Brooklyn girl dies from asthma attack

[firecoins]

Don't understand why no one calls 911. An ambulance can be sent.

If this was a cop, I fail to understand why they did not begin to write tickets.
Probably an auxiallary cop or meter maid.

 

[AtlantaEMT]

I'm confused. The girl had an asthma attack and the father claimed he had all of the "equipment" in the car. I guess an inhaler? Is he saying that the inhaler wasn't working or the medicine wasn't working? With all of that Ed Hardy I hope they could at least maintain their daughter's medicine.

 

[firecoins]

I'm confused. The girl had an asthma attack and the father claimed he had all of the "equipment" in the car. I guess an inhaler? Is he saying that the inhaler wasn't working or the medicine wasn't working? With all of that Ed Hardy I hope they could at least maintain their daughter's medicine.

They were in the mother's car? Mother was driving, no?

 

[reaper]

I'm confused. The girl had an asthma attack and the father claimed he had all of the "equipment" in the car. I guess an inhaler? Is he saying that the inhaler wasn't working or the medicine wasn't working? With all of that Ed Hardy I hope they could at least maintain their daughter's medicine.

Most likely multiple inhalers and a portable nebulizer machine. Her condition may have been to far involved for them to work. If she was shut down, the medicine cannot reach the intended goal!

 

[jjesusfreak01]

A surgical airway is designed to create an airway inferior to a block in the upper airway allowing ventilation. Asthma causes swelling in the lower airway, trapping air and preventing both ventilation and oxygenation.

Right, but I thought asthma could cause upper AND lower airway obstructions. Just checked Wikipedia, apparently that is not the case. Other than a nebulized bronchodilator, is there anything you can do for a patient like that? Can you give an IV beta 2 agonist like salbutamol?

 

[Aidey]

Is that a general you or a me personally you?

Me personally I can give IM epi and Mag with orders outside of albuterol or atrovent nebs. Other areas can sometimes give IV or inhaled steroids or whatever else their MD has allowed them to have in their toolbox.

 

[Smash]

Generally speaking, yes, salbutamol can be given intravenously. It comes in a different preparation to the nebules; I do not believe (but I do not know 100%) that the nebules can be given intravenously. The only time that intravenous salbutamol may be of any use is if the patient has such poor air entry that nebulized medications cannot reach where they need to go. Otherewise there is no benefit to giving IV salbutamol in terms of the degree to which it works.

There are a number of undesireable side effects to intravenous salbutamol, as it causes acidosis (thereby further fatiguing already tired respiratory muscles) and has a propensity to cause cardiac arrythmias (more of a problem in the elderly than in a child)

Personally, while I can give IV salbutamol, I prefer epinepherine. It has equaly effective bronchodilatory effects, is less likely to cause acidosis (but obviously may cause arrythmias) and it can help to overcome poor perfusion from dynamic hyperinflation from two fronts, both by reducing the hyperinflation and by improving venous return. I also like that it is effective for anaphylaxis whereas obviously salbutamol is not. It is often not an easy task to differentiate acute asthma from anaphylaxis in a patient who has a history of allergies and reactive airways diseases (and the atopies like asthma, allergies, eczema go together) so I like the one drug works on all idea.

Magnesium sulphate may also be indicated for moderate to severe respiratory distress (although there is actually reasonably limited data, it does seem to be effective in these patients and it is recommended by most bodies) and I would also give some intravenous corticosteroids.

 

[Aidey]

I would rather have corticosteroids than epi to be honest. Epi works, but it also increases the myocardial oxygen demand, and in patients that have any pre-existing cardiac problems that extra demand can cause damage.

 

[Shishkabob]

Albuterol, atrovent, Solu-medrol, magnesium, Epi 1:1 SQ and then we have 1:10 IV as a last ditch intervention, on top of intubating and positive pressure ventilations, just in my protocols.



Plus some places have Terbutaline.


There's plenty we can do, and plenty could have been tried on this girl had her mom not been stupid and ran on her own.

 

[Smash]

I would rather have corticosteroids than epi to be honest. Epi works, but it also increases the myocardial oxygen demand, and in patients that have any pre-existing cardiac problems that extra demand can cause damage.

I would rather have epi than steroids. Steroids work over hours to days. There is no evidence that giving steroids in the field improves outcomes, although it is intuitive that the earlier they are given the better, hence the use of them.
Epi on the other hand, will save someones life immediately. If a patient is not moving any air, the last thing they need is steroids.
Myocardial oxygen demand is irrelevant when you don't fix the supply in the first place. It may raise workload, but there will at least be oxygen being delivered and CO2 being removed, which won't happen otherwise. Hypoxia will cause far more damage than epi will.

 

[emt seeking first job]

I do not get it.

The latest is they identified the cop.

They suspend him for failing to do CPR.

I have many questions:

1) are all NYPD Police Officers required to maintain CPR certification ?

2) are they issued and required to carry face masks ?

3) is there a patrol guideline for medical calls, with children, common sense is to hold the people until EMS arrives, which in that area, would get there in about six minutes or less ?

4) did the girl stop breathing altogether ? if not, what does someone with CPR training supposed to do, other than await EMS ?

There is nothing in the NYS VTL that allows private people to disregard the law, even in a medical emergency.

I was LEO in NYS, not in the city, there was a vollie ambulance, sometimes they would take to long to get somewhere, many times we transported people to the hospital ourselves, lights and sirens.

Once I pulled over a guy for speeding. He announced his daughter was having an asthma attack, I immediatly called for the ambulance, then he wanted to leave, saying "oh, I know how to take care of her, she does not need a doctor,"

But then could not explain why he was speeding....or where he was going....

Funny thing was, in that area, the vollies would bill at a minimumn $700, and even bill if there was no insurance.

About two weeks later, he came in to complain.

I had saved my notes and his info, in case he did, was not going to give him a ticket, (an LEO has up to a year to serve a violation sumons) but then I did, (75 in a 30 + disobey stop sign ) when he came into to :censored::censored::censored::censored::censored: about the ambulance bill and how his insurance had high deductible and me or my agency should pay.......

In traffic court, the judge asked to see the medical records to see if there had been an astma attack, the guy refused, he was found guilty, he had points on his license, got revoked, (which is big deal in an area with no buses or trains to speak of....)