Inline Nebs: Intubated Patients

[18G]

Wanted to ask what most providers do for delivery of inline meds with an intubated patient. For example, an asthma patient that needs intubated or COPD patient in extremis. Does your agency have commercial items available for this?

I messed around at the station with using a standard nebulizer and the pieces/adapters don't fit so well with the ETT. Also, how effective is using albuterol straight down the ETT?

 

[DrankTheKoolaid]

re

Our commercial neb kits can be used with both BVM ( little fudging needed ) and direct fit to the Bousgniac CPAP. When on the LTV 1200 a different neb setup is needed though

 

[NomadicMedic]

We can inline nebs with both intubated patients and CPAP patients. Our vents and CPAP have the adapters needed in with the circuit.

 

[the_negro_puppy]

Our IC paramedics can give IV ventolin here

 

[Cawolf86]

We can plug the nebulizer acorn onto the end of the BVM - then the BVM connector after that connects to the ETT liike normal. As others stated the nebulizer also connects inline with our CPAP device.

 

[Handsome Robb]

Ours come with an elbow piece so we can use it inline with a bvm. Technically you need two o2 sources but you can make it work with only the one to the neb.

 

[epipusher]

we use something real similar to this

 

[Handsome Robb]

That's the same basic setup we use.

 

[Trevor]

Yup, our nebs kits also fit all of our equipment... Our BVMs, ETTs, and CPAP kits... (On a side note, I TRY not to intubate COPDers though...)

If yours dont, perhaps you need to have a discussion with your supervisor or supply people about ordering equipment that is compatible with each other...

We used to directly "instill" Albuterol down ET tubes for Hyperkalemic arrests (we dont anymore, because the net change in K+, by Albuterol, is minimal...) But i have never heard of it being given direct instillation for bronchodilation. I would ASSUME it would work, if it absorbs for the use in HyperK, obviously it would absorb for bronchspasms... But dont know for sure...

 

[18G]

We used to directly "instill" Albuterol down ET tubes for Hyperkalemic arrests (we dont anymore, because the net change in K+, by Albuterol, is minimal...) But i have never heard of it being given direct instillation for bronchodilation. I would ASSUME it would work, if it absorbs for the use in HyperK, obviously it would absorb for bronchspasms... But dont know for sure...

Thanks for the helpful responses.

I'm surprised to hear about not using albuterol anymore for hyperkalemic arrests. I have read a decent study that showed albuterol has close to the same effect as insulin/D50 which is a 1mEq decrease in potassium. The standard dose for hyperkalemia is 20mg. How much albuterol were you guys using?

 

[Trevor]

Thanks for the helpful responses.

I'm surprised to hear about not using albuterol anymore for hyperkalemic arrests. I have read a decent study that showed albuterol has close to the same effect as insulin/D50 which is a 1mEq decrease in potassium. The standard dose for hyperkalemia is 20mg. How much albuterol were you guys using?

we used to give 10mg

 

[Medic Tim]

our bvms have a port on the side for an MDI

 

[18G]

our bvms have a port on the side for an MDI

I think pretty much all BVM's do. We don't carry MDI's though and continuous nebs are most likely gonna be indicated pre-hospital.