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sofmed-
I will be the first to tell you you have worlds more experience than me. In fact, you probably have over 3x as much experience in the FIELD, than I even have in the classroom. So, anything I say here, when push comes to shove, I am hoping to learn from you, anything I can offer to you is just gravy.
I agree with the location, location, location, but in his second post, he states the unit could not be moved, I think that is why we didn't really bother discussing it. I think his original question was more of, in this situation, if the team could not be moved, what would the medic do?
Albuterol is a potent B2 agonist, causing relaxation of the bronchial smooth muscle. The side effects are caused by B1 agonism in the CV system, because even our more "selective" agents aren't completely selective. You probably are already aware of this, but hey, its not a private conversation so we'll get everyone on the same page. B1 receptors are affected by a whole range of chemicals, both exogenous and endogenous. If you've ever hit yourself or someone else in acute anaphylaxis with epinephrine just watch the HR and BP. Albuterol is chemically almost identical to epinephrine, it just has a very polar ionizing group on it to prevent it from moving into the blood from the bronchii.
My point? If the patient cannot tolerate Albuterol due to the SE profile, they have no business in the field in the Army. At any moment if you get spooked, scared, surprised, excited, or any other activation of the sympathetic nervous system, the resulting catecholamine release will activate the same receptors as Albuterol. I don't think we want people in the field that will clutch their chest and drop to the ground when the lead starts flying. Good point, that these conditions may be undiagnosed. I would agree medication is always the last option, even if its bad for my business. But in the presented situation, it seems like the best.
If my patient is having difficulty breathing, Albuterol is OFTEN the safest and most effective measure. (Unless you buy the crap that those Xopenex people lay down.)
You would be a great person to comment on the original question as to what medications are available in the field, say far removed from clinics/pharmacies. Do medics carry Albuterol? Prednisone? Would they try an antihistamine first? If the unit could not be moved, and you determined your team was healthy as a collective group of oxen, what could be done? Maybe as simple as covering your mouth and nose with a mask/scarf?
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