Help please!

[Voodoo1]

I had asked this question of my instructor, but have yet to hear back from him. I need to know why I would be establishing an IV line for a patient with a respiratory emergency (COPD, ARDS, Asthma) The question that I had asked him was regarding the treatment of an asthmatic. If a pt were presenting with pulsus paradoxus, would the salbutamol and epi do enough to clear it or is the IV there in part to help stabilize the BP? I also wanted to know why I would administer NS or ringers lactate to a COPD pt. This is just cookie cutter pt management from my textbook. I want to know why I'm doing something. Just because the book said so isn't enough.
Thanks in advance.

PS..I understand that attending to the respiratory issue is paramount, these are secondary issues I was asking about.

 

[Remeber343]

I would drop a line incase :censored: goes south. Better to be prepared then to have to scramble and get things done fast and have the chance to muck something up. If the Nebs don't work, I would want a line established and would be thinking mag and solu-medrol.

 

[Akulahawk]

In patients who do NOT have signs of dehydration or fluid overload, one of the biggest reasons to establish an IV line is: med access. That IV provides a direct route into the bloodstream. Remember, it is far easier to establish a line while there is still good systemic circulation than it is when there is none...

 

[Anjel]

In patients who do NOT have signs of dehydration or fluid overload, one of the biggest reasons to establish an IV line is: med access. That IV provides a direct route into the bloodstream. Remember, it is far easier to establish a line while there is still good systemic circulation than it is when there is none...

This.

Any one that is respiratory compromised, is an unstable pt.

Unstable pts get IVs. For an asthmatic, technically any drug you would need to give can be done IM. But like another poster said, If your pt starts crashing, then you need a line for everything else you are gonna need to give.

I would be cautious to give anyone a ton of fluids that is having respiratory problems. But definitely a line, so I have that reassurance.

 

[Voodoo1]

Thank you all for your replies. That's what I had thought, I just wanted to make sure that I wasn't missing something.

 

[Cawolf86]

I agree with mainly preventative.

Sepsis patients may need fluids or pressors and they often present with SOB.

Asthma may need Mag Sulfate.

Anaphylaxis may warrant IV epi.

Copd may require a benzo to tolerate CPAP.

CHF may require Lasix or Morphine.

Just a few common ones off the top of my head.

 

[Voodoo1]

I agree with mainly preventative.

Sepsis patients may need fluids or pressors and they often present with SOB.

Asthma may need Mag Sulfate.

Anaphylaxis may warrant IV epi.

Copd may require a benzo to tolerate CPAP.

CHF may require Lasix or Morphine.

Just a few common ones off the top of my head.

Just a thought here, I'm assuming that when you refer to the CHF you're kinda lumping it in with the ARDS pt? If the ARDS is not of cardiac origin than wouldn't Lasix be useless? Wouldn't dexamethasone be a better way to go? I would administer epi to the asthmatic pt if I felt that the vitals were not improving enough or fast enough. I'm in total agreement about the sepsis pt. Mag Sulfate isn't in my scope (boo). Neither is Lasix or any opiates (bigger boo)

 

[Cawolf86]

Just a thought here, I'm assuming that when you refer to the CHF you're kinda lumping it in with the ARDS pt? If the ARDS is not of cardiac origin than wouldn't Lasix be useless? Wouldn't dexamethasone be a better way to go? I would administer epi to the asthmatic pt if I felt that the vitals were not improving enough or fast enough. I'm in total agreement about the sepsis pt. Mag Sulfate isn't in my scope (boo). Neither is Lasix or any opiates (bigger boo)

Sorry if I was vague. I was just naming a few common situations. I was referring to known cardiac/chf history not other causes of sob with rales. Lasix for cardiac etiology in my protocol.

Yah mag works great on reactive airway disease to reduce the swelling of the bronchioles.

 

[Remeber343]

Up here for CHF we do rounds of NTG, and you can also BVM with an asthma pt to help... Just make sure you are venting when they breath. We have these cool little adapters for Nebs on ours. Works pretty well.