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Michelle Lin's Twitter Updates

@precordialthump I totally forgot about the EKG library! Awesome stuff. Keep up the great work (when do you sleep?!) 258 days ago
@emeducation Perfect, thanks for the suggestions! Turns out one is co-authored by Jeff Tabas. He already gave them all books. 258 days ago
Recommendations for an EKG resource to review bread & butter cases for senior residents? Pre-graduation panic setting in for our residents. 258 days ago
@danipedia Good point. I use the studies to convince the trauma consults NOT to get c-spine imaging on EVERYONE (citing distracting injury)! 263 days ago
@doctorflash Hi there. Just wanted to drop a note to thank you for all the extra traffic you're sending to blog. Much appreciated!! 273 days ago
 

Trick of the Trade: Opioids for air hunger

Posted Oct 04 2011 12:00am

A patient presents with significant shortness of breath from a COPD exacerbation. His room air saturation is 80%, respiratory rate of 30, and is uncomfortably seated in a tripod position. You administer the usual regimen
  • Oxygen by face mask
  • Nebulized albuterol and atrovent
  • Solumedrol
  • Bipap
  • Set up for possible intubation

With the Bipap mask on, the patient's subjective sense of dyspnea and "air hunger" seems to make it harder for him to tolerate the tight-fitting mask.


Trick of the Trade:
Use a small dose of IV fentanyl

A 2001 Cochrane review evaluated studies involving non-nebulized opioids to treat symptomatic breathlessness. The review found a small statistically significant improvement in subjective air hunger, although most studies were with small sample size numbers.


Reference
Jennings AL, Davies AN, Higgins JP, Broadley K. Opioids for the palliation of breathlessness in terminal illness. Cochrane Database Syst Rev. 2001;(4):CD002066. Pubmed
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