MDI for bronchospasm
Probably dumb question, but I couldn’t quickly find a lot of literature about it, gave up quickly due to me being a bit ADHD. Had a female smoker for routine Ortho bronchospasm on induction. It was pretty manageable after deepening anesthetic and some albuterol puffs down the ETT. For a lot of these players who spasm, I give subq terbutaline after it saved my ass once (I think). Usually give decadron too if indicated. When I was squirting albuterol down the tube, the OR nurse chimed in and...
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Source: Student Doctor Network - June 19, 2023 Category: Universities & Medical Training Authors: NumTacos Tags: Anesthesiology Source Type: forums
Bronchiolitis Treatment? (When supportive is not the answer)
A 14-month-old male presents to the emergency department with fever, cough, and increasing difficulty breathing over the past 2 days. On physical examination, the child is in moderate respiratory distress with grunting and retractions. Auscultation of the lungs reveals diffuse expiratory wheezing. The most beneficial treatment for this child's respiratory difficulty is
- amoxicillin
- dexamethasone
- diphenhydramine
- prednisolone
- albuterol
This sounds like bronchiolitis to me (< 2y/o...
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Source: Student Doctor Network - February 20, 2022 Category: Universities & Medical Training Authors: hsk013 Tags: USMLE and COMLEX Step II Source Type: forums
Interesting case
Had an interesting thing happen in the cardiac OR yesterday:
50 year old man, severe MR w/ P2 prolapse, scheduled for MV repair. Otherwise pretty healthy and well compensated, had albuterol on his med list but didn't carry a formal diagnosis of asthma and denied using his inhaler in years.
At the end of the bypass run, cross clamp comes off, start to pace, did a little recruitment then started trying to ventilate but was getting very high airway pressures. In the surgical field, the lungs...
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Source: Student Doctor Network - September 18, 2021 Category: Universities & Medical Training Authors: Hork Bajir Tags: Anesthesiology Source Type: forums
Hyperkalemia, Compartment Syndrome
One of my on-call cases from the past year:
Middle aged guy without any known medical history who passed out after taking heroin, alcohol and cocaine woke up less than 12 hours later unable to move his left leg and right arm. Brought to ER by ambulance. Found to have potassium level over >10, tall peaked T-waves and widened QRS. In the ER received aggressive IV hydration, calcium gluconate, insulin/glucose, lasix, mannitol, albuterol, bicarbonate, was also briefly on pressors for...
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Source: Student Doctor Network - February 3, 2021 Category: Universities & Medical Training Authors: coffeebythelake Tags: Anesthesiology Source Type: forums
What is your drug regimen/strategy to self treat COVID-19 while at home? lets get ideas rolling(for fun).
so, if you come down with this thing what will you want on hand? i'll give you my stockpile.
1)medrol dosepacks (or prednisone)
2) Albuterol vials (and neb)
3) Mucinex plain DS
4) ibuprofen and APAP
5) cepacol lozenges
6)Halls lozenges w/ a little dextromethorphan
7) Doxycycline 100 mg BID (to avoid bacterial complications)
and of course...................TOILET PAPER. if i could find some.....lol
but just for fun, lets hear what you think, or would do different, add, remove....etc and...
What is your drug regimen/strategy to self treat COVID-19 while at home? lets get ideas rolling(for fun). (Source: Student Doctor Network)
Source: Student Doctor Network - March 12, 2020 Category: Universities & Medical Training Authors: sozetone Tags: Job Market Source Type: forums
Severe intraoperative bronchospasm
Too many details to discuss, but essentially a known asthmatic had severe bronchospasm on induction, lungs do tight CRNA could hardly ventilate.
By the time I arrived, pt blue, sats 19 and could hardly move air. Albuterol has been attempted to delivered unsuccessfully.
I bolused 10mcg of epi incrementally until it cleared up. Extubated and did fine.
One of my partners then asked why I didn’t give Sux to break the bronchospasm. I had never considered giving Sux unless there...
Severe intraoperative bronchospasm (Source: Student Doctor Network)
Source: Student Doctor Network - October 18, 2019 Category: Universities & Medical Training Authors: needledox Tags: Anesthesiology Source Type: forums
What are things you do or do not call for in retail pharmacy
I've seen some rphs call for Ventolin and proair switches.
Would you call md if hydrocortisone 2% cream is written? That doesn't even exist so yeah
Would you call when trying to fill abilify for a patient taking risperdal or just ask the patient on that? (Source: Student Doctor Network)
Source: Student Doctor Network - October 2, 2017 Category: Universities & Medical Training Authors: Pharmer20201 Source Type: forums
CA generic substitution law?
In CA, it is my understanding that you do NOT need an orange book AB rating when making a substitution.
So can you substitute Adrenaclick for an EpiPen?
