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Now let's talk about asthma and Albuterol. Asthma is an extremely frightening problem to have. When a person has such tight airways that, though they believe they're taking a breath in, they cannot feel that they're getting enough oxygen. It's extremely scary. And if you ever wanted to kind of get an idea of what it feels like, try breathing in and out through a coffee-stir-stick straw. This is about the approximation of what it would feel like in a severe asthmatic attack. It's extremely scary. Now, let's talk about one of the best medications to use for an acute asthmatic attack and what to do to use it correctly. So, Albuterol is one of the first primary medications that's prescribed to someone who has acute or chronic asthma. Whether it's exercise-induced, like the scenario we just saw, or whether it's from a person that has persistent asthma, it doesn't really matter. The effect is pretty much the same. Albuterol usually comes in a container that looks something like this. It may be a different brand name, it might have a slightly different color, but in most cases, it will be in an aerosol type container with an actuator like this. But, more importantly, we forget about this. This is called a spacer. Now, one of the reasons I believe that most people don't have them is because, in many cases, they're extremely expensive. Now, whether that's right or wrong, that's the case, and I think many people, when they have to pay for them out of their own pocket, they say, "I don't really need it, I'll just use this." The problem with that is, is that the majority of the medication. instead of getting inhaled into your lungs and your bronchioles, where it's supposed to go, it ends up in the back of the throat and on the tongue. And therefore it decreases the full dosage and the effectiveness of that dosage. But, important steps to take when you have the proper equipment, is to shake your Albuterol prior to using it. You don't have to shake it for very long, but make sure it's mixed. You should also be sure to have actuations remaining. If you look on the back of most of these, you'll see a number in that little window. And it should not be zero, or it should not be zero zero zero. So, also check the expiration date, make sure it's not expired. Now that we've shaken it up, we're going to insert it into the actual spacer. Now, and I'm actually prescribed Albuterol, so I'm only taking what I'm already prescribed to take, I'm going to place the actual spacer into my mouth. Now I'm going to ahead and push down on the actual container, which will send Albuterol, as a mist, into this spacer, into a nebulized form. Then, I'm going to blow out and then inhale and hold my breath for ten seconds, like this: The normal dosage is two inhalations. So you would repeat it: Go ahead and let your air out. If you do not feel relief from these two inhalations of Albuterol, you usually are prescribed how soon you can repeat it. If you're not feeling relief soon, and you're still having difficulty breathing, it's important to call 9-1-1 and get the ambulance on the way, as you may be having a persistent asthma attack that will not stop with a simple rescue inhaler of Albuterol. Don't assume that it's going to get better. Call 9-1-1 and get help on the way in case you're in a true respiratory emergency.
Anyone who has experienced an asthma attack will tell you what a frightening situation it can be, as your airways tighten and no matter what you do, you simply cannot get enough oxygen into your lungs.
Pro Tip #1: Want to know what it feels like to have an asthma attack? Imagine only being able to breathe using a thin, plastic coffee stir straw. That would approximate how a severe asthmatic attack would feel.
In this lesson we'll discuss one of the best medications for acute and chronic asthma attacks (Albuterol) and how to use it correctly.
How to Treat a Patient with Asthma
As always, the first thing you want to do is make sure the scene is safe and that your gloves are on. Make sure you have your rescue mask with a one-way valve handy and introduce yourself to the victim.
"Hi, my name's _____. I'm a paramedic. I'm going to help you."
Pro Tip #2: Albuterol comes in a small aerosol container with an actuator. Whether the patient's asthma is exercise induced or persistent, the effect should be the same regardless.
In this lesson, we're going to include the use of a spacer with the Albuterol dispenser. Spacers are really expensive, which probably contributes to many people not using one, and sort of resembles a small plastic sippy cup. The spacer goes between the patient's mouth and the Albuterol dispenser.
Warning: When not using a spacer, much of the medication, instead of going into the patient's lungs and bronchials where it should go, winds up sitting at the back of the throat and on the tongue. This obviously decreases the dosage and the effectiveness of that dose.
How to Administer Albuterol Using a Spacer
Pro Tip #3: Before using your Albuterol device, make sure it has actuations remaining. To find this information, look on the back of the dispenser. Most devices have a number there inside a little window that corresponds with the number of actuations remaining. And don't forget to check the expiration date!
- Shake the Albuterol container just prior to using it. You don't have to shake for long. A few seconds will do the trick.
- Insert the Albuterol mouthpiece into the end of the spacer where it fits. (It will be obvious.)
- Place the other end of the spacer into the patients mouth. Make sure he or she completely exhales first.
- Push down on the Albuterol dispenser one time and instruct the patient to hold his or her breath for 10 seconds.
- Instruct the patient to exhale.
Pro Tip #4: A normal dosage of Albuterol for most adults is two inhalations and children may be one or two doses. So we need to always ask the patient about their specific dosage.
- Repeat – patient exhales out all air, puts spacer into their mouth, dispense Albuterol, hold for 10 seconds, and exhale.
If the patient doesn't get relief from two injections, ask them what their prescribed amount of time is between injections and doses. If the patient is still having trouble breathing, call 911 and activate EMS.
They could be suffering from a persistent asthma attack that cannot be stopped with a simple rescue inhaler of Albuterol. Get help on the way immediately, in case the patient begins having a true respiratory emergency.
It's important to avoid assumptions that the patient will get better after administering a dosage of Albuterol. Always be prepared for anything.
A Word About Asthma Triggers
Asthma is an illness in which the airways swell. An asthma attack happens when an asthma trigger, such as exercise, cold air, allergens, or other irritants, causes the airways to suddenly swell and narrow. This makes breathing difficult, which can be very frightening.
The Centers for Disease Control and Prevention (CDC) estimates that approximately 24 million Americans are diagnosed with asthma in their lifetimes. Asthma is more common in children and young adults than in older adults, but its frequency and severity are increasing in all age groups.
You can often tell when a person is having an asthma attack by the hoarse, whistling sound the person makes while inhaling and/or exhaling. This sound, known as wheezing, occurs because air becomes trapped in the lungs.
But what exactly triggers an asthma attack?
A trigger is simply anything that sets off an attack. And they can be very different for different people. Common asthma triggers include:
- Dust, smoke, and air pollution
- Exercise
- Plants
- Molds
- Perfume
- Medications
- Animal dander
- Temperature extremes and changes in the weather
- Strong emotions, such as anger, fear, or anxiety
- Infections, such as colds or other respiratory infections
Usually, people diagnosed with asthma control their attacks by controlling environmental variables (exposure to those triggers) and through medication and other forms of treatment.