When to Neb.

cruiseforever

cruiseforever

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When do you start a neb. treatment? Our system says all nebs should be started enroute. The reason is that when you start a neb. in a pt's. home they will start to feel better and will refuse transport. Then a couple of hours later or sooner you will get called back and the person will be in acute resp. distress. This is mostly related to pts. who suffer from Asthma.

I will start a neb. as soon as the pt. is on the stretcher. Just wondering what other people are doing.
 
Are you sure it's not they will start to feel better, refuse transport and your service can't bill for it?

Sometimes there's no need for the hospital, all they need is a little breathing treatment. Just like sometimes diabetics need a little choogar and then to be reminded to eat so they don't fall right back into it.
 
cruiseforever said:
When do you start a neb. treatment? Our system says all nebs should be started enroute. The reason is that when you start a neb. in a pt's. home they will start to feel better and will refuse transport. Then a couple of hours later or sooner you will get called back and the person will be in acute resp. distress. This is mostly related to pts. who suffer from Asthma.

I will start a neb. as soon as the pt. is on the stretcher. Just wondering what other people are doing.
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As soon as you realize there is wheezing, especially in the asthma patient. I've been known to start a line as a route for epi and to administer steroids as quickly into the process as possible.

Waiting until your in the truck is irresponsible in my opinion. You don't screw around with asthma....
 
For me, nebs start as soon as I see a need, and that's usually as soon as I walk in and see increased WOB or hear wheezes. Don't wait.
 
Brown agrees salbutamol should be given if short of breath with wheezes

How do we feel about nebules in the "maybe cardiac" patient as opposed to one who is clearly having a problem of respiratory origin?
 
MrBrown said:
Brown agrees salbutamol should be given if short of breath with wheezes

How do we feel about nebules in the "maybe cardiac" patient as opposed to one who is clearly having a problem of respiratory origin?
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I'm very cautious with any patient that has a cardiac history and the typical CHF s/s. However, most of the time diff breathers have 6 miles of O2 tubing snaking through the house, a couple of MDIs next to the bed and they're begging for a breathing treatment. (and sometimes there's still a smoldering cig in the ashtray)

Any question about cardiac vs respiratory, I'll go straight to cpap and defer the nebs.
 
n7lxi said:
For me, nebs start as soon as I see a need, and that's usually as soon as I walk in and see increased WOB or hear wheezes. Don't wait.
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Couldn't have said it better myself.
 
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n7lxi said:
Any question about cardiac vs respiratory, I'll go straight to cpap and defer the nebs.
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Considering how often these disease process run concurrently, why?

Nebs can increase MvO2 and worsen CHF, but CHF can also exacerbate bronchospasm. Treat with nebs, but be ready with NTG and CPAP PRN. Don't ever be afraid to go down multiple pathways if needed.
 
Heck, just yesterday I had an asthma patient at a school. The patient got nebs the moment I walked in and heard the wheezing.
 
usalsfyre said:
As soon as you realize there is wheezing, especially in the asthma patient. I've been known to start a line as a route for epi and to administer steroids as quickly into the process as possible.

Waiting until your in the truck is irresponsible in my opinion. You don't screw around with asthma....
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As soon as you recognize that the tx is needed, get it started. Reactive airways are no joke. I get even more concerned when I find out that the patient has been on a vent a few times... and feels just as bad as the last time...
 
Let your pt's clinical presentation dictate your treatment, not your company's antecdotal what ifs. For doing that increases your risk of delivering the ER a cadaver instead of a pt.
 
Bronchospasm with hx of asthma = nebulised salbutamol straight up. As we know, bronchospasm can be caused by other diseases than asthma. If its another cause with cardiac involvement, maybe spend more time to quickly assess pt, their meds adn conditions before wacking them on a β2-adrenergic receptor agonist. Often we get called to asthmatics because their meds havent worked.
 
the_negro_puppy said:
Bronchospasm with hx of asthma = nebulised salbutamol straight up. As we know, bronchospasm can be caused by other diseases than asthma. If its another cause with cardiac involvement, maybe spend more time to quickly assess pt, their meds adn conditions before wacking them on a β2-adrenergic receptor agonist. Often we get called to asthmatics because their meds havent worked.
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Which is what I had yesterday...

Had to use duonebs, solu-medtrol, Epi IM, and even a mag-drip.



I despise respiratory calls... they change so quickly.
 
Follow your protocols

In the correctional setting we had a lot of abuse if we didn't monitor them closely, but we used to lose (I mean DEAD on the floor)about three inmates a year to asthma; this was in the days when alupent inhalers were new and Susphrine injections were in our protocols.
We would address a c/o asthma like this: asses the pt, adminsiter two Albuteral metered dose inhaler (MDI) puffs witnessesd as to technique and dose (they would hog down six or seven hits if allowed); if unimproved withint about five minutes, or if it worsened without any abatement, would go to order written by the MD for that pt for nebulizer, or use protocol (0.3 ml solution albuterol in either 2 or 3 ml SNS via air nebulizer). Nine times out of ten that did it. If again unimproved, or if it got worse again shortly, call the MD (usually ordered another neb), then call 911. Never lost a pt to asthma after 1990 with those protocols.

I imagine the ambulance gets the pt after they've already used their MDI, even if their technique stinks.
PS: had a co-worker once mistaking CHF for asthma, pt was asking to use his Albuteral...NOT.
 
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The company I work for seems to have the same view

I personally start the neb for an asthma pt before even moving them to the stretcher.

But ive had my partner take off with the d50 and run out to the ambulance cause "we treat in route cause the medical director doesn't like crews getting tied up on scene with refusals"

My $0.02, First line treatments need to be initiated first, hence the name
If a patients condition resolves and they no longer desire to be transported, thats their choice.

My responsibility is to the patient, and to take the best course of action for them, not to turn the call faster, worry about whether or not the company will be able to bill, or how many ambulances are left inservice on the street.
 
I give neb treatments at the point in time I decide they are clinically indicated.

Why would an EMS company advocate delaying medication delivery and the addressing of a patients problem until they are phyiscally in the ambulance? Makes no sense.
 
18G said:
I give neb treatments at the point in time I decide they are clinically indicated.

Why would an EMS company advocate delaying medication delivery and the addressing of a patients problem until they are phyiscally in the ambulance? Makes no sense.
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Because they do not bill unless they turn a wheel (transport). It's an asinine policy, but often congruent with private service EMS.
 
emt.dan said:
Because they do not bill unless they turn a wheel (transport). It's an asinine policy, but often congruent with private service EMS.
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Arrghh with-holding appropriate meds (ventolin/glucose etc) from a time critical patient to ensure and transport/$$$$ is very poor practice. What a shame these companies prioritise $$$ of patient care. No private services here, so we dont have those kinds of probs (in that sense)
 
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