Stacked Duo nebs any info

our peds intensivist says you can give 2 A&A's back to back and one of our ER docs says you can give 3. We usually just give one combo and then additional single doses of albuterol. Respiratory usually doesn't go for giving alot of atrovent back to back.

For the nebs on kiddos: One albuterol/atrovent and then two-three plain albuterol. Might add some Decadron or other steroid also, depending on severity.

Lopressor - the AHA guidelines for AMI/ACS are the three doses of Lopressor 5mg IVP q5 minutes or until heartrate hits 60 bpm. We do not give po Lopressor - am unsure of purpose of this?? Maybe your resident could elaborate?

don't know if you still need info, but in peds, the resp treatments usually start with a duoneb of alb/at but then add other things like decadron as traumarn said. Xopinex is another new resp tx med that is showing better toleration for continuous treatments, it doesn't increase the heart rate.

As for your lopressor question, the stacked dose of 5mg q5min is pretty much a standard in our ER, especially for patients heading straight for the cath lab. It reduces preload and hopefully lessens the stress on the heart. As for the po dose after the 3 iv, I suppose that is just because they are using the iv as a loading dose and then are going to keep them on the po doses. I would n't think it would do much immediate good except with the intention of keeping them on the po doses regularly. Just ask one of your cardiologists. But I would bet that is the answer.

The warnings usually apply to regular, continued use. Things are done in the ER and ICU that are not done under normal circumstances.

atrovent shouldnt be given closely together, and honestly, for acute bronchospasm, i personally dont see a benefit... a better neb to give is instead of a regular 2.5mg albuterol tx, give 5.0mg or more... there have been times where i have been in the E.D. and had a young asthmatic in very tight bronchospasm and given them 2-3CC or pure albuterol concentrate with 0.5ccs of saline or none at all... they were all on a monitor and responded well, instead of giving neb after neb after neb, just up the concentration and get a quicker response...

xopenex is a good derivative of albuterol, but everything ive ever read says not to give it back to back, and most literature says it should be given Q6H or even less frequently...