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#41
11-01-2009, 10:00 PM
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I'm almost afraid to get into this one but...
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#42
11-01-2009, 10:22 PM
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Note: PaCO2 is taken from an ABG (Arterial Blood Gas). It would also depend on the reliability of your side stream device and air entrainment allowance for rapid RRs and high MVs. I have seen some poorly designed side streams that give false lows as the patient is huffing rapidly attempting to blow off their rising PaCO2 and lowering pH. The ETCO2 won't tell you what the pH is and if that lower ETCO2 is a desirable thing such as in DKA and sepsis or when the patient increases their RR in the face of a neuro event. The body is pretty amazing at protective mechanisms which some could mistake for "hyperventilation by anxiety/hysteria". It also won't tell you if the patient has a fever. We could also consider pulmonary emboli. You would be surprised at how some health care providers get side tracked and fail to look for the cause of the tachypnea. We have also seen too many "well meaning" CCT providers bring in patients on ventilators that they tried to "normalize" the CO2 as it was reading on their ETCO2 monitor without knowing the gradient with a known starting PaCO2. Thus, as they lower the ventilator RR, the patient's pH drops to a dangerous level as the PaCO2 rises. I also get a kick out of those who tell a DKA patient to "slow down" as their pH is approaching 6.9. They then spend way too much time focusing on the patient's RR rather than checking glucose and starting an IV. Last edited by VentMedic : 11-02-2009 at 12:36 AM.
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#43
11-09-2009, 12:19 AM
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It would be better to reply in line...
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To touch on the education issue, cool stores have their place, and I tell a few in the classroom but only to elaborate on something I am teaching. I am very critical of paramedic programs in my part of Tennessee. I believe they worry too much about formalizing the program with modules and phases they they forget about teaching and fulfilling the need for early hands on skill and educational instruction. I went to a hospital based paramedic program in Ohio and saw how it should be done. Hands on animal and cadaver labs, early field and hospital clinicals, and making the students responsible for their own education by setting tough guidelines and rules. Schools around here are too lax and I even have insider info that one would rather pass sub-par students than fail them because they don't want their budget cut, then they rely on the NREMT exam. Some of those students will pass just because of the "blind squirrel" principle. I am harder on those students and give harder reviews because I don't want sub-par care on my ambulance giving care to the public or to me. I'm ranting, I'll stop.
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#45
11-09-2009, 06:13 PM
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But, since this is a thread with the word asthma in the title, here are some interesting stats. Asthma Statistics Approximately 34.1 million Americans have been diagnosed with asthma by a health professional during their lifetime. An estimated 300 million people worldwide suffer from asthma, with 250,000 annual deaths attributed to the disease. Workplace conditions, such as exposure to fumes, gases or dust, are responsible for 11% of asthma cases worldwide. About 70% of asthmatics also have allergies. The prevalence of asthma increased 75% from 1980-1994. Asthma rates in children under the age of five have increased more than 160% from 1980-1994. It is estimated that the number of people with asthma will grow by more than 100 million by 2025. Asthma accounts for approximately 500,000 hospitalizations each year. Children 5-17 years of age missed 12.8 million school days due to asthma in 2003. Asthma accounts for about 10.1 million missed work days for adults annually. Asthma was responsible for 3,384 deaths in the United States in 2005. The annual economic cost of asthma is $19.7 billion. Direct costs make up $14.7 billion of that total, and indirect costs such as lost productivity add another $5 billion. Prescription drugs represented the largest single direct medical expenditure related to asthma, over $6 billion. In 2006, asthma prevalence was 20.1% higher in African Americans than in whites. The prevalence of asthma in adult females was 23% greater than the rate in males, in 2006. Approximately 40% of children who have asthmatic parents will develop asthma. In 2005, 8.9% of children in the United States currently had asthma. Nine million U.S. children under 18 have been diagnosed with asthma at some point in their lifetime. Nearly 4 million children have had an asthma attack in the previous year. More than 11 million people in the United States have had an asthma attack in the last year. Asthma accounts for 217,000 emergency room visits and 10.5 million physician office visits every year. In 2006, almost 2.5 million people over the age of 65 had asthma, and more than 1 million had an asthma attack or episode. In a survey of U.S. homes, approximately one-quarter had levels of dust mite allergens present in a bed at a level high enough to trigger asthma symptoms. In 2007, 29% of children who had a food allergy also had asthma. Asthma increases the odds of healthcare use in obese people by 33%. http://www.aaaai.org/media/statistic...statistics.asp
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#46
11-10-2009, 07:09 AM
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Thanks VentMedic for opening up an encyclopedia in front of me. Although this one is scary especially when you talk about children in the age group of 5-17 suffering with asthma. As far as your take on spamming is concerned I just like to continue the conversation so some informative input could be seen.
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#48
11-11-2009, 09:46 PM
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#49
11-11-2009, 11:01 PM
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lol, allow me amend.
Adult asthma patients in severe respiratory distress will get CPAP first and everything else follows. Forgive my lack of specificity  Last edited by rjstine65 : 11-11-2009 at 11:02 PM. Reason: Edit misspelled word
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#50
11-12-2009, 12:38 AM
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For severe respiratory distress, we rarely use CPAP. We may use BiPAP with a very minimal amount of PEEP/CPAP. Air trapping is always a concern.
We also avoid using nebs with noninvasive since the high flow rates can bring about turbulent flow and reduce particle deposition. There are now a few studies on the medical search engines for some additional reading. Nebulization associated with Bi-level noninvasive ventilation: Analysis of pulmonary radioaerosol deposition http://www.resmedjournal.com/article...292-1/abstract
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