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Clinical Protip

9 comments

When it’s oh-dawn-thirty and your patient has oh-my-God respiratory distress that woke him up from a sound sleep and now he can’t breathe unless he’s sitting up and he can’t get enough air in his lungs and he’s so combative from hypoxia you can’t even manage to keep a non-rebreather on him and he’s tachycardic and extremely diaphoretic and oh-my-God hypertensive…

… it’s likely acute pulmonary edema, not asthma, no matter how wheezy they sound.

Put away the albuterol and start liberally fogging the nitro to them, and if they’re still alert enough to respond to coaching, CPAP.

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Posted by on August 1, 2012 • Filed under: Uncategorized
  • Old_NFO

    Interesting twist… I’d have missed that one! Thanks!

  • Tracer

    It would be nice if we could add a solution of IV Nitro to the nebulizer and fog-away. But then again, I still frown on the “magic 3-doses.” These folks need relief, not prolonged suffering so yes; CPAP and Nitro are the way to go.

  • Cath

    Oh. I had this patient some years ago, and didn’t understand. Now, I will likely never forget. Thanks! :-)

  • Bobball

    So true…

  • Too Old To Work

    It’s one thing, although inexcusable, for pre hospital providers to do this. It’s another for hospital providers to do it. Yet, time and again, I see doctors making this mistake. I’ve blogged about it at least once and frequently “correct” newer EMTs and paramedics when they start down this road.

    It’s simple really. Patients over the age of 50 do not suddenly develop Asthma in the middle of the night. They DO however, develop CHF under those circumstances, and often in the setting of MI.

    For every 20 patients that end up on CPAP for CHF, I might get one that ends up on CPAP for Asthma or COPD.

  • N3qtrtme

    Thanks for painting a much clearer picture of this presentation for me.  I will definitely be changing my index of suspicion for these cases!

  • Starjack

    Thanks for the protip.

    Is it okay if I blogroll you?  I’ve been reading your blog for a couple of months and recently started my own.  I’m just getting the blogroll set up, and I’d like you to be the first addition.
    Thanks,
    Starjack.

  • Ambulance_Driver

    Of course! Shooter a link to your blog, and I’ll put you on the Blogroll O’ Doom, as well!

  • The (Not-So)Flying Monkey

    Where the hell did I put my propofol?

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