What about Ventolin or Proventil for ProAir? (Source: Student Doctor Network)
Source: Student Doctor Network - July 17, 2017 Category: Universities & Medical Training Authors: Lexington2012 Source Type: forums
Cardio Pharm Question
Mr Green, a 54-year-old banker, had a cardiac transplant 6 months ago. His current blood pressure is 120/70 mm Hg and heart rate is 100 bpm. Which of the following drugs would have the least effect on Mr Green's heart rate?
(A)Albuterol
(B)Epinephrine
(C)Isoproterenol
(D)Norepinephrine
(E)Phenylephrine
Answer : E
Could someone please explain why E is correct? Thank you
Wouldn't you get reflex bradycardia w/ Phenylephrine? (Source: Student Doctor Network)
Source: Student Doctor Network - February 10, 2017 Category: Universities & Medical Training Authors: DocMiami Source Type: forums
Case from yesterday
Hey all, had a case yesterday that I want to hear from you all about.
75 year old male marine Vet, h/o severe COPD on home oxygen and several meds (albuterol neb 4x/day, symbicort, spiriva, daliresp, a few weeks ago started on prednisone taper down to 5 mg/day), h/o MI and severe PVD, h/o PE on Xarelto (last taken a little less than 2.5 days prior), IDDM, a hint of dementia and anxiety, comes in for a hip fracture after falling. You see him on oxygen, sitting in bed, speaking in somewhat...
Case from yesterday (Source: Student Doctor Network)
Source: Student Doctor Network - August 6, 2016 Category: Universities & Medical Training Authors: Urzuz Source Type: forums
Product Substitutions and Other RX Changes Without MD Input
I understand you can substitute ProAir 8.5gm for Ventolin 90mcg/actuation 18gm if the MD specified 8.5gm, the active ingredient being bioequivalent. How far can you take this sort of liberty before insurance or the MD gets upset? What are the limits for the pharmacist to purview these things? Thanks! (Source: Student Doctor Network)
Source: Student Doctor Network - June 21, 2016 Category: Universities & Medical Training Authors: clarkbar Source Type: forums
Let's talk technique
Lets see how people approach this case.
3-5 yo pt with history of asthma. Had an episode of RSV one month ago with residual cough up until 2 weeks ago. Currently doing well, afebrile and mild cough but not much different from his usual status. Hasn't used albuterol in over a week. Posted for BMT & adenoids at out-pt surgery center. Parents are well educated non smokers. Pt is not obese and has mild snoring habits but no real OSA. Enlarged tonsils but no symptoms of tonsillitis in the...
Let's talk technique (Source: Student Doctor Network)
Source: Student Doctor Network - March 30, 2016 Category: Universities & Medical Training Authors: Noyac Source Type: forums
Bronchoscopy Question
My 17 month old son has a CRMS dx (df508 + a "varying consequence" mutation and negative sweat). We switched clinics about 4 months ago. Our new clinic felt that my son's health history and culture history warranted a bronchoscopy. Last Wednesday he had the bronch as well as an endoscopy and an Infant PFT. Normally they have you return 2 weeks post procedure but because of the holiday it looks like we may not be getting in until sometime next month. I've asked the nurse to talk to our pulm about getting us results over the phone at least - we'll see if it happens - but in the meantime I have a couple questions...
Source: Cystic Fibrosis Families Forum - December 16, 2015 Category: Respiratory Medicine Authors: emason Tags: Families Source Type: forums
eRapid and Bubbles
Ok, I know I recently posted about this, but I'm confused, so I'm trying again since I'm not getting much help from clinic. I asked them for a new mask for my son's eRapid (he uses it for albuterol.) He has been using the Pari Smartmask Kids Mask (he's 2 years old) and we had a few left over from our last pulmonologist (but he definitely needs a new mask.) So, I went to pick up the masks, and they gave me two Bubbles the Fish masks.
I don't think I can use these. Pretty sure I read somewhere the Bubbles mask is not compatible with eRapid...So, I guess my questions are, can I use the Bubbles the Fish mask with the eRapid fo...
Source: Cystic Fibrosis Families Forum - December 14, 2015 Category: Respiratory Medicine Authors: martatv75 Tags: Families Source Type: forums
Diagnosed at 36
Hi everybody,
I joined the forum when i was diagnosed with cystic fibrosis this summer, but for some reason I couldn't post under my old screen name.
I was diagnosed in July after my pulmonologist did a full panel of bloodwork. I had previously passed 2 sweat tests. I have moderate bronchiectasis and am culturing m. absessus. I spent 4 weeks on iv antibiotics this summer and got pancreatitus as a side effect. This was my drs big hint.
As i said in the title i am 36yo. I had no idea anything was wrong with my lungs till i got pregnant with my now 4yo son(carrier-d1125h). At 5 weeks pregnant i had my first and only re...
Source: Cystic Fibrosis Newly Diagnosed Forum - December 2, 2015 Category: Respiratory Medicine Authors: alikat0079 Tags: Newly Diagnosed Source Type: forums
