resulting in a fix for the pump problem. Combine this last after nitro, and lasix..... then do an in-line neb tx via CPAP if needed. OF course if the pump is broken then how is the oxygenated blood gonna get where it needs to be? Also, getting a pertinent history as to the cause of the CHF/AHF is the best way to treat.... :wink:

Another question: would you use Valium as an anti-anxiety med prior to the placement of CPAP?? We don't carry Ativan and it's becoming a HUGE problem with me because I feel Ativan does a better job, but that's another topic. 8)

[CaliMedic209]

we just got cpap and have no sedative to administer prior to using the cpap!!!!! ughh!!! if someone is freaking out because they cant breath the last thing they want is for you to strap a mask to their head!! we used to have ms in our chf protocol however it was removed kinda stuck here

[AnthonyM83]

Hey what part of Cali are you from?

As far as strapping the mask to their head, from what I've seen with acute severe CHF patients, if that mask is going to help them breathe they will be caring ONLY about that mask and nothing else. It's like how someone described a tension pnuemothorax...they're in such distress they'll let you shove a large gauge needle into their chest if it's going to provide relief...

[ambodriver]

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

well this study stated that bronchodilators should be used when symptoms present, but it quickly reminded the reader that it is not the end all be all therapy. I think that is what some of us have been saying. Treat the wheezes but it is not the tx for the bigger picture. Great read, thanks for posting.

[CaliMedic209]

anthony you are right.. in some patients (especially ones familiar with the procedure) they want nothing more than the mask... but others that dont quite know whats going on, it can be quite a task

[CaliMedic209]

oh yea.. sorry.. im from the central valley

[Swe112]

Hey everyone. Im rookie in the prehopital care and have some questions for you. I sometimes find it very hard to see the underlying problem for a pat with dyspnea, especially the different between CHF and excaserbation COPD. Do you have any suggestions for how you, clinical, can make the difference between the two diagnoses in prehosp inviroment ? And if you cant make the different, how do you treat the dyspnea?

We carry 02, albulterol, atrovent, lasix, Cpap, nitro, morphin, Solu-corteff.

Sorry for my bad english. Hope you can understand my problem... Best regards.

[ambodriver]

yes in CHF look for other symptoms, such as + JVD, rales, edema specifically pedal edema, hx of CHF, heart attacks. Difficulty breathting when laying down, do they use pillows to prop themselves up? etc etc

COPD look for those other signs such as meds they use, barrel chested, "Blue bloaters". Usually people with copd will know they have it and take some kind of neb. tx.

[Odorono]

Other tips for CHF:

--Keep in mind that patients in dependent positions might present with sacral edema before pedal edema. Check the flanks and buttocks of NH/ sedentary patients.

--Do a full assessment, and pay attention to hepatomegaly and do a quick check for hepatojugular reflux (firmly palpate RUQ for several seconds and observe JVD).

--If you're on the fence and EKG findings are suggestive of ischemia/injury/infarct, lean towards CHF as secondary to ACS.

--Lung sounds have been discussed extensively elsewhere on this forum; be familiar with the phrase, "all that wheezes is not asthma."

--Also refer here: http://www.emtcity.com/phpBB2/viewtopic.php?t=2496