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We have been using almost exclusively MDIs and spacers since Jan 99.  We
currently only use spacers fro patients who are at the very severe end of
the spectrum or who are getting worse (extremely rare).  Our results to
date show that there has been no increase in the number of patients being
admitted to ICU, or longer length of stay in hospital.  I have been
surprised initially at how well it works.
 
Our regime is 6 individual puffs for children <6yrs and 12 puffs for those
greater than 6yrs.  These are given every 20 mins and may include 2 and 4
puffs respectively of Atrovent.  Oral prednisolone would then be given.
 
We reuse the spacers by cleaning them through a washer not sterilizer and
then letting them drain as detergent drip dried spacers have less of a
static charge and thus allow more aerosol to be given
 
Treatment with spacers is continued on the ward and the same process of
weaning the patient occurs as with nebulisers.
 
I think that this to work well it needs to be a hospital policy, not just
an Emergency department policy otherwise the patients and parents get
confused.  We have had good acceptance of this treatment and parents are
now bringing in their own spacer device.
 
Hope this is helpful.
 
Peter Barnett
 
 
 
 
 
 
 
 
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>Approved-By:  jay pershad <[log in to unmask]>
>Date:         Tue, 7 Sep 1999 22:25:32 -0500
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>Sender: Pediatric Emergency Medicine Discussion List
>              <[log in to unmask]>
>From: jay pershad <[log in to unmask]>
>Subject:      MDI
>To: Multiple recipients of list PED-EM-L <[log in to unmask]>
>
>In light of all the evidence confirming the successful use of MDI's for mild
>to moderate acute asthma exacerbations, I was wondering if anybody is using
>them as a first line mode of Beta Agonist administration (instead of "wet"
>nebulizations) in cooperative patients???
>
>If so, how many puffs? How often? Are you reusing the canisters for multiple
>patients? How is the re-use of spacers handled w.r.t sterilization etc?
>
>Thanks for your time & input.
>
>Jay
>Jay Pershad, MD
>"PEM -pal"
>
>For more information, send mail to [log in to unmask] with the
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>The URL for the PED-EM-L Web Page is:
>  http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html
>
>
Dr. Peter Barnett  MBBS  FRACP MSc(epid) FACEM
Deputy Director
Department of Emergency Medicine
Royal Children's Hospital
Flemington Rd,
Parkville, Victoria
Australia,  3052
 
Telephone     + 61  3  9345.6592
Facsimile      + 61  3  9345-5938
 
E-mail            [log in to unmask]
 
For more information, send mail to [log in to unmask] with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is:
  http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html