- Oxygen by face mask
- Nebulized albuterol and atrovent
- Solumedrol
- Bipap
- Set up for possible intubation
With the Bipap mask on, the patient's subjective sense of dyspnea and "air hunger" seems to make it harder for him to tolerate the tight-fitting mask.
Trick of the Trade:
Use a small dose of IV fentanyl
A 2001 Cochrane review evaluated studies involving non-nebulized opioids to treat symptomatic breathlessness. The review found a small statistically significant improvement in subjective air hunger, although most studies were with small sample size numbers.
Reference
Jennings AL, Davies AN, Higgins JP, Broadley K. Opioids for the palliation of breathlessness in terminal illness. Cochrane Database Syst Rev. 2001;(4):CD002066. Pubmed
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It seems like a funny choice of drug. You're treating an anxiety states. Why not give an anxiolytic like versed? That's what I do and it seems to work well in most cases.
ReplyDeleteI find that treating anxiety/dyspnea with a benzodiazepine causes respiratory depression much more often than opioids. So I tend to shy away from benzos.
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ReplyDeleteAs a med student, I have learnt that regular Morphine is the drug of choice for instance when a terminal patient becomes dyspneic. I am aware that your post is about a different condition/situation; but why do you use Fentanyl?
ReplyDelete@Andy: Good question. For acutely ill patients, you want to do no harm. Because different people respond to IV opioids differently (sedation, hypotension), it's wise to titrate up with short-acting agents in the ED.
ReplyDeleteThanks, that clarifies it :) Your blog is fantastic, checking your posts is a daily routine for me, and many of my fellow medstudents.
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