Acetylcysteine

[MedTrans68]

I swear we learned in school that when Mucomyst is adminstered to have suction on standby.

Well, a patient was given it, started coughing profusely, blocked his airway with phlegm or whatever, fell off the bed, hit his head, lost consciousness, and fractured a rib.

I questioned staff about why wasn't suction on standby. All said no, never heard of that practice. Anybody have an opinion here?

[wooh, BSN, RN]

If he was coughing hard enough to cough himself out of the bed, it sounds like his cough WAS adequate that suction wasn't needed.

[vampiregirl, BSN, RN]

What type of healthcare setting is this that suction was not on the wall and easily accessible.

I work LTC, we have suction on the crash cart for each unit.

I have occasionally had orders for mucomyst. On the several patients I've administered it to, I've always first administered an albuterol tx. Our protocol requires nurses to remain with a patient during a neb tx (any neb tx). It usually is very effective - just smells horrible!

[Esme12, ASN, BSN, RN]

Ok. My dealings with mucomyst has been purely nebulized treatments. That is good to know in the future. :-)

IN the presence of Tylenol overdose it can also be given IV.

[MedTrans68, ASN]

It was given by nebulizer. RT was at doorway. Watching him. Watching the halls. watching him. Watching the halls. I was about 15 feet away in a nurse station unaware of exactly what she was giving him. RT always just comes on the floor and does their thing then leaves. Suction is on the wall with canister. It is bagged unless hooked up and on standby. O2 sat is right there at bedside on a long cord because there is an MP5. I work on telemetry. The RT staff is very much older, early 60s. Not sure of years of experience but assume not nearly a newbie.

Pt just kept saying afterwards that something felt stuck in his throat and he couldn't breathe to the point he like passed out. I dunno. It was just chaotic and I am trying to work smarter and learn from it. The suction part stood out for me from school because they kept reiterating that but i just don't get why RT never heard of it, especially when it is clearly a bolded warning on the clinical pharmacology paper for mucomyst.

[Esme12, ASN, BSN, RN]

It was given by nebulizer. RT was at doorway. Watching him. Watching the halls. watching him. Watching the halls. I was about 15 feet away in a nurse station unaware of exactly what she was giving him. RT always just comes on the floor and does their thing then leaves. Suction is on the wall with canister. It is bagged unless hooked up and on standby. O2 sat is right there at bedside on a long cord because there is an MP5. I work on telemetry. The RT staff is very much older, early 60s. Not sure of years of experience but assume not nearly a newbie.

Pt just kept saying afterwards that something felt stuck in his throat and he couldn't breathe to the point he like passed out. I dunno. It was just chaotic and I am trying to work smarter and learn from it. The suction part stood out for me from school because they kept reiterating that but i just don't get why RT never heard of it, especially when it is clearly a bolded warning on the clinical pharmacology paper for mucomyst.

Right... I can't answer for the RT. Having suction available does not mean having it open and ready to go. But do you see where the nurse reacted?

The nurse hears a commotion...runs in finds the patient on the floor unconscious. She assesses. Ok he is breathing and has a pulse, he is not blue...lets get him off the floor. Lets get him up in the bed....now lets Get him some O2..ok still breathing...so airway is OK...no need to suction right now...lets get some vitals.

Scrambling for the pulse ox in the midst of chaos isn't a priority. All you want to know is are they breathing? Do they have a pulse? ARE THEY BLUE?

You don't want to start blindly sticking suction cath in his mouth in case he has an upper airway obstruction...lets say he had a cough drop in his mouth that he sucked into his throat with the breathing treatment because mucomyst tastes so bad....because you will just jam it further down his throat and really obstruct the airway. If they are moving air leave it alone until you have a better handle in the situation. If they don't have vomit pouring out of their mouth leave it until you have a better assessment.

Now the patient could have very well had a mucous plug. Coughed until he passed out probably not from a lack of O2 but from vagal response. If he was able to talk after the incident without deep suctioning his airway was fine all along.

Do you see what I mean? Does this help?

[wooh, BSN, RN]

IN the presence of Tylenol overdose it can also be given IV.

Or PO if you want the person to think twice next time they decide to take a bottle of tylenol.

[Esme12, ASN, BSN, RN]

Or PO if you want the person to think twice next time they decide to take a bottle of tylenol.

I am all for deterrent medical treatment....but if they are too sleepy or the levels too high the department I work for opts for IV

[MedTrans68, ASN]

That does help a lot. Really a lot. It opens my eyes to a bigger picture, has helped me understand the situation better. Thank you!!

[psu_213, BSN, RN]

Or PO if you want the person to think twice next time they decide to take a bottle of tylenol.

The one time I gave it IV, it was for an OD on Tylenol PM, which is, of course, Tylenol with diphenhydramine. Needless to say, PO was not an option. (I would put a 'smiley' in here, but I think that would be inappropriate in the context of a Tylenol OD.)

[KelRN215, BSN, RN]

Is there a time in acute care when you're not expected to have suction ready at the bedside? This was part of our basic safety checks when I worked in the hospital.