Acute Asthma.

[BushyFromOz]

No. We were discussing options before it gets to that point.

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Yeah, thats what i thought, i skimmed through using my galaxy phone but i could not find the post regarding CPAP again

[Blakes Username]

So it sounds like steroids would be an option, but more as a prophylaxis - although if they aren't contraindicated and we have time it looks like a good component to consider... will check out the parmacokinetics there.

And if they are already in rep. arrest - 1:10,000 Adrenaline IVP and a drip for continuous infusion en-route would be a good basis for resuscitation (in combination w/ ventilation and compression's if it deteriorates into cardiac) - at least at the first point following arrest. Guidelines decree that I can only focus on one pharmacological intervention but now my asthma management plans are gonna ROCK!

Would administering adrenaline/epi pre-cardiac arrest - (e.g the phase of respiratory arrest before cardiac) - possibly be of some benefit for resuscitation or defibrillation if needed and therefore act as a sort of therapy and precaution?

If that doesnt work you can also try Magnesium Sulfate as it has great bronchiodilation and anti-inflammatory properties.

I think magnesium looks like quite an interesting intervention, I remained quite skeptical until now as it is in an natural occurring mineral (or less pharmacuetic than most) and my assumption was that it hasn't been pharmacologically targeted in the same way as most medicines, but then again I suppose adrenaline is quite similar in that respect - It would be interesting to see if magnesium has an analogue by now like salbutamol and adrenaline.

Ketamine if you need something to facilitate intubation, or if you bring the saturation up to the point that it's necessary.

Is this due to Ketamine's ability to cause respiratory depression?

Edited September 24, 2012 by Blakes Username

[chbare]

I'm not sure a similar analog exists. When comparing epinephrine and albuterol, you are comparing complex molecules. The big difference between them involves molecular changes. With albuterol, you make a change to the hydroxyl group on the number three carbon of the benzene ring of an epinephrine molecule and you end up with albuterol.

Magnesium is an element and modifications would either change the element all together or substantially change it's electronic structure. The only realistic change would be to add electrons to the Magnesium ion and revert to elemental Magnesium. Unfortunately, the consequences of administering elemental Magnesium would be disastrous. However, you may be on to something. Perhaps there exists a molecule the acts like Magnesium on smooth muscle but lacks the side effects?

[Arctickat]

What does everyone think about Glucagon in this case?

[DwayneEMTP]

Man, that's a good question.

I know that it can be good for spasm, and this is more or less a giant spasm, right? I'm not sure how aggressive it would be compared to the other options though? I've never heard of it used or even considered in such a situation...

So, to sum up, no idea. But I love the question...

[rock_shoes]

What does everyone think about Glucagon in this case?

I've heard of it but I don't recall what the intended mechanism of action was supposed to be.

Something for me to do some research on! I've been sitting out on industrial sites this month and could use the stimulation.

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[chbare]

When you administer albuterol and it activates a Beta 2 receptor, most paramedics are taught: B2 ---> magic occurs ---> bronchodilation. (I mean no offense to paramedics by the way.) However, the process is a bit more complicated. This response is known as a g protein coupled response. In a nutshell, the activated B2 receptor activates g proteins in the cell membrane. G proteins in turn activate adenyl cyclase and adenyl cyclase assists with the conversion of ATP into cAMP. cAMP interacts with receptors on actin/myosin cross bridges and this is what essentially leads to bronchodilation. You could in essence say that increased cAMP equals smooth muscle relaxation and bronchodilation.

Glucagon has it's own receptor, but that receptor is also g protein coupled and one of the outcomes of glucagon receptor activation is an increase in cAMP production. In theory, this sounds like a nice "back door" mechanism for bronchodilation. Unfortunately, the data that I have seen is not conclusive and some studies contradict each other. I would say the evidence for the use of glucagon in this case is relatively weak, but I do not think it would necessarily be harmful.

[DwayneEMTP]

When you administer albuterol and it activates a Beta 2 receptor, most paramedics are taught: B2 ---> magic occurs ---> bronchodilation. (I mean no offense to paramedics by the way.)...

None taken as I'm certainly one of those...in fact the one thing that kept ringing through my head while I was reading was.."One time at ATP cAMP..." And then you said, "back door" and I was a complete loss after that...

Thanks for that though....It's frustrating to have at least kind of learned much of that years ago only to find that most of that much has fallen out of my brain from disuse...

[chbare]

Yeah, it is tough. I remember much of this stuff simply because I receive repeated exposure. It is also tough to try to teach mechanisms and pathways to paramedic students because they often do not have the background to intuitively understand the concepts. It becomes an "in one ear and out the other" exercise.

In all honesty, even among other allied health students such as respiratory who have additional science prerequisites, I would say most end up forgetting the fine details after making it through pharmacology. It's the nature of the beast so to speak. You teach to a somewhat arbitrary standard in many cases and hope critical concepts end up sticking. If you are lucky, you find a forum such as this and engage in frequent episodes of mental masturbation to keep your self sharp. (As is the case currently)

[DwayneEMTP]

Exactly...which is why I get frustrated with folks that bring "What? You can't change it, so why argue about it?" Most things we can't change, but we can try and exercise our brains sometimes...

That's why you're such a gift here...to make sure we don't spend all of our time arguing over whether or not dog O2 masks are a good idea or not.. :-)

I do truly believe that the mental exercise of debate has value of it's own, regardless of the subject...And, that being the case, theoretically, we should spend less time debating hosemonkeys and more debating sex...I mean, I know we've got girls here that can hold their own...so to speak...