Nebulised Saline

enjoynz

enjoynz

Lady Enjoynz
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Hi All!
I was wondering if you could give me an answer about nebulised Saline
for pt's suffering from smoke inhalation.
We use to have protocol to give it here years ago, but it is not taught any more.
Do you have it as part of your training still and if not can someone tell
me what the reason is for not giving it anymore.
I was talking to my ambulance partner (EMT-I ) about it yesterday and he wasn't sure why it was stopped either. :unsure:

Cheers Enjoynz
 
Why? Humidified oxygen would do about as much good... I guess, in some cases it would not hurt however; I can remember exactly which one, but humidified oxygen is contraindicated.

R/r 911
 
Neb Saline = poor mans Humidified O2
 
Humidified O2 is a new one to me, sorry.
We only have straight O2 here.
It sounds interesting, can you tell me how it works, please?

Cheers Enjoynz
 
enjoynz said:
Humidified O2 is a new one to me, sorry.
We only have straight O2 here.
It sounds interesting, can you tell me how it works, please?

Cheers Enjoynz
Click to expand...
It comes in a little clear bottle that attaches to an O2 regulator/tubing. You can get more info here.
 
Ridryder911 said:
Why? Humidified oxygen would do about as much good... I guess, in some cases it would not hurt however; I can remember exactly which one, but humidified oxygen is contraindicated.

R/r 911
Click to expand...

So what are the contraindications for using humidified O2, please?
Can it be used for smoke inhalation?

Cheers Enjoynz
 
Nebulized saline as humidity? Sterile preservative free water is used for humidity in most respiratory humidity systems. If giving a NS neb, one might as well toss in some albuterol to at least be therapeutic.

The sterile water humidification bottle pictured in the link is for comfort and not therapy. It is used for patients that might be wearing a nasal cannula more than 24 hours.

No absolute contraindications for humidity with a relative contraindication for bronchospastic patients or those that suffer from cold induced asthma.

For smoke inhalation a high FiO2 may be required if the CO levels (carboxyhemoglobin) are high. These patients may also require a high flow humidity system and be able to maintain the high FiO2. Many large bore tubing humidity systems will decrease flow as FiO2 is increased due to decreased air entrainment (Venturi principle of operation). Due to facial burns the patient may not tolerate a standard aerosol mask and a face tent may need to be used but this system is high flow with a lower FiO2 delivery.

Hospitals will also have the ability to deliver high humidity, high flow (up to 40 liters) via their specially designed nasal cannula systems. This may be better tolerated provided the nares are not inflamed.

All of these systems I just mentioned can deliver high flow humidity and are capable of being titrated to an FiO2 of .21 - .28 to get the patient off the oxygen clock.

For prehospital smoke inhalation, a NRBM may still be the best bet for a higher FiO2 until the CO levels are known.
 
We don't have a humidifying system but I hear that just filling a neb with water instead of albuteral will do the job. Is this true?
 
Ridryder911 said:
Why? Humidified oxygen would do about as much good... I guess, in some cases it would not hurt however; I can remember exactly which one, but humidified oxygen is contraindicated.

R/r 911
Click to expand...

Paraquat poisoning?

Vent and/or rid chime in on this one. I remember something about paraquat poisoning and not using Oxygen on a NREMT EMT-I85 knowledge exam about 4 years ago.
 
Rattletrap said:
Paraquat poisoning?

Vent and/or rid chime in on this one. I remember something about paraquat poisoning and not using Oxygen on a NREMT EMT-I85 knowledge exam about 4 years ago.
Click to expand...

I believe you are right. I could not recall if it was paraquat or mustard gas poisoning? I do remember something that the more humidified oxygen, the potential for chemical burns?... Too many bridges have been crossed since then....

R/r 911
 
emt/ff71185 said:
We don't have a humidifying system but I hear that just filling a neb with water instead of albuteral will do the job. Is this true?
Click to expand...

The water would also have to be preservative free. NEVER use tap water. You would also have to have the ability to bronchodiate in case of bronchospasm since a neb is designed to break down the particles into a very small size, much smaller then a humidifier designer specifically for humidification of the upper airways. So, you would have to switch to NS/Albuterol. All of this can cause time to be wasted when there are other assessment and treatment priorities before humidifying oxygen.

Prehospital, humidification rarely if ever necessary. Even for patients with trachs, a short time off their humidifier and on an oxygen mask or trach collar with a venturi adapter will be okay.

For smoke inhalation, giving oxygen at a high FiO is priority for the CO. You do not want to be messing around with a 40% neb and water. If necessary, the person will be traveling to the HBO system with a NRBM until they are in place for the dive. Surviving the Carbon Monoxide is the priority. For burn patients, exposing them to unnecessary cold water vapor may also accelerate their heat loss.

