Salbutamol in the setting of pulmonary embolism

[Smellypaddler]

I put a post in the education forum but figure with the lack of a single response it may sit better in here.

If you have a patient that you believe is suffering from acute asthma and they are "circling the drain" so to speak. What effect will nebulised Salbutamol and Ipratropium Bromide have on them if they in fact are suffering from a pulmonary embolism.

By using a Beta II agonist that makes them tachycardic will that then increase flow from the RV towards the PE and raise pulmonary pressures? Is it likely to increase flow through the pulmonary system and thus increase left atrial pre-load?

I can't find any reference to the effects of asthma drugs on a pt suffering a PE and am confused as to the A&P surrounding this.

 

[Christopher]

I put a post in the education forum but figure with the lack of a single response it may sit better in here.

If you have a patient that you believe is suffering from acute asthma and they are "circling the drain" so to speak. What effect will nebulised Salbutamol and Ipratropium Bromide have on them if they in fact are suffering from a pulmonary embolism.

By using a Beta II agonist that makes them tachycardic will that then increase flow from the RV towards the PE and raise pulmonary pressures? Is it likely to increase flow through the pulmonary system and thus increase left atrial pre-load?

I can't find any reference to the effects of asthma drugs on a pt suffering a PE and am confused as to the A&P surrounding this.

If you have bronchoconstriction on top of a V/Q mismatch from a PE, it will probably help somewhat to relieve the bronchoconstriction. Just like in CHF+COPD patients, sometimes you'll have to put a neb on them due to being in a gray area of treatment.

Patients with a PE are already in a sympathetic overdrive and B2-agonists probably wouldn't make this any larger. Ultimately the patient will continue to compensate and increase HR (and maybe SV) until either the clot is lysed or they can no longer tolerate it.