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Duoneb Video

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In this video presentation will be discussing the pharmacological benefits of doing ab also known as a butyl and petroleum bromide and which respiratory emergency this drug benefits the most doing that will be the drug of choice for any copd exacerbation but it can also be used in an asthma attack we’ll talk about why this drug is more effective for copd shortly

But for now let’s look at our estate protocol when reviewing the rest tory distress protocol you should notice that under the wheezing title albuterol and albuterol with petroleum is listed as a reminder wheezing should not be the only reason to give a bronchodilator a perfect example that i can think of is a severe asthmatic episode where the patient is so clamped

Down that the minimal air movement occurring does not produce wheezing upon auscultation just because wheezing goes away in a patient is not always a sign of improvement any patient with a history of asthma and is struggling to breathe with or without wheezing it’s probably a good idea to start a nebulized bronchodilator pediatric patients experiencing an asthmatic

Attack may not have wheezing at all instead there are several scenarios where peds will present with persistent coughing the sim flies to a copd exacerbation however i will say this about copd exacerbations a lot of these patients can be coached out utilizing breathing techniques which is often more effective than throwing bronchodilators at the problem that of

Course depends on the severity and patient cooperation but it’s not going to hurt the patient by giving them a bronchodilator unless for some reason they’re having some crazy tacky me simultaneously occurring our contraindications as mentioned if the patient does have a very high heart rate you need to weigh out the risk of giving out butyl meaning is the high

Rate tachycardia secondary to the rest or distress or is it actually cardiac in nature if the patient has a dramatic increase in heart rate during administration or the rest or distress gets worse probably need to go ahead and discontinue the treatment and as always make sure the patient is on a cardiac monitor when ministering a bronchodilator precautions or

Side effects as mentioned the heart rates going to usually go up to some degree patient may get tremors palpitations headaches sweating or even dizziness the dosage is listed on the package is three milligrams total our butyl all being two point five milligrams and the remaining 0.5 milligrams is a petroleum bromide this is category a and the same dosage applies

To our pediatric patient population albuterol versus a petroleum albuterol sulfate is a drug we have been allowed to administer for years and most of us are very familiar with its mechanism of the action as a refresher we need to understand how it works so we can compare it to a petroleum broma a butyl is often referred to as a beta agonist which means that acts

On the sympathetic nervous system more specifically the beta 2 receptors the beta 2 receptors are located on the smooth muscle cells within the bronchial airways when they are activated it causes those smooth muscles to relax resulting in bronchodilation in basic terms we are giving a drug to open up the airways that makes it easier for the patient to breathe if

Atropine bromide a drug we are not as familiar with essentially does the same thing but in different way the parasympathetic system also has receptors located on the smooth muscle within the bronchial airways these are called muscarinic receptors and when activated they do the opposite of the beta receptors they cause the smooth smooth muscle to contract resulting

In bronchoconstriction instead of giving a drug to activate these receptors which is the case for our butyl we want to give a drug that is going to block these receptors and that’s where appropriate fills in a petrol priam is known as a muscarinic antagonists are an anti muscarinic so why did we switch from using a butyl by itself and go to the drug that combines

A butyl with the petroleum there’s two patient populations that we usually find ourselves administering bronchodilators to those are your asthmatics and those are your patients with copd now there’s not a lot of evidence that suggests asthmatics will benefit from adding it petroleum to a butor all but with copd patients there is in a study conducted in the nineties

Spira metric data was obtained and indicated that the copd patients had an increase in their fev1 we’re combining albuterol with the petroleum verses using either agent alone in basic terms doing them makes it easier for these patients to exhale by causing greater bronchodilation and that’s what they need this effect hasn’t been clearly demonstrated in your asthmatics

However there isn’t any negative impact either when combining these two drugs for the patient that’s having an asthmatic attack this is just a visual reminder on how to set up a nebulizer occasionally you see medics put the 6 inch corrugated tubing between the mouthpiece and the tps adapter located above the medication just remember that the tubing which acts as a

Reservoir is attached on the other end opposite of the mouthpiece medication chamber is obviously where you’re going to insert the medicine but you do not have to unscrew the two pieces to do that if you keep the medication chamber intact and pour the medicine in from the top it’s gonna save you some time and make it less likely to spill out and finally you attach

The tubing to your oxygen cylinder set the flow somewhere between six to eight liters per minute and your treatment will last somewhere in the range of five to ten minutes if your patient is unable to use the mouthpiece setup you can always utilize a mask in our case you would take a non-rebreather mask disconnect the oxygen reservoir and insert the medication

Chamber directly into the opening of the mask just remember to take off the seals so that the excess air saw has an outlet to be removed and in conclusion our butyl / petro priam is an effective drug especially for our copd population however use caution when giving this drug to patients in respiratory distress secondary to congestive heart failure these patients

Can deteriorate if you increase the workload on the left ventricle one of the side effects about butor all is obviously increasing that heart rate and we don’t want to make the situation worse for these type patients

Transcribed from video
Duoneb Video By PFD Emergency Medical Services Division