Should IV Ventolin be considered for suspected H1N1 patients?

[tniuqs]

With more of the experienced providers perhaps a redundant comment but adding these devices in circuits (and moreover placement) can cause some adverse effects generating more PEEP or changing I;E ratios inadvertantly, or saturating the filter with sputum ... while I am on that topic dont forget to change out side stream ETCO2 sample filters on ones monitors.

In passing remember that BVM or as some call it a "bagger" and where to place the HME/HMV or any filter other wise one may not be protected, some place it between the patient and ETT (and dependant of the type of filter) some use a flow diverter.

The incidents of nosocomial infections with any hospital equipment is quite high risk, and second on the hit parade is respiratory and the first is urinary cath so be careful out there.

I post this link in regards to O2 delivery devices ie modified NRM ... hope this link works.

http://www.gutz.com/display.php?psku=304020&lid=1&zid=1&origcat=30&mode=sp

If it doesn't goggle GUTZ medical and click on Oxygen and Entonox supplies, its on right side and one page down ... oh yes I have searched for who makes or just how effective (FLO2MAX® Filtered Oxygen Therapy Mask) it may be.

cheers and a timely thread.

Edited October 7, 2009 by tniuqs

[VentMedic]

Now for the IV Ventolin question again.

Would flu symptoms with no history of pulmonary problems be an indication for Ventolin?

Is Ventolin indicated for PNA with the absence of pulmonary disease history?

Isn't this similar to the CHF and ventolin debate?

[tniuqs]

Now for the IV Ventolin question again.

Would flu symptoms with no history of pulmonary problems be an indication for Ventolin?

Is Ventolin indicated for PNA with the absence of pulmonary disease history?

Isn't this similar to the CHF and ventolin debate?

Ah back on thread right then .. well if there is any sign or symptom of bronchospasm then why not treat with a beta 2 selective drug ie risk vs benifit... maybe use flow volume loops on that graphics package on the PB 840 to document on ventilated patients (outside voice there) and on the spontaneously breathing H1N1 patient use bedside spirometry or even a cheap "quicky" study with Peak flow meters to validate further study .... hey I bet Galaxo would be non board with Spacers and MDI's too.

Food for thought.

But IV ventolin ... umm last patient I gave 250 mics to back in the day got really pasty and dropped his B/P, it was transient BUT the patient did stop wheezing but thats anicdotal as when we used 90% ETOH SVN on Flash PE ...

cheers

[rock_shoes]

While we're at it. What about the possibility of using other beta agonists? Terbutaline and Levalbuterol come to mind. Perhaps a different drug would be more optimal depending on method of administration? I suspect that few studies have been done regarding alternate methods of administration due the fact that nebulizers are typically highly effective.

[VentMedic]

While we're at it. What about the possibility of using other beta agonists? Terbutaline and Levalbuterol come to mind. Perhaps a different drug would be more optimal depending on method of administration? I suspect that few studies have been done regarding alternate methods of administration due the fact that nebulizers are typically highly effective.

There actually have been many studies for many different routes since epi and theophylline days. The opinions are mixed for levalbuterol (Xopenex). Terbutaline is good and has a place.

Epi vs Albuterol

http://scholar.google.com/scholar?q=epinephrine+albuterol+IV&hl=en

Levalbuterol

http://scholar.google.com/scholar?hl=en&q=xopenex+levalbuterol

Terbutaline

http://scholar.google.com/scholar?hl=en&q=terbutaline+

http://scholar.google.com/scholar?hl=en&q=terbutaline+IV+asthma

I personally think MDIs (Metered Dose Inhalers) would be a safer route provided the health care provider wears an N95 mask when near the patient. Of course, this might not be cost effective but it could be an alternative for suspected flu cases with a hx of pulmonary disease.

[tniuqs]

Ah back on thread right then

I have no idea how that happened ?

Back to the regular scheduled programming.

Edited October 8, 2009 by tniuqs

[rock_shoes]

There actually have been many studies for many different routes since epi and theophylline days. The opinions are mixed for levalbuterol (Xopenex). Terbutaline is good and has a place.

Just at a quick glance it appears as though most of these studies involve inhaled routes of administration with the odd look at either IM or SC epi. I'll dig a little deeper through them and see what I can find.

I personally think MDIs (Metered Dose Inhalers) would be a safer route provided the health care provider wears an N95 mask when near the patient. Of course, this might not be cost effective but it could be an alternative for suspected flu cases with a hx of pulmonary disease.

I think the filtered O2 therapy masks (which also allow for filtered nebulized med admin) Squint managed to find might be even better. At a unit price of $6.99 canadian based on a box of 50 they are actually pretty cheap. Knowing what we pay for our Salbutamol nebs I think it would be more cost effective than a new MDI for each of these patients.

[VentMedic]

For the patients' benefit, several of our EDs have gone to giving MDIs instead of the nebulizers. The ED can dispense meds so the patient doesn't need another script and then have to find the cash and pharmacy for another MDI. They will have their medication to last for a few days. Getting meds is often the problem here in the US with the lack of insurance especially now with the high unemployment rate.

I also find I can give in a shorter time the same amount of medication and often much more with an MDI than with a nebulizer. Unless you are using a BAN (Breath Activated Neb), you are receiving a very small percentage of the medication. An MDI and spacer or holding chamber can deliver a larger percentage of medication. In the helicopter and CCT we do carry the MDI since the space is tight and we may be running a ventilator.

[1EMT-P]

IV Ventolin may play a role in the treatment of these patients where it is approved, but what about using Sub Q Brethine?

[tniuqs]

'rock_shoes'

Just at a quick glance it appears as though most of these studies involve inhaled routes of administration with the odd look at either IM or SC epi. I'll dig a little deeper through them and see what I can find.

Good and report back ... besides what else is there to do in Merrit anyway ?

I think the filtered O2 therapy masks (which also allow for filtered nebulized med admin) Squint managed to find might be even better. At a unit price of $6.99 canadian based on a box of 50 they are actually pretty cheap. Knowing what we pay for our Salbutamol nebs I think it would be more cost effective than a new MDI for each of these patients.

May be but very dependent on the fitting of the mask I would suspect.

The spacers could be sterilized and/or could follow the patient to wards (cost efficacy)if admitted and some types can even be used in-line on a circuit, ah now your making ME think rock shoes. I will do some emailing to some other RT supplier friends and see what we can come up with no point in reinventing the wheel.

There is a study (somewhat related) with Paeds and racemic EPI over Ventolin (SVN) for moderate to severe croup and was called disappointing.

Levalbuterol vs ventolin with no clear advantage in acute exacerbations of childhood asthma although hospitalizations were marginally lower ... I have the briefs of the studies if you so desire, to use as a sedating bed time story.

What is surprising that PALS has jumped on this EPI bandwagon for all croup ... and I am so not a fan of putting BPs and heart rate into the troposphere.

cheers