Question: In the case of a patient who is in obvious respiratory distress with wheezes audible once you make patient contact (i.e. without auscultation), is it necessary to administer o2 via NRB first? Obviously these patients are in need of salbuMtamol and can not tolerate an MDI and spacer. The time it takes to first put on a NRB and then set up a nebulized treatment seems counter productive. Can we start with a nebulized treatment and then apply o2 via NRB after the 1st treatment while we reassess the patient?
Great question. The immediate priority for a patient in obvious respiratory distress is oxygen. This may significantly lessen the distress the patient is experiencing (despite the wheezes) while you prepare salbutamol by the appropriate route of administration. The patient is more likely to deteriorate first from hypoxia rather than bronchoconstriction, therefore no delay in the administration of oxygen should occur.