At 01:58 AM 23/05/01 +0100, Craig wrote:
>We have been using spacers rather that nebulisers for the mild-mod-severe
>groups for the last 6 months. This is supported by the literature - the only
>reason we are not using it in the life threatening group is that it hasnt
>been studied in that group - so the evidence is not there one way or
>another.
Toronto EMS did a study but I'm not sure if they made the distinction as to
severity.
This said
What is your strategy in low to No volume (Vt) Asthma Pts
1 ) MDI adapter for the puffer
2 ) In circuit Aerochamber
3 ) Or in circuit Neb "T" piece
4 ) Salbutamol down the tube
>The main problems have been convinving parents, GP's and ambulance staff
>that it works. Despite an education campaign prior to changing our
>guidelines ambulance and most GP's are still using nebulisers. The
>expectation of "cure by nebuliser" is a powerful effect and even good
>evidence has an up hill battle in the face of this culture. We hope every
>child we see we are converting and most parents go away sold - not all, but
>most
As for the Ambulance staff
I think I can speak for most of them
The Ned is a lot easier Hands off No coaching necessary & Calms Pt & family
(their is a psy component in asthma... and we certainly try to address some
of it)
Do your Paramedics
Do Peak Flow prior to giving Tx ?
>We are using 6 puffs via age appropriate spacer = (approx) 2.5 mg neb, 12
>puffs = 5mg. This is combined with a new "asthma action plan" designed
>around the spacer at discharge.
Don't quote me on this
... and we will definitely put this one under cultural medical difference
But at one point or still is
...for peds (1 to 8 yo from memory)
in eastern Ontario
On the acute status asthmaticus
They would give Salbutamol nebs till tremors were detected on the infants
... then they would hold for a period of time
They claim it was the most effective way to break them from the acute phase
of Asthma
... I think they actually published this
I am not sure if this has translated to reality in peds ER in my neck of
the wood
Charles Brault EMT-P
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