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No exact science... 
If they come in mild, 1-2 Duonebs, reassess and go from there
If they come in moderate, 2-3 Duonebs, reassess and go from there
etc...
Trial not meant to mean unequivocally 1...
Cheers,
TZ


Dr. Todd Zimmerman 

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-----Original Message-----
From: Marty Herman <[log in to unmask]>
To: PED-EM-L <[log in to unmask]>
Sent: Fri, Oct 31, 2014 1:58 pm
Subject: Re: My name is Dr. Indigo Montoya, You Killed Albuterol..


Just one Duo Neb? How many Asthmatics break/ clear with just one Neb? 
arty
Marty, (Dad, Bro etc.)
artin Herman , M.D. 
ent from my iPhone

 On Oct 31, 2014, at 1:57 AM, Nassif, Douglas S <[log in to unmask]> wrote:
 
 Ahh, but it's only mostly dead. 
 
 Sent from my iPhone
 
> On Oct 31, 2014, at 1:55 AM, "Julian Orenstein" <[log in to unmask]> wrote:
> 
> Inconceivable
> Jb0renstein 
> 
> Sent from my iPad
> 
>> On Oct 30, 2014, at 8:07 PM, Todd Zimmerman <[log in to unmask]> 
rote:
>> 
>> I am pretty sure it is Inigo Montoya.
>> 
>> 
>> 
>> Best movie ever.
>> 
>> How about this:
>> Trial of Duoneb
>> If you see a positive clinical response, great, if not...well...don't  give 
>> it anymore.
>> If a very strong positive clinical response, consider steroids in addition. 
>> Can you believe I said that?
>> I understand the studies for "traditional" bronchiolitis, I also understand 
>> there is a subset of these patients that I see that have a very favorable  
>> response to this treatment. I also see some variation to the response year 
>> by  year. 
>> Have also heard and (think I have, as we have no rapid test for this)  seen 
>> very good response with EV D68 to Albuterol + steroids.
>> Just Sayin...
>> 
>> Todd Zimmerman DO
>> Medical Director, Peds EM, Alexian Brothers Women and Childrens  Hospital
>> and glutton for Punishment as Med Dir of Clinical Informatics,  St. Alexius 
>> Medical Center  
>> 
>> 
>> In a message dated 10/30/2014 6:39:38 P.M. Central Daylight Time,  
>> [log in to unmask] writes:
>> 
>> ...  prepare to die.
>> 
>> In face of the recent AAP Guideline on the management  of bronchiolitis, I
>> am recruiting other Peds ED centers who will be  endorsing this set of
>> practices to serve as the treatment group in my  non-randomized
>> observational study. Our center will serve as the  'out-of-control' group
>> and we will be initiating a new clinical pathway  entitled... 'Empiric
>> therapy for the treatment of undifferentiated  respiratory distress in
>> infants.'
>> 
>> It is my hypothesis that our  group's admission and bounce-back rates will
>> be the same as last  year.
>> 
>> I anxiously await the data from the centers who adopt the AAP  approach!
>> 
>> 
>> Jay Fisher MD
>> Medical Director, Peds EM, Children's  Hospital of NV
>> Physician Consultant, Dread Pirate Roberts
>> 
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