Ipratropium Help

[armymedic571]

As a side note, i absolutley hate it when people move these patients without putting in a IV on the premise of "saving time", really pisses me off!

Bushy......a little off topic, but thank you......maybe I should bring you over to speak to our providers.......

To the OP....

Your assessment of the protocols here in PA is correct. One of the base issues when the "new" state protocols were written was they were left vague to be further clarified by regional or local Medical Directors. To further complicate this....many did not.

My Service Medical Director is also our regional Medical Direcctor, and unless you corner him.......good luck getting answers.

As a general rule, you can give continuous nebs per protocol of any of the prescribed type, ie (Albuterol alone, Duoneb "albuterol/atrovent", or alupent). There is some discussion, as you mentioned as to the efficacy of giving continuous Duoneb, because of the potential side effects of the Atrovent being it is an anti-cholinergic.

Depending on your standard of care in your area, placing the patient on the monitor and starting a IV line/lock would be prudent.

I once asked Dr Bledsoe how much Atrovent was too much. He relpied, "when the patient starts to seize then you'll know". I don't think he took me serious, but it was funny at the time.

Hope that helps......good luck in your search.

J

[MSDeltaFlt]

Atrovent any more frequent than Q4-6hrs is redundant. Give it once with albuterol and then keep giving albuterol continuously.

[Kaisu]

Atrovent any more frequent than Q4-6hrs is redundant. Give it once with albuterol and then keep giving albuterol continuously.

For all patients? In all circumstances? Please explain why.

[Kiwiology]

For mild asthma we give one round of nebs (salbutamol) however for moderate to severe life threatning asthma its continious nebules.

The other servive here uses ipatropium bromide, however the area I am currently in does not.

[BushyFromOz]

For mild asthma we give one round of nebs (salbutamol) however for moderate to severe life threatning asthma its continious nebules.

The other servive here uses ipatropium bromide, however the area I am currently in does not.

Serious?? Is this a johnnies thing? Dude, that's fucked up!

[Kiwiology]

No ipatropium at the Jacko's mate

[MSDeltaFlt]

It's redundant because of its length of duration. It will still be working at its peak 4hrs after you give it. That's why. So just give it once with albuterol and then you don't need to give it again until 4hrs later at the earliest; sometimes 6hrs later. However you CAN keep giving albuterol only back to back and even continuously for an hour or two to get the effect you need; so long as pt's VS will tolerate it (Heart Rate, BP, cardiac O2 demand, etc).

[Kaisu]

It's redundant because of its length of duration. It will still be working at its peak 4hrs after you give it. That's why. So just give it once with albuterol and then you don't need to give it again until 4hrs later at the earliest; sometimes 6hrs later. However you CAN keep giving albuterol only back to back and even continuously for an hour or two to get the effect you need; so long as pt's VS will tolerate it (Heart Rate, BP, cardiac O2 demand, etc).

ok... follow you so far... what about peak therapeutic levels? wouldn't repeated dosages increase levels and at what level is the best efficacy for that specific patient? (btw.. appreciate you responding. Thanks for letting me pick your brain.)

[MSDeltaFlt]

As far as therapeutic levels go, you'll know you're getting therapeutic when VS, breath sounds, and overall pt status improve.

When you hear more air exchanging, respirations are less labored, and pt states they're breathing better, you're getting there. When lungs are clear, and there's no SOB, then you're therapeutic. Odds are you might not make it THAT far by the time you get to the hospital. Just get them on the road to recovery is all you can do most of the time.

[Kaisu]

As far as therapeutic levels go, you'll know you're getting therapeutic when VS, breath sounds, and overall pt status improve.

When you hear more air exchanging, respirations are less labored, and pt states they're breathing better, you're getting there. When lungs are clear, and there's no SOB, then you're therapeutic. Odds are you might not make it THAT far by the time you get to the hospital. Just get them on the road to recovery is all you can do most of the time.

and if that takes 5 doses in the COPD'r?