Tricks of the Trade

[livnbreathems]

hey guys trying to stir up some more discussion....Does anyone know any good tricks of the trade? I heard that treating asthma with no other choice can be treated by giving a patient coffee. I do not think I would give a patient of mine coffee even if it was available for I fear what it might actually do!!! :shock:

[Eydawn]

It is true that caffeine can be administered with some bronchodilatory effect... I've been known to grab a cup of coffee or tea, and the combination of the warm liquid plus the caffeine helps me a bit. (I'm an asthmatic, FYI). But it's not in my scope of care and better results could be produced in a *patient* by getting them to an ER and providing supportive care enroute...

Now, if you're out at a summer camp, it's a staff member that's well known to you, and all the BLS rigs in your area are tied up and you're waiting for advice from A: your boss and B: your medical director, then I could see asking the patient if they were a tea or coffee drinker and asking if they wanted some... if the attack was mild enough to warrant stay and play instead of calling for the helivac. If not... well, it's time to fly...

Tricks of the trade aren't what you want to look for I don't think... you want to start asking some questions with focus... Don't be afraid to ask a stupid question. You'll get a smart-aleck response and a link to the appropriate thread in most cases.

There's any given number of tricks for any given number of situations... but you gotta make sure you've got a good handle on what your situation is first.

Wendy

CO EMT-B

MI EMT-B

[SARgal]

Yes, in my experience, caffeine eases asthma symptoms. I've had to 'treat' my daughter's asthma with a can of Coke before. She left her albuterol MDI in school that day and didn't realize it until bedtime, when she needed it. She was 13 at the time and a little p.o.'d that the soda kept her up half the night! I had her drink half the can and it was enough to stop the coughing/wheezing.

I can't see myself treating a patient with caffeine though. I am only a Basic, and if I have a Pt with difficulty breathing, I've got ALS on the way. If my Pt has no medication that I can assist with, then I'm going get this guy moving, finish out my SAMPLE, get some vitals, give lots of assurance and meet ALS en route. I don't see where stopping for a cup of Java fits in there.

But I am VERY new, I still have lots to learn. Could be I'm wrong...

:shock:

[livnbreathems]

I have been an EMT for about several years and an EMT-E for a while hear lately. I would not treat my patient with caffiene either I was just interested in if it does work. Just in case like you said you get into particular "CRISIS'S". I have plenty of way for treating asthma in the back of an ambulance. I know I am not as high trained as some of you all but the things I can do seem to work rather nicely! Thanks guys great replys.

[spenac]

I use it when have mild asthma. Works similar to theophylline, in fact if patient on theophylline is heavy coffee drinker (caffeine) may actually go beyond beneficial levels and become toxic.

In the field our basics treat astma with albuterol or duoneb via neb by written protocol so no need to give them coffee.

[cfaulknor]

the other trick that works in an asthma situation... I used this when I worked in the Health Office at the local Scout Camp....

What is the other drug we give for asthma? Epi...

somehow, startle the patient... yell "Boo!" jump, do whatever you have to to... but it'll unload enough epi into their system to be as effective as an injected dose...

[AZCEP]

Treading dangerously on the urban myth ground there. :roll:

The patient that is experiencing a respiratory problem bad enough to seek treatment is already dumping their endogenous epinephrine stores into their circulation. You would have to throw them off a bridge to get a big enough change to have a clinical effect.

The coffee can work as a way to prevent needing any rescue maneuvers. Once the bronchoconstriction happens, you need something that will work much faster than the GI tract will allow.

[Ridryder 911]

the other trick that works in an asthma situation... I used this when I worked in the Health Office at the local Scout Camp....

What is the other drug we give for asthma? Epi...

somehow, startle the patient... yell "Boo!" jump, do whatever you have to to... but it'll unload enough epi into their system to be as effective as an injected dose...

Okay, let's stop with the unscientific facts and potential dangerous treatments. This was supposed to be tricks of the trade, not wives tales such as using drinks with caffeine and scaring people. As well as Azcep describes some as physiologically impossible if not dangerous. Stress induced asthma as per stress with fright can cause a sudden catecholomine response releasing histamine, and can actually increase bronchospasm. Also caffeine is NOT recommended for those that have a history of asthma, as well. Underlying previous administerd medications along with caffeine can cause an increase in ventricular rate, over stimulation, etc. thus causing further complications and the possibility of preventing further treatments that could had been administered.

Let's keep it real folks, unless you have solid literature or respectable citations, let's not give unfounded medical advice. We attempt to make sure that treatments are in concurrent with most medical standards.

R/r 911

[VentMedic]

It is true that caffeine can be administered with some bronchodilatory effect... I've been known to grab a cup of coffee or tea, and the combination of the warm liquid plus the caffeine helps me a bit. (I'm an asthmatic, FYI).

Caffeine is part of the Xanthine family same as theophylline. Patients going for Pulmonary Function Tests are advised to hold all caffeine products 12 hours prior to testing. It does produce some bronchodilation and skew percentage results when testing albuterol. I have seen the bronchodilation effects of expresso in the PFT lab. It was impressive.

http://content.nejm.org/cgi/content/abstract/310/12/743

In rural regions, physicians have long advised parents to give their child black coffee or tea when experiencing difficulty breathing while driving to the hospital.

However, I would rather have an inhaler or nebulized Albuterol for a more direct application if given a choice.

[Eydawn]

Espresso does the trick, huh? How about that! Good thing I like coffee! As I said... I'd rather go for the standard treatments first... but hey, if you're in a rural situation and it could potentially benefit your patient (I mean, drinking hot water sometimes relaxes the person enough to help them control their breathing... I've seen that one work a few times, so tea or coffee potentially might have the same effect, psychological or not...) then you might want to consider it. But you better have a good documentation for why the situation necessitated something unorthodox like this.

Since we're going on the asthma alternative treatments at the moment, who has a take on the ye old throw them in the bathroom and run the shower full blast trick... I know I hop in the shower for the warmth and the steam and it seems to help me, especially if I'm also battling some sort of upper respiratory infection, but what could be the pros and cons of this in home use with family/friends or as something you've seen a patient do?

Wendy

CO EMT-B

MI EMT-B