Asthma attacks without an inhaler

[Asysin2leads]

Just a reminder that MDI's are for symptomatic relief of minor asthmatic symptoms and aren't really a life saving intervention... I mean, they're nice and all but if an asthmatic is really in trouble they're going to need a bit more than an albuterol puffer.

[Matthew99]

Wow. Interesting to read the split replies!

Remember acute asthma is an inflammatory codition of the small airways, characterised by bronchospasm, mucouse pluging and oedema, none of which 02 is going to change.

What if it's not acute? Can O2 alone do the job? (I'd imagine anyway a first aider should call an ambulance since he/she doesn't have the knowledge or equipment to know whether it's acute or not).

If I am working first aid and I have no ability to give meds I'll give medical control a call and ask them to allow me to use the inhaler. Giving them all the particualars as well as how far the ambulance is away. More than likely the doc will give the order to use the inhaler.

Not sure have such a thing in Israel that I can call and it'd give me permission.

Seriously your best bet is to use common sense, but can't EMT-B give Ventolin / Salbutamol in a known Asthmatic ? I have literally in my career used a 55 gallon barrel of this med and negligible (if any) side effects ever documented.

In Israel, the regular ambulances don't even carry it. Only the advanced ambulances.

Yes its not medication and no it won't completely fix the situation but it will buy you time and releave the patient discomfort to a degree.

How can it make it worse?

And one more thing, oxygen is a drug according to most that I know. Who gives the order to administer the oxygen? If you are a simple first aider with no licensure other than a first aid card and you are carrying oxygen, isn't that breaking the rules as well? Ambulance crews can't even give oxygen if it's not in the protocols or doctor's orders can they? So to extrapolate, if you are working a first aid station and there are no protocols or directions but you are given a bottle of oxygen to use, aren't you breaking the RX rule??

Well, oxygen is allowed. After you go through the course and they teach you how to use it, it's ok.

[BushyFromOz]

Are you part of MDA matt?

[DwayneEMTP]

A2L, man, it's good to see you! I've missed you here Brother, as I'm sure many others have as well.

I think that the replies give you a good idea of both sides of the argument. As you can see, the major reason for not giving it in the USA if you're confident that the patient has a prescription for it is legal, not medical.

Also, as pointed out, the question is good, but the one place that you went off into the ditch is asking if you should call an ambulance should things not improve. The ambulance should have been on the way the moment you wondered if O2 was necessary or not. If they called an ambulance the chances of them improving are small, and retarding great. Play the odds and get ALS enroute if possible.

And if this is an teen/adult patient the odds are excellent that they will know exactly if it's acute, how severe it is, what the cause and rapidity of onset means for their immediate future, etc. Ask them. And if they are having too much trouble breathing to answer, know that you/they are already in big trouble and get people moving...

Good question man...

Dwayne

[Kiwiology]

There is (locally speaking) no legal protection from prosecution under the Health Practitioner (Competency Assurance) Act or the Medicines Regulations for a person in this situation.

An inhailer contains salbutamol, a prescription medicine. WIthout a practicing certificate which enables prescription or a legal instrument of delgation (standing order) it is illegal for somebody to supply-for-administration.

[Just Plain Ruff]

There is (locally speaking) no legal protection from prosecution under the Health Practitioner (Competency Assurance) Act or the Medicines Regulations for a person in this situation.

An inhailer contains salbutamol, a prescription medicine. WIthout a practicing certificate which enables prescription or a legal instrument of delgation (standing order) it is illegal for somebody to supply-for-administration.

and isn't a prescription required for home oxygen? I believe that my grandfather who needed home oxygen needed a prescription. For one poster above to say that oxygen is allowed without a script, I believe that is a wrong statement.

Well, oxygen is allowed. After you go through the course and they teach you how to use it, it's ok.

So you are saying that once you go through the EMT or paramedic course, that just because you were taught how to give let's say Adenocard or dopamine that it's ok to give it?

What about an epi pen, you get taught how to administer it, right, you do know an epi pen requires a script right. So once you've been given training on how to give it it's ok to give it without the script or protocols to give such a medication?

Can you clarify that response quoted above.

[uglyEMT]

Squint thanks brother. You are making me look up the studies about the humidified O2. I wa just going by my local protocols and standing orders. I will look into possible side effects.

