Bronchospasm or something else?

Over at the Respiratory Cave, Freadom has a group of "Olin's" which are a listing of all the magical properties that Ventolin is supposed to have, but we all know better now don't we as RT's, and hopefully most RN's who look at our RT blogs have learned from us on what breathing treatments can REALLY cure. Actually our breathing treatments can really cure .. (drumroll please) .. is NUTTIN!!! No really it cannot cure anything, it can only help ease the discomfort of a symptom which would be a bronchospasm. Thats right Ventolin or Albuterol only really relieves bronchospasms.

So what am I getting at here, well I'm going to show different problems that we are called for that this wonder medication cannot really do anything for because it's not a bronchospasm issue. Please feel free to comment and criticize to your heart's content if you disagree with me on this topic. But really some things we cannot help a whole lot with Albuterol.

1. Congestive Heart Failure - the fluid needs to come off, make them pee or if it's bad enough get em on a bipap.
2. Fluid Overload - not our fault, again Lasix would help here, and stop all the damn fluids.
3. Rib fractures - these hurt to breath deep, Albuterol will not make you breathe deeper.
4. Pneumonia - will not cure this problem, might help them breathe a little easier but it will not get rid of the pneumonia.
5. Gas - let it out, its pushing up on your diaphragm making it hard the flatten and take a deep breath.
6. Over Eating - they ate to much and it stopping the diaphragm from flattening, so unable to take a deep breath.
7. A Cold - of course its harder to breathe, they have a stuffy nose, no lets not try Albuterol and see if it helps at all.
   
8. Croup - doesn't help at all, period. Try Racemic.
9. On a Ventilator - just because you are on a ventilator doesn't mean they need Albuterol. If their lungs are tight then yes, but not just because they are ventilated.
10. High Fever - did you ever think the patient has a high respiratory rate because the body is trying to blow off heat. No really it's true.
11. Chest Pain - yes it hurts, and it's probably hard to take a deep breathe because it hurts, and not do not switch to Xopenex because it won't have as much of a effect on the cardiac areas.
12. Because you don't know what else to do for the patient - if you don't know Doc, how are we supposed to know.
13. Anxiety - almost forgot this one, Give this person some Ativan or Xanax, these do wonders for anxiety. Calm them down. Take the caffeine away, turn off the light and go to sleep.
    

Yes it's one of those things we RT's deal with, and of course it will not change anytime soon because no one really treats it like a controlled medication, it's more like a "let's try to see if it does anything" drug. There is a lot of common sense involved in using nebulized medications and MDI's, for instance: if the lungs are full of secretions or the patient if fluid overloaded how is the medication going to get through the fluid? It would be like trying to salt a burger in the bottom of a pond. It just won't get to where it is supposed to.

Off my soapbox I go, Drive on RT's.