Respiratory Distress Protocols

Replies to This Discussion

Permalink Reply by Jasen Adam on December 15, 2008 at 8:52am

Rambling Thoughts said:

Jasen said:

I have been begging for our region to take a look our resp protocol and keep getting shut down. From what I am reading we are waaaaaaaaaay behind in times as usual. Maybe after reading all the options on here I'll try to bring it back up again.

What is your protocal Jasen? Where?

I am from Danville, IL
Protocol says to give Albuterol, Brethine and if resp failure is imminent then intubate using Versed.

▶ Reply to This

Permalink Reply by Tracey Baker on December 15, 2008 at 9:54am

Depends so much on capno wave form..Many go into CHF with a hx of COPD. The key is this: If you have no capno, none..are baffled by LS, blood pressure is the key to treat..High B/P always suggestive of CHF with dyspnea...ALWAYS..That is solid advice from numerous respiratory therapists and has always rang true..Also laxis with Gravelous Lung Sounds, solidifies mucous. CPAP is glorious. Mag Sulfate is glorious. Many are reluctant to change protocols because in many instances it guards against bad judgment in the field. Hence, no matter what your protocol, a solid assessment and ability to access on line medical is always a key to serve the patient well, and right.

Jasen said:

Rambling Thoughts said:

Jasen said:

I have been begging for our region to take a look our resp protocol and keep getting shut down. From what I am reading we are waaaaaaaaaay behind in times as usual. Maybe after reading all the options on here I'll try to bring it back up again.

What is your protocal Jasen? Where?

I am from Danville, IL
Protocol says to give Albuterol, Brethine and if resp failure is imminent then intubate using Versed.

▶ Reply to This

Permalink Reply by Darin Moore on December 15, 2008 at 10:28pm

here is a copy of our protocol

Rambling Thoughts said:

Depends so much on capno wave form..Many go into CHF with a hx of COPD. The key is this: If you have no capno, none..are baffled by LS, blood pressure is the key to treat..High B/P always suggestive of CHF with dyspnea...ALWAYS..That is solid advice from numerous respiratory therapists and has always rang true..Also laxis with Gravelous Lung Sounds, solidifies mucous. CPAP is glorious. Mag Sulfate is glorious. Many are reluctant to change protocols because in many instances it guards against bad judgment in the field. Hence, no matter what your protocol, a solid assessment and ability to access on line medical is always a key to serve the patient well, and right.

Jasen said:

Rambling Thoughts said:

Jasen said:

I have been begging for our region to take a look our resp protocol and keep getting shut down. From what I am reading we are waaaaaaaaaay behind in times as usual. Maybe after reading all the options on here I'll try to bring it back up again.

What is your protocal Jasen? Where?

I am from Danville, IL
Protocol says to give Albuterol, Brethine and if resp failure is imminent then intubate using Versed.

Attachments:

• RESPIRATORY DISTRESS.docx, 19 KB

▶ Reply to This

Permalink Reply by Jasen Adam on December 16, 2008 at 12:41am

Thanks Darin but i can't open a .docx file

▶ Reply to This

Permalink Reply by Lee V. Rosato on December 16, 2008 at 3:28pm

Jasen,

Go to this website at Microsoft to get the reader:
http://www.microsoft.com/downloads/thankyou.aspx?familyId=941b3470-...

▶ Reply to This

Permalink Reply by James Ellen on December 16, 2008 at 4:49pm

Hello everyone,

Thanks for all the replies and making this an interesting discussion. This has been a hot topic with some of my medics and reviewing our protocols. I dont feel like we are behind like I was informed we were the other day. I forgot to add we do have the option of using Mag, just have to call for it and really need a good capnogram to justify it.

OK, last major question...Is anyone out there using Xopenex instead of the traditional Albuterol or DuoNeb treatments and what have been the pro and cons of it?

▶ Reply to This

Permalink Reply by Cory T. Spankowski, NREMT-P, LP on December 23, 2008 at 12:21am

Yes, it was a great discussion. It brought out the very best of EMS providers and their respective thoughts. This is always a great thing!

