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Saturday, July 24, 2010

Racemic Epi

If you thought this was going to be a constructive post about race epi, think again. It's not. I'm taking up space on this blog to say the following:

"Who the heck thought of giving Race Epi for stridor anyway? Who was it? What science did they base it on? I have never once given a race epi to a kid and had it work. I seriously....

"And who the heck told nurses that it's a good idea to give a kid a shot before the breathing treatment. I told them not to do it. They ignored me. so I left. I left the ER room. I went down the hall, to the bathroom, and I could hear that kid crying all the while."

"I came back and the nurses were upset with me. 'Why didn't you stay and give this kid a treatment. He's got croup, and he needs your treatment.'

"'Look,' I said, 'I told you before you gave that shot I can't give a treatment to a crying kid. I told you not to give the shot until after the treatment. You didn't listen to me. So I left and went pee while the kid was crying. Yes, I went pee. And I can hear he's still crying.'

"'Why can't you give it when he's crying. He's taking deep breaths and will inhale more of the medicine.'

"'What books are you reading? What science do you base that claim on?' You can't give a treatment to a kid who's exhaling for 80% of each breath, and his inhalations are turbulent. . The kid gets no medicine that way.'"

I gave the treatment anyway, and the kid cried through the whole thing. And, I confess, I gave it with a blowby, where 80% of the medicine blew off into the fluorescent lighting.

So, I ask you, how much of the medicine do you think that kid got? You do the math. I would have the nurse do the math too, but I didn't want to explain to her how useless blowbye's were too, lest she'd have me coo cooing with that kid to try to get him to calm down, and Lord knows that kid was ticked because of that needle. The kid was in the right too. He had every reason to be ticked off.

Yet, since his lungs were clear and he didn't' need the treatment anyway, I gave it by blowby, talked with the mom for a while because she was really cool and smart, and walked right back out of the ER.

So who the heck thought of doing race epi on kids anyway? What's the point? Was it just to please the nurse? Make the mom think we were doing something? Or was the 4% of the medicine that reached the airway of benefit?

Note: In an upcoming post I'll take up the topic: Racemic Epi: Why is it used for stridor? What's the science behind this? Any studies, or just theory?

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