new paramedic - question on breathing treatments

[JakeEMTP]

There are site rules?

I have a feeling your sarcastic side is slipping through and I actually chuckled, being a huge fan of sarcasm. But yeah, right next to the "twit-ter" insignia are (gasp!) the rules!

[tcripp]

I have a feeling your sarcastic side is slipping through and I actually chuckled, being a huge fan of sarcasm.

Oops. Busted!

[VentMedic]

Thanks. Not all systems use the same abbreviations and that's not been one of mine. That one we are expected to spell out.

Actually, it would be great if everyone got in the habit of spelling out the word with their suggested abbreviation in the original post. Then, others can follow suit if they choose. That way, we are all on the same page. (i.e., ...pnuemonia (PNA)...)

Either that, or we create a page on this site with agreed to abbreviations/acronyms?

There are certain standardized abbreviations/acronyms that must be used which you will commonly see in hospitals and long term care facilities. There is also a list of abbreviations that must not be used.

JCAHO "do not use" list:

http://www.jointcommission.org/NR/rdonlyres/2329F8F5-6EC5-4E21-B932-54B2B7D53F00/0/dnu_list.pdf

Some disease processes such as pneumonia (PNA), cystic fibrosis (CF) chronic obstructive pulmonary disease (COPD) and Amyotrophic lateral sclerosis (ALS)have accepted abbreviations. Chronic obstructive lung disease is sometimes used but not as often as COPD. A patient may be more likely to use the term if the physician brought the language into simpler terms. Chronic lung disease (CLD) is sometimes used in describing infant and pedi pulmonary disease such as bronchopulmonary dysplasia.

Of course each profession has its own set of terms and abbreviations. You will see me use some of the above from my RT profession and feel free to ask questions. I may also use "ALS to mean Amyotrophic lateral sclerosis and not Advanced Life Support but then the context of the statement should indicate that.

Examples of different abbreviations for other professions (most are recognized internationally):

Respiratory Therapy

http://www.rcjournal.com/guidelines_for_authors/symbols.pdf

Physical Therapy

http://physicaltherapy.about.com/od/abbreviationsandterms/a/PTabbreviations.htm

Radiology

http://www.rtstudents.com/radiology/radiology-abbreviations.htm

EMS sometimes falls outside of some standardized abbreviations. Example: DIB may mean Difficulty in breathing to EMS but is rarely used in the hosptials. The hospital staff may use SOB or DOE which can be more descriptive.

Thus, the abbreviations that are literally made up (and some do have a habit of doing that) and not listed in YOUR own policy manual are the ones that are truly invalid for your charting purposes. However, it is wise to follow the "do not use" list especially when it comes to medications. Write out what you can. However, if you do a thorough lung exam, it might take up alot of space to write out each lobe or segment.

That being said, I will try to write out some of the abbreviations. However, I suggest you get into the habit of reading medical literature (other than JEMS) which will generally have a list of many different terms and abbreviations included with each article. This will also help you when reading medical reports in patient charts.

[speedygodzilla]

Thanks. Not all systems use the same abbreviations and that's not been one of mine. That one we are expected to spell out.

Actually, it would be great if everyone got in the habit of spelling out the word with their suggested abbreviation in the original post. Then, others can follow suit if they choose. That way, we are all on the same page. (i.e., ...pnuemonia (PNA)...)

Either that, or we create a page on this site with agreed to abbreviations/acronyms?

I totally agree. I had guess pneumonia from the context but wasn't totally sure.

I am a brand new medic as well, have yet to even start orientation yet (waiting for state license). I plan to only give Duonebs with chronic conditions, and when their at home treatment is ineffective. I figure you can always start off with Albuterol, and add Atrovent down the road as needed. But I do plan to start my COPD, asthma patients who have had little to no relief from Albuterol alone off with a Duoneb from the start.

As for the CHF patients, well I have the advantage of having CPAP where I work and plan to start off with that and add Albuterol through CPAP as indicated. I too have heard many medics say they will never give CHF patients Albuterol and I beleive I understand the risk of opening the lungs to all the fluid. But with CPAP I have come to the understanding that they constant pressure reduces this risk and keeps the aviola open. Still not 100% clear on this as I have yet to see it done on a patient and if I have I seem to have forgotten, too busy driving.

Good questions!

[VentMedic]

Great idea. Might be something to put in the site rules, if anybody reads them when they join!

Does that mean I have to write out SpO2 as "Oxygen Saturation by pulse oximetry" each time?

[tcripp]

Does that mean I have to write out SpO2 as "Oxygen Saturation by pulse oximetry" each time?

No, I'm just hoping you will know which ones I'm familiar with and which ones I am not and clarify accordingly. Wait...there's that sarcasm again.

Point taken.

I've worked in multiple industries so I'm well versed in having to learn new abbreviations/acronyms as they apply to the new industry.

I also know that it will take a little time until I am sure I am doing the same thing.

[VentMedic]

I totally agree. I had guess pneumonia from the context but wasn't totally sure.

I am a brand new medic as well, have yet to even start orientation yet (waiting for state license). I plan to only give Duonebs with chronic conditions, and when their at home treatment is ineffective. I figure you can always start off with Albuterol, and add Atrovent down the road as needed. But I do plan to start my COPD, asthma patients who have had little to no relief from Albuterol alone off with a Duoneb from the start.

Let's start off with a clarification of "Duoneb". It is not meant to be Duo Neb as in two med neb although it is a catchy name. DuoNeb is the brand name for a combination medication of albuterol and ipatropium bromide and is from Dey Pharmaceuticals. Not every person will know what you mean since some use the generic formulation and I don't believe DuoNeb is available in most of Canada. In fact, here in the U.S., there are many hospitals and EMS agencies that do not use DuoNeb because of the cost. It can also be mistaken for "Dual Nebs" which is a therapy term in respiratory for certain high flow device setups.

