Question: Some years ago during a recert in the fall a question was posed regarding administering a nebulized treatment of ventolin to a patient who otherwise would not tolerate an MDI but also had a fever above 38C (all other conditions met). The question was answered by stating if all attempts fail for use of the MDI, a nebulized treatment could be administered if all droplet precautions were taken (N95 worn, gown worn closed window to cab area, goes without saying truck disinfected). Is this in fact the case? (Updated)
This question regarding use of nebulized ventolin in the setting of fever has been posted on the ASKMAC website which can be found by searching under category (bronchoconstriction) searching by dates (Oct 30, 2012). Medical Council continues to endorse the answer to this previously asked question.
If the patient is febrile, and has severe respiratory distress with signs and/or symptoms of COPD or acute pulmonary edema, then CPAP should be considered and the appropriate PPE should be used.
CPAP does not aerosolize infectious droplets as nebulization does, however, it is still important to protect yourself from communicable diseases.
So, with that said, unfortunately for your patient who cannot tolerate the MDI, we cannot move ahead to using the nebulizer for your own safety.
This question was updated on February 7th 2020