February 8, 2023

I’m about to drop knowledge girl i’m so glad so here we go all right we’re going to jump into this uh i’m going to have to videotape these things so we have a handful of videos that are available to you did rick tell you all about that it’s embedded somewhere on one of your things i don’t know which one it is but um unfortunately the majority a lot of our stuff

Especially the things we really need like io and iv somehow those videos got disappeared i don’t know where they went to so i’m gonna do some low budget film action so we can upload this to youtube so you guys can go back if you need a review so what we’re going to talk about real quick is albuterol last week we discussed inhalers we talked about how you guys now

Can administer you no longer have to assist we talked about six rights and we talked about what medicine is used for so now we’re going to go to the next thing which is the nebulizer it’s something you guys will be able to carry as amt’s and you’ll be able to administer it it’s very important right so now you can actually start to actively treat certain patients

Give me some examples of a patient that might need a nebulizer asthma patient obviously what did you say okay so wheezing obviously is one of the key indicators that’s an assessment that we would find what types of disease path what are we looking at so asthma is one allergic reaction right copd patients absolutely what else about ch chf patients right uh what

About just bronchitis right that could trigger some inflammation so what is wheezing this constriction is mucus build up right in the lower airways usually in the bronchials and so then when we administer albuterol what are we effectively doing dilating those products right so that helps for that gas exchange because ultimately an asthma patient they can breathe

In just fine right it’s the expiratory problem they have so get forcing that air back out that’s where you’re going to hear those wheezes now there are definitely a few things to know about asthmatics so some are like what i would refer to as a brittle asthmatic it doesn’t take a lot to trigger an asthma attack those those kind of folks can be very fragile in fact

I’m going to encourage you to do this i hope your ears are turned on your brain’s engaged and you’re going to make a quick mental note on this if you make an asthma patient there are a few questions you need to get to quickly your sample op qrs tear is going to be important but i want you guys to throw in a couple extra ones i want you to ask how often do you have

Asthma attacks i want you to ask have you ever been hospitalized i want you to ask have you ever been intubated patients that are hospitalized patients that are intubated from an asthma attack can go from talking to you to dead before you even have a chance to get them on the way to the hospital i saw it happen in front of my face so i’m telling you don’t waste

Time don’t waste time with treatment don’t waste time with transport you are going to treat on the scene this is not a load and go situation necessarily immediately immediately you need to address the problem which is going to be with oxygen and then it’s going to be with butyrol treatments so you guys are going to be aggressive to that but then you’re not going

To stay on the scene once you get the treatment started we need to think about loading and getting out of it because they can go from talking to you to bad now there are those that are seasonal asthmatics so sometimes when the seasons change spring and fall in particular their asthma kicks up you have childhood asthmatics so they will grow out of it as they get

Older some do and then you also have um exertional asthmatics somebody that starts to play sports you may have someone who’s playing sport and all of a sudden now they have an asthma attack come on so now they got to step out they usually have their inhaler with them and they can correct the problem pretty quickly those things said we’re going to treat all the

Patients the same rapid assessment listen to breast sounds listen to breath sounds and if they’re having a really really hard time talking avalon should you ask them 9 000 questions right then no no i’m going to give you a quick story these are free josue these are free i’m not charging you for these but i will throw them in so you remember stuff i told you guys

Or i may have mentioned to you guys i had a brazilian exchange student that stayed with me for almost a year and she would come to class with me from time to time this is how this is how obvious it can be we had an asthma patient we were doing a scenario the person just kept asking questions she said and this girl’s 16 she’s never done medical anything and she

Doesn’t speak a lot of english and she grabs me well and she’s like it’s okay why are they not giving oxygen so if it’s obvious to a 16 year old that has never done anything medical i should be honest to you guys oxygen treatment albuterol let’s talk about it comes in these cool little things right here all right so who can tell me the breakdown what is the

Milligrams what is the volume 2.5 milligrams 2.5 milligrams extend saline anybody 0.3 okay so it’s three cc three mls three cc’s or three mls that ccs and ml’s are interchangeable it’s actually sterile water i used to say saline as well i always thought it was it’s actually sterile water i have to look at that one somebody tell that to me i said really look it

Up it is steroid that said it’s concentration and volume concentration being the 2.5 milligrams and that’s what’s most important that you know how much of this do you put into one of these things the whole thing the whole thing now i put we have several up here thank you mr danny by the way uh we have several different versions and there are even more than this

Nebulizers come in many shapes and forms okay this one here has this long little bendy flexi thing here nobody in here is old enough to remember what a papa was from mcdonald’s which is sad to me but this is a spacer this is to keep your medicine from wasting out too much obviously they breathe in from this side remember i think i said this last week you don’t

Instruct them to take a deep breath in and hold it tell them to breathe normally in through their mouth into their mouth okay and they’re just going to breathe until all of this is taken it simply unscrews put the medicine in the bottom like so now what do you set your oxygen at top number six eight six to eight that’s the ring six to eight yep whatever yo we’re

