Kaisu Posted July 6, 2008 Posted July 6, 2008 Ok - so I did some research - intubating a kid in status asmaticus is very risky. That is probably what caused the bronchiospasm and the arrest. (damn - killed another one). Non-invasive ventilatory assistance and IV Beta2 agonists would have been the better way to go. The thing is.. there is very little evidence and the treatment appears to be subjective. I am very glad you posed this scenario... if I ever run across this, I will be much more hesitant to intubate and will explore other options. What would you suggest for IV beta 2 agonist?
chbare Posted July 6, 2008 Author Posted July 6, 2008 I like the way you think and a very good consideration. Bronchospasm, pneumos, and barotrauma are going to be very real concerns with this little guy or any little guy with asthma this bad. However, the problem is something else with this patient. Take care, chbare.
mobey Posted July 6, 2008 Posted July 6, 2008 Ok I am pulling this out my a$$. What about exercise induced bronchospasm, whether it is related to asthma or not. (kid was not diagnosed w/asthma anyway). As he works to breathe through the constiricted bronchioles he further triggers the bronchoconstriction?? If we can get him back, stick him on a ventolator for a while and keep on stickin him with epy, and bronchodilators. I am really just shootin from the hip here though. great scenario, I love it when I have no idea what to do, keeps the gears turnin!!
chbare Posted July 6, 2008 Author Posted July 6, 2008 Not activity induced spasm in this case. Let me add another part to the puzzle? While you start to work the code, one of the ER nurses goes out and talks with the parents. She asks them if they have any more information about their child. The mother replies, "it's probably not important but he has a hard time getting around sometimes. walking up stairs is nearly impossible some days and we are planning on having somebody check him out." Take care, chbare.
Kaisu Posted July 7, 2008 Posted July 7, 2008 OK.. so this is right out of left field but... Does the kid have a neurological problem? Could the B2 agonists have precipitated a seizure? Do we need to administer ativan? _ No raucous laughter allowed - its not polite.
chbare Posted July 7, 2008 Author Posted July 7, 2008 You are on the right path as far as how you are looking for a problem. This is not related to seizures. Take care, chbare.
Laura Anne Posted July 7, 2008 Posted July 7, 2008 Wait, what does mom mean, 'a hard time'? Is he out of breath, or is it just his energy? Is it a problem with motor function perhaps? I guess they would be other signs for Muscular Dystrophy.....
Kaisu Posted July 7, 2008 Posted July 7, 2008 So this is related to a neurological issue.. the kid's not having a reaction to albuterol - like life threatening paradoxical bronchospasm? Or is it a hypersensitivity reaction to one of the RSI drugs?
Eydawn Posted July 7, 2008 Posted July 7, 2008 Did this kid use his rescue inhaler way too much before he got admitted to the ER? Does he use it on a daily basis? I'm thinking that plus 1hr albuterol treatment, his potassium has completely bottomed out.... Using too much albuterol can lead to fatigue, chest pain, arrhythmia, hypokalemia... Working on the hypokalemia theory, irregular heartbeat with premature contraction, muscular fatigue, weakened accessory respiratory muscles... Also, steroids may also contribute to lowered potassium. Is this kid on a daily steroid dose? I know some poor children that are for asthma. If he's using too much albuterol, and taking steroids, this would all make sense.. Am I off in left field somewhere? Wendy CO EMT-B
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