What the hell am I supposed to do with this?
Started by MirrorTodd
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I think per rectal albuterol?
It’s for a nebulizer set up.
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Albuterol bullet for nebulizer. What's the issue?
Lol random drug with no nebulizer in sight. I guess I could put it in an atomizer and squirt it down the tube if necessary.
D
deleted87051
Salbutamol - Intravenous
To guide staff with the use of intravenous salbutamol.
That is a super high concentration
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It is?
Almost looks like it's 12.5mg. That's prolly what they meant.
2.5 mg in 3 cc
Isnt that 12.5/3? Ive seen lactic acidosis after 25 mg in the ED to 9.
Oh I see its a parenthesis. Nevermind that is the usual concentration....
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Just squirt it down the tube, enough will get down at usual flows, even without the nebulizer. Won't be too useful in awake patients without the nebulizer components, though.
Before there was a ready-made "duoneb" vial, we used to mix 2.5 mg albuterol vial(above) with 0.5 mg ipratropium vial and administer it nebulized Q4PRN. This was during my last life as a respiratory therapist about 20 years ago.
What you’re supposed to do is rarely use it if it’s an asc
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I wounded if one could squirt it in your HME filter and have it be nebilizer that way?
Nobody here has attached a nebulizer to the circuit and used this? I do it all the time in someone who is in bronchospasm. It’s a very standard concentration of albuterol and costs a small fraction of an MDI.
I have never seen a connectable nebulizer.
How often are you getting bronchospasm? Im like twice in 10 years and probably even then it was just a jumpy academics staff
D
deleted1183938
You still have to order it this way at some of these little hospitals. I don’t know if they then mix it up manually or they have the duoneb. I suspect the former.
I would like to know how you jerry rigged this bullet onto the circuit?
Oftentimes the PACU RNs have the appropriate nebulizer attachment so I'll ask the circulator to go get it from PACU as it's not normally found in our ORs. Patients smoke it like a peace pipe in PACU, you take the 2 ends off of either and plug them in-line with the inspiratory limb of the anesthesia circuit then plug your supplemental O2 line into the bottom of the nebulizer, increase flows until it bubbles/nebulizes. Just have to make sure to keep the nebulizer oriented upright with the albuterol liquid in the bottom of it.
Ask for a nebulizer kit, here's what it looks like. You remove the mouthpiece and the open exhalation pipe and hook it in-line with the inspiratory limb.
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About 50% or more of my practice is pedi. They come in sick, junky, whatever. I will often give half the neb after we intubate and the other half during wake up. As a bonus for wake up it helps wash out the sevo. But for the same reason watch out if you give this during a case. You will need to give some supplemental propofol because it dilutes the sevo.
That is exactly right! Had a patient start moving during a case as a resident.
So you give the med in a kind of 'draw over' mode? Does that really work? I've seen people put a nebulizer in line with aux O2 going to the nipple thingy on the bottom of the cup but the flow required to actually nebulize causes volatile agent dilution and you have to adjust the FGF/vent to not get Vt and PIP problems. The MDI inhaler adapters are way less hassle.
In the picture I just didn’t attach the oxygen tubing to the bottom of the nebulizer reservoir. You are correct that it will throw off the Vt sensors.
I like this method more then the MDI for couple of reasons. First, it’s hands free. I’m not manually squeezing the MDI. Second is that the albuterol nebule doses cost pennies while the MDI costs around $10.
