Ipratropium / Atrovent Question

[mobey]

Different delivery methods will again have to be repeatedly tested to see if there is actually no difference. However, the new canisters have made it difficult to adapt many of the MDIs to a ventilator or BVM circuit so it is difficult to even use in the same way as before. Long term MDI users are now preferring nebs in the ED where before we did give MDIs for rescue.

One problem I find here is that there is a lack of training on how to properly use the aerochambers.

[tskstorm]

Outdated information.

This was true with ONLY the older MDI form with the CFC propellant. All Atrovent MDIs should be HFA and the soy allergy does NOT apply in any way to the liquid form of Atrovent or "Duoneb".

However, the soy (lecithin base) does still apply to the Combivent MDI (CFC) since it was granted a stay of execution by the FDA...at this time.

Unfortunately it specifically states in the protocol it is contraindicated by soy and or nuts.

Unlike most medications where it is just expected you will know the contraindications and use clinical judgment in administering a medication this is specifically stated any deviation from this would be an issue.

thanks for the info though !

[VentMedic]

Unfortunately it specifically states in the protocol it is contraindicated by soy and or nuts.

Unlike most medications where it is just expected you will know the contraindications and use clinical judgment in administering a medication this is specifically stated any deviation from this would be an issue.

thanks for the info though !

Unfortunately some that write the protocols, and the providers as well, do not read the medication inserts or keep up to date with drug information. Again, this was only true for Atrovent MDI and Combivent MDI which contained the CFC propellant. So, unless your service is using these, it does not apply. The liquid form does not have a lecithin base and has never been included in this contraindication.

There is another issue for Atrovent and that is glaucoma. Luckily I have only blinded 1 person in 20 years and it only lasted for 6 hours....a very long 6 hours for me and the patient. That was in the ED and the glaucoma meds were overlooked in the history taking by both the Paramedic with EMS and the RN. I then made the stupid mistake of assuming there were not other meds or medical conditions on the list.

In the hospital and for prescribing Atrovent we do look at other things such as renal function but again, in EMS that probably won't be an issue unless you try to run "continuous Duoneb".

Edited May 5, 2009 by VentMedic

[tskstorm]

Unfortunately some that write the protocols, and the providers as well, do not read the medication inserts or keep up to date with drug information. Again, this was only true for Atrovent MDI and Combivent MDI which contained the CFC propellant. So, unless your service is using these, it does not apply. The liquid form does not have a lecithin base and has never been included in this contraindication.

There is another issue for Atrovent and that is glaucoma. Luckily I have only blinded 1 person in 20 years and it only lasted for 6 hours....a very long 6 hours for me and the patient. That was in the ED and the glaucoma meds were overlooked in the history taking by both the Paramedic with EMS and the RN. I then made the stupid mistake of assuming there were not other meds or medical conditions on the list.

In the hospital and for prescribing Atrovent we do look at other things such as renal function but again, in EMS that probably won't be an issue unless you try to run "continuous Duoneb".

The protocol was only implemented in Jan 09. That's NYC REMAC for ya!

Again thanks for the information.

Edit for: year

Edited May 5, 2009 by tskstorm