Needle decompression in crashing status asthmaticus

[VentMedic]

Vent thanks for the education. These are the types of things I enjoy seeing from you. Sorry I have gotten sideways with you on a couple of topics lately.

Differing opinions are what make this place interesting at times. It helps when the people you are debating with have some knowledge and intelligence to their credit.

It is always a pleasure to debate you sir.

[robsta]

With no air moving in or out I would think an intra-muscular shot of adrenaline would be giving the patient the best chance.

If they are breathing then oxygen, nebulised bronchodilators, position.

Rob

[BushyFromOz]

With no air moving in or out I would think an intra-muscular shot of adrenaline would be giving the patient the best chance.

If they are breathing then oxygen, nebulised bronchodilators, position.

Rob

Yeah, unfortunately i cant give it until they actually become unconscious.

[pond life]

It is possible to give Salbutamol (ventolin) (?albuterol is it in the US) by nebulisation in an unconscious or failing respiratory effort patient by using a T-piece. Not sure if you use them stateside so I will dig nout a pickie for you.

Mike

[VentMedic]

It is possible to give Salbutamol (ventolin) (?albuterol is it in the US) by nebulisation in an unconscious or failing respiratory effort patient by using a T-piece. Not sure if you use them stateside so I will dig nout a pickie for you.

Mike

Bag it in. Adapt the neb between the bag and ETT. Some BVMs have an MDI port but with the new HFA (thank you Canadians ) canisters, not all may fit properly. The same if they are on a ventilator.

[Camulos]

It is possible to give Salbutamol (ventolin) (?albuterol is it in the US) by nebulisation in an unconscious or failing respiratory effort patient by using a T-piece. Not sure if you use them stateside so I will dig nout a pickie for you.

Mike

T- piece works quite well with BVM and also within a ventilator circuit. Depending on the ventilator you may have to get a bit tricky and compensate for the additional external flow. Some ventilators do have an in built nebuliser through which you can T-piece however I personally don't like them. I have used the T-piece method with salbutamol, atrovent, adrenaline and magnesium with good success in the past.

Stay safe,

Curse :evil:

[VentMedic]

T- piece works quite well with BVM and also within a ventilator circuit. Depending on the ventilator you may have to get a bit tricky and compensate for the additional external flow. Some ventilators do have an in built nebuliser through which you can T-piece however I personally don't like them. I have used the T-piece method with salbutamol, atrovent, adrenaline and magnesium with good success in the past.

I wouldn't try this with a few of ATVs found on some EMS trucks in the U.S.

What transport ventilator are you using that has a built in nebulizer. Price for this extra accessory as an option?

Whenever nebulizing any med, filter your machine to prevent contamination to it and the exhalation port to prevent exposure to you and bystanders. Albuterol rarely causes a reaction but like any med that YOU don't need, avoid inhaling the stuff. Even when giving a regular neb in the ED I practice the 5 foot rule or wear a mask. And yes I will wear a mask when in a closed space like a truck especially with kids. I just draw a funnier face than my own on the mask for them to stare at so not to frighten them.

Even without the med inline with a ventilator, whatever bacteria/viruses/fungi are in the patient's lungs with be exiting the exhalation port at up to 60 L/m.

When running meds like lasix, mag, morphine and high dose albuterol, we don't use a regular acorn neb. The waste and particle size variation makes for inefficient delivery.

[Mateo_1387]

Even without the med inline with a ventilator, whatever bacteria/viruses/fungi are in the patient's lungs with be exiting the exhalation port at up to 60 L/m.

WOW. Talk about high flow ! :shock:

[Camulos]

What transport ventilator are you using that has a built in nebulizer. Price for this extra accessory as an option?

Sorry to create a misunderstanding. Damn night shift does that though I suppose :roll:

In my prehospital work I have only ever used the T-piece with a BVM. Ventilator wise I was referring to my hospital work where we use the T-piece with the ventilators in ICU. I have used a few different vents in the past but we are currently using drager XL. I have never used a T-piece within a transport ventilator circuit. To be honest I actually prefer not to use our transport ventilator on critically unwell asthma pts at all if it can be helped. Prefer just to manually bag as I can then "feel" lung compliance.

I guess that the other benefit of just bagging is that I don't see a waveform in front of me exhibiting how bad the pt is breath stacking and therefore I am able to remain blissfully unaware- JOKE!!!!

Hope this makes sense as I really need some sleep.

Stay safe,

Curse :evil:

[ERDoc]

Whenever nebulizing any med, filter your machine to prevent contamination to it and the exhalation port to prevent exposure to you and bystanders. Albuterol rarely causes a reaction but like any med that YOU don't need, avoid inhaling the stuff. Even when giving a regular neb in the ED I practice the 5 foot rule or wear a mask. And yes I will wear a mask when in a closed space like a truck especially with kids. I just draw a funnier face than my own on the mask for them to stare at so not to frighten them.

You have never worked in the asthma booth in the peds ER of Jacobi hospital in the Bronx. It is quite an experience. It is basically a regular room that they knocked the front wall out of. There are hard plastic chairs along each side with an oxygen port for each chair. As the name implies, this is where all the asthmatics go. The residents are assigned to the asthma booth for one hour during each shift, any more and you would have some strung out residents. You would see 10-12 pt/hr at minimum. After your hour you would come out with the shakes from all of the albuterol you inhaled. But hey, at least you weren't wheezing.