Rattletrap and Rid,
Okay, I have to look the chemicals up. I remember having some of this back in FF school many, many years ago. However, I don't remember seeing it on the HazMat recert CEUs.

I know we keep mineral oil around for potassium or magnesium exposure as well a few other chemicals where water is not advised.
 
I'm sorry but, I you hand me a NS neb when I can't breath. I may just take the oxygen tubing and choke you with it. Hello! Give me something that will help me to breath!
 
Here is a trivia question. There is a medical condition (common in pediatrics, until surgical repair) that one can actually cause more harm by giving oxygen to them, than withholding it. (I know Vent already knows this..)

R/r 911
 
Oxygen is indeed contraindicated in paraquat poisining - paraquat is reduced to radical form in the lungs, a form which oxygen will then oxidize the cation form of paraquat and superoxide. Superoxide is really really good at destroying pretty much everything in the nieghborhood, and the enzyme in the body responsible for processing it isn't quick enough. The cycle can then repeat itself, as paraquat acts much like a catalyst. The consequence is that paraquat inhalation is extremetly toxic, much moreso than by other routes. Plus, if you live, it can cause all kinds of other problems, particularly neurologic problems, due to a couple of different, but similar, chemical reactions.

Rid's trivia:

I'm going to take an easier out - I'm sure this is not the answer you were looking for, but apparenlty "being a newborn in need of recussitation" is a condidtion in high Fi02 can be harmful.

My guess is that its a vascular congenital defect, which is exacerbated by the vasoconstricting influence of o2 though?
 
Thanks for the update on paraquat poisining .

Ridryder911 said:
Here is a trivia question. There is a medical condition (common in pediatrics, until surgical repair) that one can actually cause more harm by giving oxygen to them, than withholding it. (I know Vent already knows this..)

R/r 911
Click to expand...

Rid's question is a good one because you will be seeing more of this population as adults that have been surgically repaired as infants and peds. Oxygen will no longer be a detriment to them but don't expect an SpO2 of 99% either.

jrm818 said:
I'm going to take an easier out - I'm sure this is not the answer you were looking for, but apparenlty "being a newborn in need of recussitation" is a condidtion in high Fi02 can be harmful.
Click to expand...

NRP has re-examined its use of O2 in the delivery room.
http://www.hopkinscme.edu/ofp/eneonatalreview/Newsletters/1206.html#article2

jrm818 said:
vasoconstricting influence of o2 though?
Click to expand...

Oxygen is actually a potent vasodilator. In utero the baby's pulmonary vasular resisitance (PVR) is high when the lungs are not active in respiration. When the baby takes its first breath at even room air (21%) after birth, PVR decreases, and pulmonary blood flow increases dramatically as the lungs assume the function of gas exchange.
 
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We use nebulized saline to add to our Ventolin especially for pediatric administration. The equipment list put out by the MOH reqiures a bottle for humidified O2 and all it is is a bottle that you put sterile water in and the O2 travels through it to make it less dry. Saline does the same but you are using a neb mask for nothing really.
 
VentMedic said:
Oxygen is actually a potent vasodilator. In utero the baby's pulmonary vasular resisitance (PVR) is high when the lungs are not active in respiration. When the baby takes its first breath at even room air (21%) after birth, PVR decreases, and pulmonary blood flow increases dramatically as the lungs assume the function of gas exchange.
Click to expand...

i was thinking of systemic arterioles, not pulmonary, which are the opposite. in hindsight, not only did I not make that clear, but it also doesn't make very much sense - it's unlikely that a systemic problem would as direcly influenced by high Fi02 as would a pulmonary problem. Besides, if the mystery condition were systemic normal room air should also elicit the problem (excpt in cases of respiratory compromise), since high 02 saturation is the norm. :blush:

Also, since you acutaly konw the answer to the trivia question, and focused your post on pulmonary reactions to higher O2 concentrations, I think it would be a good guess that the answer lies in the lungs somewhere...
 
jrm818 said:
Besides, if the mystery condition were systemic normal room air should also elicit the problem (excpt in cases of respiratory compromise), since high 02 saturation is the norm. :blush:
Click to expand...

Very true and often the baby is placed on subambient oxygen as low as 16% if necessary by adding more nitrogen.

If Rid doesn't jump in sooner, I'll post some good links later or try to add to his post.
 
Go ahead Vent.... I was reviewing some literature in teaching PALS, ped.'s refresher portion, etc. and was reviewing T o F. Surprising how much I had forgotten.

Not trying to hijack the thread, but it appears the initial post/question has been answered.

R/r 911
 
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