As far as your statement about EMT-Bs being allowed to administer said meds. Sorry not around here. We can't even give ASA for chest pain. Only meds we are allowed is O2 and Epi Pen. Being in a restrictive system has made me realize not to work too far outside my boundries. Will I turn a blind eye, yes. As stated about the wife "remembering" the Bayer commercials. Each situation is different, if this person was in distress and their parent was their with said parents inhaler I would probably "instruct" the parents. Would I use a strangers? I don't know, I haven't been presented the situation. I believe Ruf brought up the point that if you did administer the med from a stranger and the patient sucomes to the attack and dies you are in a shitstorm. Did the inhaler cause said death, I highly doubt it, but try explaining that to 12 people that couldn't think of a good enough excuse to avoid jury duty.

Now if I contact OMC and they said yes go for it, then by all means I would be asking everyone to empty pockets and purses to find me an inhaler.

This is an awsome topic, thank you Mathew for bringing it up!

[Kiwiology]

and isn't a prescription required for home oxygen?

yes

[Just Plain Ruff]

here is the bottom line, if you are not allowed to give the medication, if you are working only in a first aid capacity even if you are a medic then you are just that, a first aider. You work to the job not the certification.

If I'm working on a BLS truck but I'm a medic (why would I do that but it does happen), then you are effectively a EMT. If you are working on a fire truck without medic equipment but you are a medic, then you are working as an EMT.

So working as a First Aider, you are expected to work as just that. You call 911, you try to stabilize the patient best you can, if you cannot get medical control to authorize the inhaler and the patient doesn't have an inhaler, then you don't give the inhaler.

Sucks to be the rocket scientist who forgot their inhaler but life sucks. You use what equipment you have and hope the ambulance gets there in time to give the nebulizer and other meds as needed.

Bottom line, my certification and livelihood require me to do my job as required. If I don't have the tools that's on the organizers of the event. My family requires that I provide for them and I cannot provide for them if I get fired or lose my cert because I went beyond my scope of practice for a given job. Without an order for the inhaler and I give it, I have just gone beyond my scope of practice and 99% of the time nothing will go wrong but theres always that 1%.

but I'm going to do all I can to prompt someone in the audience with an inhaler to step up and use their personal inhaler. Maybe by saying "Boy, I really wish that you had brought your inhaler with you" loud enough for someone to hear and speak up and say "I have an inhaler" I'll reply with something like "I cannot use it, I need to get orders from a doctor to give it" and hopefully that person will step up and just give the inhaler.

Wishful thinking I know.

I am also a realist and I know that if the patient is in acute crisis, nothing is going to fix the issue aside from a nebulizer. The inhaler might stave it off but neb meds are needed. Let's just hope the ambulance gets there in time so I don't have to face that situation.

[tniuqs]

Hear in Kanukistan (AB) we have a deal called the Health Professions Emergency Aid Act, as long as there is no negligence and one provides care within the defined scope (even if a death occurred) this legislation covers us as we have no Good Samaritian Act that pertains to Professional Health Care Providers, if after a fatalities inquiry and then proceeds to hearing we are judged by our peer group NOT the general public at large. Thank You.

If a "tort" lawsuit were to ensue, (damages) if one was not charged for gross negligence then that court would not stand a snowballs chance of any "conviction" we are defined by our registration NOT the job we are being paid to do. On the other hand if we "withheld" treatment one could be charged. In an known Asthmatic and not permitting the use of someone's else's MDI ... well that would not be me I will sleep well at night knowing it was the RIGHT thing to do.

The different countries laws aside .. I will do what is best for my patient FIRST then deal with the possible repercussions, that said to make changes towards independent practice one may have to break a few old eggheads.

I would suggest you review the nebuliser vs MDI with spacer controversy as far as efficacy in delivery, although my personal view differs than the studies done by Galaxo based on decades of care, perhaps a topic for discussion at a later date.

Sucks to be the rocket scientist who forgot their inhaler but life sucks.

I can tell you that this is a daily occurrence for admission to the ER and if folks actually took more responsibilities for their personal care .. well Health Care Costs would go down, although sometimes it falls onto ones pocketbook and not being able to afford their own ... ps I have a few spare MDI I carry just in case of this event its happened to me a couple of times).. its just the way I roll.

cheers

There is (locally speaking) no legal protection from prosecution under the Health Practitioner (Competency Assurance) Act or the Medicines Regulations for a person in this situation. An inhailer contains salbutamol, a prescription medicine. WIthout a practicing certificate which enables prescription or a legal instrument of delgation (standing order) it is illegal for somebody to supply-for-administration.

Hey Kiwi ... grow a pair ... LMAO !