OK, you are new and asked for some armchair quarterbacking, so I will give it. Please bare in mind I am responding only to th einformation you have provided.
First, it says you "sat up the asthma patient to help with airway". Asthmatic patients are very rarely laying down or any other postion than sitting when they are truly in an attack. Remember the word "tripod" from class?
When an asthmatic is laying down, it is bad juju cause that means they are done, going to cease breathing pretty soon and I highly doubt one neb trmt would turn around a patient who has reached this point. They would not even be able to hold themselves up and actually recieve the treatment.
Then you say "bystander says....". Good rule of thumb is acknowledge the bystander but do not allow what they tell you to cause you to become tunnelvisioned. What does YOUR ASSESSMENT tell you....that is the important question.
Bystanders can easily influence an inexperienced provider down the wrong path, I have seen it many times. Be confident in yourself and competent in your knowledge and abilities.
Now as for the patient vitals...do those sound like a patient in serious distress? Pulse is not that fast, SPO2 is ok, and respirations are even in an ok range depending on presentation.
Then you say "definitely an asthma attack according to pt", well again I ask you...what does YOUR assessment tell you? Yes, patients should know their history and often do have it correct, but there are many out there that lie for attention or truly do not know what is going on.
OK, pet peeve time. It is NOT O2 "stat", it is O2 "sat" as in saturation not staturation. Please learn that so you dont say it in front of someone at the hospital and make yourself look further uneducated.
Now finally the med portion. You have a "known asthmatic" that does not have a rescue inhaler. Patient is unsure what she is or isnt allergic to and does not know why or which type of inhaler she had. It seems odd that any known asthmatic would not have an inhaler, epecially when they are prone to attacks serious as this one.
So, not knowing any of her allergy information, you decided to go ahead and give a neb treatment. Kudos to taking some intiative and making a decision, but did you consider the ramifications of what if she were alllrgic to it and you went ahead and killed her? Did you consider contacting medical control, a supervisor, anyone else that you could bounce the decision off of? I suggest med control of course, but did you?
After the med delivery, her airway opened and her sats increased....they increased from 94% to 97/98%?? What were her sats when you very first got there?
FYI, O2 sats are great but irrelevant. You can tell me so much more by noting physical changes in appearance and comfort levels than a machine with a number. Also, no where here did you mention auscultating lung sounds. This is so very important! You said you heard wheezing which is fine, but did you listen to where the wheezing was coming from?
Where it is coming from and whether it is inspiratory or expository wheezing is important. I have had patients fake wheezing before and a simple stethoscope could help you learn so much more about your patients condition. It also gives you a baseline to note actual improvement.
For example, if you tell me patient had wheezing in XYZ lobes inspiratory and expository pre neb treatment...and then follow up with wheezing diminished or resolved post treatment....that is more helpful than saying an O2 sat increased a few points. See what I mean? Also if you describe their overall apearance, color, body position, etc...this is more pertinent than a number off of a machine.
OK, so once she was able to talk and tell you it was a steroid inhaler that gave her problems, was she able to tell you what these problems were? Again, more important information either not asked or overlooked.
Finally, you ask what would I have done. If I were a basic, in your situation, I would of called med control. Once you have done that, all is well and you do what the doctor tells you.
One last thing to consider, do you think any of this may have been a panic attack or drama code?? This is a very real possibility, especially with the young females. A very thorough assessment could of revealed other possible causes. An thorough assessment also involves history gathering. What led up to this event, what was going on just prior, has she been having problems for several hours or days, or was this a sudden acute onset?
If this were a simple panic attack, you would not be the first to be fooled into thinking asthma first. It has happened before and will happen again, just learn from it.