Videotaping so just a little change come on in all right that’s your you’re good um six days so what’s your what’s your goal for this you wait until you get a missed that’s the bottom line so you turn up to six no missed all right it’s not a very good miss say this one’s broken man doesn’t matter doesn’t matter on this one all right so it should have a mist it

Doesn’t have a mist on a different one so we will hook up this dude i’m going to show you all of these some of your services will have this memphis used to have these i don’t know if they still do beyond the next one yeah yeah you got the mask once you have these these like this that go with the mask they have a little knob on the top that’s that’s just to keep

From wasting medicine which i’m going to show a lot of stuff usually comes disconnected in the back so you have to kind of put it together all right so these if you have one of these little green button on top the goal for this is that it doesn’t waste the medicine so the patient has to be strong enough to breathe in and when they do that knob will go down i’m

Not gonna put my mouth on this greg knox i don’t know where this thing’s pinned but i would show you otherwise so you breathe in and the knob the little ball on the top goes down and then they breathe in like that that way they’re not wasted now let’s say they’re too weak and they really can’t draw in that deep you can override it by just twisting that and now

It’s a continuous flow so they can breathe in naturally again they have to still be able to hold this for them to be able to use it so let’s just say they’re too weak they’re too uh the respirations are just they can’t do it all right so you need to help them out a little bit that’s why we have this mask by the way when should you turn this on before after you

Put the medicine in after i promise you try putting medicine on while this is turned on you’re saying i have a geyser in your eyeball you’ve got albuterol in your eyes it doesn’t work the same as sailing i’m just letting you know it’s happened to me you get excited you’re in the middle of a call you turned it on now you put the stuff in there on top of it you’re

Like well that did not work out like i needed to so all of these are just options and that you may have something different at your service you’ll have to know what your service carries really alone turn it on this will be a continuous flow but now you can just put this on their face like a non-rebreather bone it’s on there so breathing it in easy peasy when it

Runs out check them reassess the patient that’s the game plan here is you reassess after each treatment they need more can you give them more of course is there any contraindications for this say that again all right it’s okay i mean i know this is the mask i’m sorry you should not be able to breathe adequately i’ll be able to uh so if they can’t draw the the

Air in themselves they’re having to be ventilated yes you’re right that would not work out so cpap machines and we’re going to go over that actually rick’s going to teach you that some not all some cpap machines actually have a connector for this so you can hook them up to a neural treatment while they’re on cpap that works really well not all of them have that

Attachment so ultimately the medicine itself is fine to give a person asked me what’s for what about the heart rate well i had a conversation with the doctor and they said the heart rate’s elevated but the justification is the fact that the patient still has too many wheezes they’re not breathing adequately they need the medicine that overrides the idea of a high

Heart rate because they can treat a high heart rate but if they don’t get their lungs opened up that’s going to be the bigger problem so that said albuterol really does not have any quote contraindications if it’s indicated for the patient’s condition provided the patient can breathe it in so that’s really the bottom line that said should you start an iv with

Patients like this that are on this they’re on this you just started an int yes why uh you’re ahead of your game a little bit but that’s where i want you to start thinking the idea is not so much everything you can do it’s what’s going to be needed later so think about that so you guys may only be up to a certain level but as soon as you pass care off which if

It’s not to a paramedic it’s going to be to a nurse at the hospital or something you guys need to have that in mind that now they can give steroids so an iv or an int as we’re talking about is going to be needed so don’t think well all i can do is give out utero i can’t inject this in the veins no you can’t but there’s other treatments down the road that patient

May need so the iv access is necessary yesterday i didn’t mention that and there was some confusion on it it’s like why should we start wearing this so i want to go ahead and mention that now any questions on albuterol when you guys use this yes there’s nothing wrong with that unless you have two or two stuff what does it have like a portable and a main is that

He was hooked up to it’s not something you’re ever going to see in a book i’m glad you’re mentioning that because i need to kind of i’m going to piggyback on that comment here in just a second that said is that wrong it’s not wrong is it is it taught it’s not taught either and so i will talk about that i just want to finish with this though when you guys use

This stuff in the scenarios in the lab i want you to open it i want you to get used to putting it in there i want you to recap it right now we’re out of oxygen on our small bottles so if you’re using a small bottle you’re not going to be able to turn on something i want you to get the muscle memory because a true story when i came out of my paramedic class we did

Very little hands-on stuff it was mostly book talk i know this was a long time ago but still the hands-on matters and i found out later that one of my classmates shortly after we got out the field had an asthma patient and did not know how to assemble one of these things and put the medicine in it i was like you know what i had to fumble with it myself i figured

It out but i can see that you don’t do something it may be foreign so i want you guys to practice practice like you play now to piggyback on what you just said um you can stop on the scale because otherwise it’ll run too long my battery will die so i’ve got to

Transcribed from video
Nebulizer+Albuterol By Southwest-EMS