Thursday, December 24, 2009

Albuterol is not a miracle drug

Wow, it seems that incompetence never takes a holiday, and does not care whether you are a Doctor, nurse, or paramedic. I wrote last week about a Doctor who insisted that I did my patient a disservice by going with CPAP instead of Albuterol on a patient with symptoms of CHF.

Well, not to be outdone, we arrived at one of the nursing homes in our area for a reported "heart attack" (I won't even go into the nurse's inability to use big boy words) to find every nurse in the facility in this lady's room. The group included LPNs, CNAs, and even a couple of RNs, and all were trying to administer Albuterol to a woman who was sitting up in bed. The woman looked pretty sick- pale, cyanotic lips, etc.

As I got closer, I noticed to source of the problem. She was pulseless and apneic. I started chest compressions, and one of the nurses was heard calling the facility's Doctor, and could be heard complaining that we didn't know what we were doing, as they had just checked the patient, and she was fine. Nevermind that she was in Asystole. Even as I was doing chest compressions, one of the RNs was still trying to give the Albuterol. WTF?!?!?!?

By the time we got to the hospital, we had her intubated, had started an IO, and had given 3mg of Epi, and 2mg of Atropine. The hospital gave 2 more of Epi, and 1 of atropine, and lo and behold- we got a pulse and a BP of 80/60, but it was not to last. She passed away.

So, the lesson here for all of you incompetents- if the patient is not breathing, Albuterol will not help. Just sayin.

Note: Not all nurses are incompetent, just the ones in the nursing homes around here. We often joke that the nurses who scraped by with an 80.1% on the exam are the ones in the SNFs around here.

Note 2: SNF- now there is a joke in itself- SNF= "Skilled Nursing Facility" Haha.

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