beta blockers vs. albuterol

[sledogg1]

Nova Scotia Anaphalyaxis Epi 0.3mg 1:1000 IM and 1.0ml 10000 near death top off with diphenhydramine 25-50 mg iv/im salbultamol 5mg and if on a bata blocker glucagon 1.0mg every 5 min.

Asthma Salbutamol and Ipratropiumand ei near death 0.3mg IM 1:1000

Croup Recemic Epi 0.05/mg mg arosol to a max 0.5mg

Carry Mag Sulfate for the Torsade's and Toxcemia but not for asthma

[Acosell]

Can I ask a follow-up question?

Say I'm on scene treating a severe SOB with wheezing via ventolin. I see that the ventolin has little to no effect but realise the patient is on ventolin. Woudl I looked at as if I was crazy if I were to patch to the doc and ask for direction (possible epi?) on this case? I'm asking more in an Ontario perspective.

I recall a case presentation at a conference last year (Due North actually... I think the presenter was your BHP, but I forget now)

Anyhow, there was an asthmatic patient with SOB. They treated with salbutamol with no change in the patient. It became evident that the patient had a history of beta blocker use. The medics patched and got an order to give glucagon before trying another dose of ventolin.

I am probably forgetting part of that presentation, but that was the jist of it. Anyway, like Lithium said, the worst the doc can do is say no... That or decertify you, but that's why you just use your partners name/OASIS

kidding of course

[VentMedic]

People always want instant gratification.

One dose of albuterol delivered with the standard issue nebulizer probably will not give a response immediately everytime on severe exacerbation, beta blocker or no beta blocker. The average oral beta blockers that COPD pts, including asthmatics, are on will still leave enough receptors sites available for albuterol. This is proven time and time again in pulmonary labs on COPD pts who have all the "ol" meds on board. Usually it will take just a standard dose nebulized or by MDI for maintenance. That is one purpose of the Pulmoary test to determine an effective rescue inhaler for them.

If a pt is already on albuterol and he is still wheezing when you see him, doesn't always mean that med is not working for him. That dose and delivery may not work effectively now. People using MDIs without spacers usually have poor delivery anyway. When a person is SOB, their technique worsens. AND, the cause of their wheezing needs treatment.

The albuterol will help some but effective delivery will have to be accomplished. Maybe once the cost of the BANs (breath activated nebs) come down alittle, that should be your neb of choice on the rescue vehicles. You'll have then 80% better chance of binding with the receptors. The days of the standard 2.5 mg x 3 are hopefully moving behind us. With the newer nebulizers, the continuous nebulizer is also taking a back seat. To have a person sit with a "face mask" for 1- 4 hours getting the same medication dose that a BAN can deliver in 7 minutes is wasted time. We used to have people on continuous nebs for hours and in some instances, days. Most of the medication is wasted by the face mask and the delivery is ineffective. The airways may also be so tight that Heliox will have to be used.

Whatever is causing him to wheeze may need serious treatment without further delay. Hydration, steroids, antibiotics, diabetic meds and is there a cardiac component involved? COPD pts are not always straight forward. They come with several medical issues and breathing is just one of them. Forcusing on one system may distract you from other things that can create respiratory distress and wheezing.

In the hospital, it may take us hours or days to turn a pt around. A definitive diagnosis, if possible, needs to be made by the various diagnostic tools to determine what has spurred the battle before defeat is imminent.

Trying other things enroute is fine as long as it doesn't cause delay transport or complicate other medical issues the pt may have.

[paramaniac]

Can I ask a follow-up question?

Say I'm on scene treating a severe SOB with wheezing via ventolin. I see that the ventolin has little to no effect but realise the patient is on ventolin. Woudl I looked at as if I was crazy if I were to patch to the doc and ask for direction (possible epi?) on this case? I'm asking more in an Ontario perspective.

Here in England, given your scenario, we would go ahead with 500 MCG of Epi I.M, with a further 500 MCG 5 minutes later.

As someone else mentioned, steroids can be useful, however, the benefits may not be immediately apparent, particularly if transport times are < 30 minutes.

We give Hydrocortisone (Glucocorticoid) 200MG I.V for any prolonged transport time.