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Wednesday, August 12, 2009

The ongoing drama of crying baby's and blowbys

I'm just curious here, but since most studies show that 90% of the aerosolized medicine is wasted when giving a blowby treatment, and a laminar flow is recommended for maximal impaction of the medicine to receptor sites in the lungs, how much of the medicine do you think a child is getting if he is wailing through the entire blowby treatment?

I bet it's less than 1%, although I'm not sure any studies have ever been done to determine this. Yet commonsense says that most of that medicine I just gave that 3 YO kid impacted outside that boy's body, and the rest never made it beyond is oral cavity.

And, sorry doc, but the treatment was pretty much useless. Although the doctor was convinced that it was my breathing treatment that cured that kid of his congested cough. Well, I've lost patience with doctors and nurses to explain again and again that crying baby's don't get the medicine, and blowby is pretty much useless.

I would give the treatment with a mask or mouthpiece to most kids who are compliant, but the blowby remains the only option for non compliant kids and babies. Now, personally, I don't think the treatment for congestion was indicated anyway, but I don't see any harm in trying. Still, he didn't get the medicine.

The irony of all this is neither the doctor nor the nurse considered any of this science. Nor the fact that my being in the room is merely causing that little boy serious anxiety, and better therapy would be for that kid to be left alone.

Although I'm not a well trained doctor, and I'm prone to be wrong from time to time, science is science, and science says blowbys and crying do not equal good impaction of aerosolized meds in the lungs.

Yet, from behind me, the nurse says, "It's okay that he's crying. He gets more of the medicine that way."

"Ahhhhhhh," I think. I say: nothing. I give up. I've already explained the science a million times. It never yet has sunk.

As soon as I stop the treatment the kid smiles at me, and says, "Thanks." Wow! That's all it took to make him better was for me to stop. Who would have thunk it? Oh, I did!

Yet, it often seems no doctor nor nurse ever seems to consider blowby and crying science as I finish the treatment. They usually simply ask this simple question: "Is he better?"

I say, "We'll have to wait and see, because I can't assess him at the moment because he don't like me much."


Anonymous said...

So, the deep breaths that they take when they're crying don't get any meds in there? Is that because the mask is too far away from their face? Would it work to put the mask on them and let them cry (instead of holding it by them)?


Rick Frea said...

Using a mask and a blowby is the most effective way of giving a breathing treatment. A child should never be crying. A blowby should never be given.

I have a few links that explain this in further detail I'll put on here in a few days.

Anonymous said...

Get rid of the nebs... do MDI's

Rick Frea said...

I agree. Read that article. Discussed with ER Docs and it will not happen where I work.

Anonymous said...

Great article! I much prefer MDI's for my asthmatic kids (now 8 and 5, but using them with spacer for 2+ years with the younger).

Do you have a link to instructions for the soda bottle spacer trick? Spacers are pretty expensive, and not covered by insurance. Maybe this would make a good blog post? ;)


Anonymous said...

Try to talk the docs into MDI's by using the H1N1 virus route. We have been asking all the docs that refuse to order MDI's to please switch all their suspected droplet precaution patients over to MDI's so they aren't spewing contaminated aerosol particles all over the room for 10 minutes. They still get their albuterol in a little more contamination friendly way.