No SOB, no complaints, but wheezing?

[tcripp]

As some of you know, I like to bring these kinds of scenarios to you just to see how you might have handled a particular call. So...

You are called out to a roll over. To keep it simple, your patient is fine and walking and even refuses transport/treatment. You clear c-spine in the field per protocol. There is NOTHING in his presentation that indicates he needs treatment/transport. However, you are trained to offer that ride twice and the second time he says, okay. Let's go.

Your assessment shows a man who's BP is elevated (both normal HTN and the fact he just had a little excitement with his roll over) and he is tachy. As you make the 15 min trip to the closest appropriate facility, you see that both are returning (as they should) to normal. (Yes, you did do an EKG and it showed sinus tach in 12 leads.)

Since you are a fantastic medic (giggle), you do a complete head to toe and listen to lung sounds. Odd...you hear wheezing. His SPO2 is 96-98% on room air, his color is fine and when you ask him about his breathing, he tells you he's breathing fine in full, complete sentences. Nothing indicates any issues. (Oh, further hx tells you that his has asthma.)

So, here is the question. Do you give him a breathing treatment just because you can hear the wheezes?

[ShockDoctor]

Honestly and realistically, I probably wouldn't do anything. If he has asthma, he's always wheezing; it's nothing new. I'd assume he'd have an inhaler with him, and I'd let him use that if he wanted. I wouldn't start pulling anything out for the short trip to the hospital.

[Katiebug]

No. Pt is asymptomatic. Is he a smoker? Hx of lung problems besides asthma? Recently Ill? Anything pertinent besides a little wheezing?

Edited for spelling

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Edited July 31, 2011 by Katiebug

[Bieber]

I would probably just monitor the patient and bring him in for the reasons listed above.

[tcripp]

No. Pt is asymptomatic. Is he a smoker? Hx of lung problems besides asthma? Recently Ill? Anything pertinent besides a little wheezing?

No ma'am. Nothing more than I gave you above.

For the record...I provided no treatment other than comfort.

But, my QA/QI came back with the suggestion that I could have given a neb treatment for the wheezing. I was just curious to see if anyone else would have taken that route.

[paramedicmike]

I'd ask whoever was driving to kill the engine at a convenient stopping point and listen to lung sounds again.

You know... so there's no engine noise interfering with anything.

[island emt]

No ma'am. Nothing more than I gave you above.

For the record...I provided no treatment other than comfort.

But, my QA/QI came back with the suggestion that I could have given a neb treatment for the wheezing. I was just curious to see if anyone else would have taken that route.

Did the QA/QI person give a reason of medical necessity for you to administer the nebulizer treatment other than "because you can do it"?

Often times we get the same from the regional med control QA/QI board.

Why didn't you do this? or Why didn't you start an IV on this Pt?

My normal answer is that there were no sound medical needs for the treatment to be given , even though our protocols allow us to do it.

No Treatment is completely safe or without risk, & I don't do things "because I can".

[tcripp]

I'd ask whoever was driving to kill the engine at a convenient stopping point and listen to lung sounds again.

You know... so there's no engine noise interfering with anything.

No interference. This was wheezing.

Did the QA/QI person give a reason of medical necessity for you to administer the nebulizer treatment other than "because you can do it"?

Often times we get the same from the regional med control QA/QI board.

Why didn't you do this? or Why didn't you start an IV on this Pt?

My normal answer is that there were no sound medical needs for the treatment to be given , even though our protocols allow us to do it.

No Treatment is completely safe or without risk, & I don't do things "because I can".

I will usually ask for clarification when I get a "did you consider" or "why didn't you". Sometimes I get it...sometimes I don't.

[tniuqs]

All that wheezes is not all asthma.

SD: If he has asthma, he's always wheezing; it's nothing new.

Most incorrect, auscultation and identifying broncho-spasm is highly suggestive that patient is in status, controlled asthmatics do not wheeze.

Maybe getting a bit more throughout history, like what other meds is the patient on, last ER visit, is he on any inhaled roids, when and how frequently does he need salbutamol ?

Just me I would give him round of salbutamol "on the house" reason being an adrenegic response could precipitate an asthmatic event, the risk (very low) vs benefit.

Just what "factors" where involved in this roll over in the first place is more of a question raised in my mind was this patient driver or just there for the roller coaster ride as an active participant?

cheers

[tcripp]

All that wheezes is not all asthma.

Most incorrect, auscultation and identifying broncho-spasm is highly suggestive that patient is in status, controlled asthmatics do not wheeze.

Maybe getting a bit more throughout history, like what other meds is the patient on, last ER visit, is he on any inhaled roids, when and how frequently does he need salbutamol ?

Just me I would give him round of salbutamol "on the house" reason being an adrenegic response could precipitate an asthmatic event, the risk (very low) vs benefit.

Just what "factors" where involved in this roll over in the first place is more of a question raised in my mind was this patient driver or just there for the roller coaster ride as an active participant?

cheers

Interesting thought process and hence the reason this forum rocks! The pt was the driver who had been texting when he lost control of his vehicle; minor damage.