Episode 155

Hi Jennifer. Here is the response from Andy Sloas....

One should view lungs with acute asthma as grades of fire (2 alarm, 3 alarm, etc). Do the firefighters ask how much water to put on the fire? No, they pound that fire with water until it’s gone. Albuterol will not make the head, heart or lungs explode so think of yourself as a firefighter and just coat those pulmones with albuterol until the fire is out. As far as the anticholinergics…there’s a new article out that from Cochrane that says it doesn’t hurt, but also doesn’t work in hospitalized patients: Vézina. Inhaled anticholinergics and short-acting beta2-agonists versus short-acting beta2-agonists alone for children with acute asthma in hospital. Cochrane Database of Systematic Reviews 2014, Issue 7. Art. No.: CD010283 but there’s weak evidence that it helps break asthma in mild-mod ED patients to the point that you may be more likely to discharge them from the ER. When things don’t hurt, but may help I usually continue to use them. If you were to give a ton of anticholinergics then you may cause some anticholinergic toxicity in theory (red as beat, hot as Hades, mad as a hatter, etc), but at the worst the kid probably gets a little agitated. What do I do? Start continuous albuterol (beta), add 3 doses of the anticholinergics (making the duo neb), then I continue the albuterol (beta) by itself and do not go back to the anticholinergics in those that do not respond and need more treatment. You’re not going to do any harm and it may help.