DuoNeb

[VentMedic]

Sorry for not stating that more clearly.

"Selling" the med; "This is what we use I've seen it work well on others. Let's give it a shot."

Or, "It's new and has gotten some rave reviews in the Pulmonary ward". (for a lighter atmosphere)

As oposed to "We don't use MDIs here, nebs are better anyway".

Or when instructing a pt in the ER avoid; "Although nebs work better, the doc has written you a script for an MDI".

This happens alot and now the pt will always have those words somewhere in his mind when he/she has an asthma attack.

Long term management; When a pt is end stage COPD, or just feels nothing is working, any encouragement that might get them back on track can get them through another day. The psycological aspect of COPD can fill text books several times over. Whatever I can say or do (without deception) until other meds can kick end to give a long term effect....

Air compressors; Small electric compressors can be plugged into the rig's electrical system. There are also battery operated ones. There are still some U.S. systems that are afraid of the hypoxic drive and don't put more than 2 L of O2 on a COPD pt. Many ERs only use compressed air on COPD pts. This is despite all the data that shows O2 good, hypoxemia bad. The SpO2 you see may not be the SaO2. But that is a Pandora's Box that should be opened carefully.

I have had the displeasure of witnessing hypoxemia by with holding O2 first hand many times over the years. I also get to take care of the end results in the ICUs and Subacutes (long term vent facilities).

There are alot of articles in the following journals comparing nebulizers, asthma attacks, accute exacerbations etc. Our medical directors give us articles to review. Some we try to duplicate to see if we get the same results.

http://www.rcjournal.com/

http://erj.ersjournals.com/

http://ajrccm.atsjournals.org/

As a Respiratory Therapist, I have several protocols to choose from in the hospital and on the CCT units. I still keep my Paramedic certification for special events; doing coverage on sporting events. Not as exciting as working EMS, but my admission is free and my aging back doesn't complain as much.

The EMT-Bs and EMT-Ps working EMS have my respect. (Although I have seen some ambulances better equiped than some of the ERs and ICUs I have worked in)