If you are going to use rescue therapy, you might as well hit the patient with the Albuterol/Atrovent combo first since Atrovent is technically not a rescue medication but can be considered one if used as frontline in rescue. Its action is also not as quick as albuterol so if you are going to use...get it in right away. Albuterol and Atrovent are two very different medications in different classifications and it is not "if one doesn't work try the other".

Edited April 1, 2010 by VentMedic

[speedygodzilla]

Let's start off with a clarification of "Duoneb". It is not meant to be Duo Neb as in two med neb although it is a catchy name. DuoNeb is the brand name for a combination medication of albuterol and ipatropium bromide and is from Dey Pharmaceuticals. Not every person will know what you mean since some use the generic formulation and I don't believe DuoNeb is available in most of Canada. In fact, here in the U.S., there are many hospitals and EMS agencies that do not use DuoNeb because of the cost. It can also be mistaken for "Dual Nebs" which is a therapy term in respiratory for certain high flow device setups.

If you are going to use rescue therapy, you might as well hit the patient with the Albuterol/Atrovent combo first since Atrovent is technically not a rescue medication but can be considered one if used as frontline in rescue. Its action is also not as quick as albuterol so if you are going to use...get it in right away. Albuterol and Atrovent are two very different medications in different classifications and it is not "if one doesn't work try the other".

Little confused. Duoneb "is not meant to be Duo Neb as in two med neb." It is my understanding that Duoneb is Albuterol and Atrovent Nebulize together. In fact I have never seen Duoneb come that way, and have always just actually mixed the two and documented at Albuterol on one line, and Atrovent in the other.

I still don't see a reason for not considering Albuterol by itself for some patients. If Albuterol will do the job by itself why not let it? Atrovent is a great tool to help Albuterol be more effective but is not needed for all patients. At the same time there isn't much of a contraindication for adding Atrovent (besides allergies including soy and peanuts) so I guess it wouldn't hurt to add. At the same time I am still on the fense in thinking that I can always add Atrovent as needed, while I can't take a drug away I have already given.

[chbare]

I just want to emphasize a point Vent made earlier. Not all dyspnea patients need or will be helped by a bronchodilator. Specifically, not all pneumonia patients with dyspnea need bronchodilators. Pneumonia is fairly specific to the alveoli, if your patient has an alveoli problem without bronchospasm, dilators are not all that helpful. Remember, we do not have beta adrenergic receptors in our alveoli, contrary to what many people believe. Rather, the decision to use a dilator should be based on good evidence pointing to bronchospasm. Unfortunately, albuterol is not the scrubbing bubbles all purpose lung cleaner and general purpose respiratory cure all that people often make it out to be.

Take care,

chbare.

Little confused. Duoneb "is not meant to be Duo Neb as in two med neb." It is my understanding that Duoneb is Albuterol and Atrovent Nebulize together. In fact I have never seen Duoneb come that way, and have always just actually mixed the two and documented at Albuterol on one line, and Atrovent in the other.

I still don't see a reason for not considering Albuterol by itself for some patients. If Albuterol will do the job by itself why not let it? Atrovent is a great tool to help Albuterol be more effective but is not needed for all patients. At the same time there isn't much of a contraindication for adding Atrovent (besides allergies including soy and peanuts) so I guess it wouldn't hurt to add. At the same time I am still on the fense in thinking that I can always add Atrovent as needed, while I can't take a drug away I have already given.

Vent was stating Duoneb is a brand name for a medication produced by a specific company, Dey Laboratories. In fact, Duoneb does come in a single dose container. Therefore mixing your equivalent of a Duoneb is not technically Duoneb as this is in fact a brand name.

Take care,

chbare.

[VentMedic]

Little confused. Duoneb "is not meant to be Duo Neb as in two med neb." It is my understanding that Duoneb is Albuterol and Atrovent Nebulize together. In fact I have never seen Duoneb come that way, and have always just actually mixed the two and documented at Albuterol on one line, and Atrovent in the other.

I still don't see a reason for not considering Albuterol by itself for some patients. If Albuterol will do the job by itself why not let it? Atrovent is a great tool to help Albuterol be more effective but is not needed for all patients. At the same time there isn't much of a contraindication for adding Atrovent (besides allergies including soy and peanuts) so I guess it wouldn't hurt to add. At the same time I am still on the fense in thinking that I can always add Atrovent as needed, while I can't take a drug away I have already given.

DuoNeb is ONE vial of medication but is formulated in combination. Thus, you document DuoNeb with the understanding by your formulary (or protocols) that it is a DuoNeb. Also, if you look at the meds in DuoNeb you will find it states 3.0 mg Albuterol with the atrovent where as your standard Albuterol dose will be 2.5 mg. However, there is a notation on DuoNeb is that it is equivalent to the 2.5 mg base. Again, it is a difference in the formulation. If you were in a system that held you accountable for your medications, you would come up short if you document Albuterol and Atrovent as two separate medications but give DuoNeb. Your company could also not justify charging for a more expensive "DuoNeb" if you did not charge it as given.

If you look at the links I posted you will find that many of the medications are combinations such as Advair and Symbicort. You must know the combo name and the medications each contain to know what you are giving.

As far as allergies, liquid Atrovent has NEVER had the peanut issue. It was only a concern with the CFC propellant formulation with a lecithin base for MDIs with Atrovent and Combivent. Atrovent MDI now has the new propellant formulation (HFA) and is not longer an issue. Combivent, at this time, still has the CFC propellant and lecithin base which makes the peanut allergy still valid.