Xopenex...GREAT med!!! As far as I know, predominantly used in the E.D., setting. I personally haven't heard of it being used pre-hospital...but I see it happening sometime soon.

Take care, and for God's sake be careful out there!

James Ellen said:

Hello everyone,

Thanks for all the replies and making this an interesting discussion. This has been a hot topic with some of my medics and reviewing our protocols. I dont feel like we are behind like I was informed we were the other day. I forgot to add we do have the option of using Mag, just have to call for it and really need a good capnogram to justify it.

OK, last major question...Is anyone out there using Xopenex instead of the traditional Albuterol or DuoNeb treatments and what have been the pro and cons of it?

▶ Reply to This

Permalink Reply by Tracey Baker on December 23, 2008 at 11:15am

In following this thread I want to add some things that I see that concern me personally with DIB calls:

Foregoing OXYGEN! Huge issue with me. HUGE.
Not determining if acute episode has now become chronic if not even status.
Inaccurate assessments by not asking pertinent questions:

What have you been taking? How LONG? Have you EVER been intubated as a result of this condition..DING DING..BIG QUESTION!

Lung sounds assumed and not re-assessed during and after tx.

Huge issue: Why is it that EPI seems to have taken a back seat to tx? Our protocols are pretty clear for EPI. If I hear one more time, "No epi, look at his/her HR?"..I may strangle someone. "Hello. He/she can't breathe: balance the system w/EPI!-HR will decrease!" Last I knew pathopysiology and pharmacological ins and outs were pretty important.

Have not used Xoponex.

Magnesium sulfate is fantastic..After all other tx's have deemed insufficient.
I marvel at the continued use of A/A duovents if the patient states: I have used my inhaler all day long and it has gotten worse as they are struggling to breathe, and low and behold a Medic has another A/A duo on them?? I don't get it to be honest with you.

Too many fail to tx secondary episode early w/ solumedrol..let alone primary reaction with EPI..for Gods sake EPI works! As does humidified EPI. I do not understand some things when the answer seems obvious..? To take this discussion further: Has anyone else gotten in this position?

It shows me that many do not understand the beauty of the body attempting homeostasis and how we assist this mechanism...I guess I hold very tight to the concept that education, along with complete and accurate assessment can alleviate NON-WORKING medication administration if it is all weighed and quickly assessed--Hence giving the proper tx NOW!

Case in point: I got written up for administering EPI in our system..which is a protocol. Only for the guy who wrote me up to be placed on suspension for inappropriate write up and showing the QA Manager that HE could not comprehend protocols, let alone administer the protocol based upon of S/S!! Not like biting your nose to spite your face!................................Tracey

▶ Reply to This

Permalink Reply by Allen D. Slotterback on December 23, 2008 at 11:19am

I agree with Matt. I have used Mag many times, and with great success. It is recommended to use Mag early if you plan to use it at all. By utilizing the mag early you maximize it's affects by allowing the subsequent albuterol or duoneb treatments to penetrate lower into the lungs and be more effective themselves. I usually mix 1-2 grams of mag into a 1000cc NSS bag and run wide open. It's important to remember that airway dryness is part of the equation and the extra fluid also helps in treating the symptoms. Of course caution must be taken in patient's with possible CHF.

▶ Reply to This

Permalink Reply by Tracey Baker on December 23, 2008 at 11:29am

We have to use as last alternative IF A/A nebs have been used. However, I do get consult and use ASAP if all other tx's have deemed insufficient! ABSOLUTELY!

Allen D. Slotterback said:

I agree with Matt. I have used Mag many times, and with great success. It is recommended to use Mag early if you plan to use it at all. By utilizing the mag early you maximize it's affects by allowing the subsequent albuterol or duoneb treatments to penetrate lower into the lungs and be more effective themselves. I usually mix 1-2 grams of mag into a 1000cc NSS bag and run wide open. It's important to remember that airway dryness is part of the equation and the extra fluid also helps in treating the symptoms. Of course caution must be taken in patient's with possible CHF.

▶ Reply to This

▶ Reply to This

• First
• Previous
• Next
• Last