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(29:10) It was finals week at the end of Ron’s first year of paramedic school. In this episode we go back do an overview of the classes he took and what we thought of them.
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Listener Questions
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I have a question for your next episode. I had a call today, a woman in her early 30’s had some breathing problems. The patient had bilateral ronchi in lower lobes. No wheezing heard. The patient has cystic fibrosis. The senior paramedic did an albuterol treatment. Not that I really disagree with that treatment, I wanted to know what would be an ideal treatment for an acute CF attack. I checked on the patient later on and it turns out she actually had pneumonia. Was albuterol the ideal treatment, or could this made a patient worse?
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I just looked up CF treatment in Up-To-Date, and while it’s for chronic treatment not acute treatment, B2 agonists are indicated for patients with CF. Additionally, nebulized hypertonic saline has shown some promise in some small studies and is currently on the recommended list. Cystic fibrosis is a problem with the cystic fibrosis transmembrane conductance regulator, which is a protein that controls the movement of chloride across the cell membrane. In the airways, it controls chloride moving from inside the cells to the outsides (and does the opposite on the skin). The most common counterion for chloride is sodium. Water follows sodium. So if chloride can’t reach the airways, sodium won’t follow, which keeps water from moving into the airways.
Why is this a problem? Because mucous production proceeds without trouble leading to thicker airway mucous. Thick airway mucous has a harder time being cleared (mucociliary clearance, basically an escalator for bacteria leading away from the lungs), which means a higher chance of pneumonia. So, in the end, the problem with these patients isn’t too much fluid in the lungs (e.g. pulmonary edema), but actually not enough water leading the mucous to gum up the works.