Let me continue this over here since it is a similiar discussion. These are important issues that should be understood when treating different diseases.
Originally Posted by MasterIntubator
Maybe so.... but out of the 100 or so cases of interest that I am my fellow trained EMT-Bs have had, we have had success.
By this, I take it you mean you got them to the hospital alive?
For many asthmatics, they need some nebulizers, steroids and fluids. However, one should not think asthma is not a serious disease because you haven't seen status or one decompensate.
As an EMT-B, you probably had no option but to bag if a patient stops breathing. For the breathing asthmatic however, that may NOT always be the best treatment. If one does choose to bag someone they should understand compliance and resistance as it pertains to the disease process. It is a little more than just squeezing a bag. Do you NOT understand what is meant by pathophyisology or disease process and how to apply it to whatever equipment you are using?
Originally Posted by MasterIntubator
And as far as barotrauma, it did not make a difference what mechanical delivery method was used ( BLS/ALS/Anesthesiology circuit/NPPV/brochos/etc ). What we did find out, is that many of them did not decompensate further with assisted BVM, even with trained inexperienced folks. Some did... even in the ER setting. So that leads me to believe that sometimes you can't do anything to help those folks
One must understand the difference between BAROTRAUMA and VOLUTRAUMA.
An asthmatic can hold their own for quite awhile which is why this leads some to believe what they did in the field "fixed" the patient or it was a save. Decompensation is not a good thing and it should be avoided. This is why EDs usually have immediate access to HeliOx, BANs and the ability to get different medications. Once an asthmatic starts to decompensate, if the ED does not have much advance technology, the patient may die or at the very least end up with 2 chest tubes which then only complicates the situation further.
Heck, if you want to get exotic, might as well place pressure along the thorcic cavity to assist in expiratory effort.
Nothing exotic about this either as it is done in other countries as well as being trialed in this country.
In my BLS days, I have had many of the same questions and problems. We had less ALS folks to jibber jabber physiological effects and analyze the 'whys' and 'what fors' during an emergency. I knew about the basic physiology as taught. Anything greater was doctor stuff.
But ya know.... it freakin worked when you needed it the most.
Than as time went on, I learned more and why... but things have not changed that much... I am just more aware and have better understanding.
Again, another downfall in EMS is this BLS and ALS mess. Being BLS is not an excuse for not being aware of the complications of using a BVM or not having a basic (not as in BLS) understanding of the disease processes.
Holy crap we can get out panties in a bunch over a rare barotrauma. ( the top FASC docs still can't agree on it )
That is why I wasted the time to put in my first writing about training... obtaining skills... and not be over zealous. I am sure one of the professional EMTs who has studied had read it fully and got the point
Barotrauma? There is nothing exotic about this. Doctors do argree it and
VOLUTRAUMA exists. What can't be agreed upon is the best treatment and technology for it.
We STRIVE to make both BAROTRAUMA and VOLUTRAUMA "rare". This is why we spend over $50K for each ventilator and have many different gases and medications available.
Just like with all the posts... there is something in them all for someone. Learn it all young folks, learn ALL the ways. It will come.
This I agree with but one should not just view the BVM as a simple little BLS tool. It should be understood well as any other piece of medical equipment.
Understanding the disease processes and knowing one's limitations can not be stressed enough. Getting an SpO2 on an asthmatic DOES NOT necessarily mean you are winning the war. You may not even be winning that battle if you have not lung sounds indicating air movement with that SpO2 of 100%.
There are a few disease processes that may just require a quick RSI and placement on the best technology available with the appropriate gases and medications.
In the ED, we just know we can not spend much time bagging a severe asthmatic, ARDS and some PNAs including PCP and that from a potent strain of Influenza A.
However, I can use a BVM a cardiac arrest patient with no active pulmonary disease or a COPD patient for as long as it takes to finish a code, intubate or transfer to a more appropriate place for intubation. I just know the types of patients that I prefer not to prolong bagging or in some cases do as little BVM as possible.
What I initially said would be anaphylactic.