Umm...WHEN exactly are we going to come across these?!

[fireheart]

More of a moment than a suck, but the Tales of First Aid Training continue.

This time, it's for my Emergency Asthma Management course. Yay! Luckily the place where I am doing said course has a module specifically designed for childcare workers and schools (I technically fall into both categories). So ALL the people in training are childcare workers or school workers in some shape or form.

So we go through the basic "this is what triggers asthma, this is what to do in the event of an asthma attack" stuff...and then CUE the inhalers.

There were four main "styles" of inhalers, plus four different "types" of medication. In a childcare scenario, specifically an after-school care or a long day care scenario? We're likely to see the relievers and MAYBE the preventers, done mostly in MDI form (your stereotypical "inhaler").

So WHY did we need to know about the OTHER groups of inhalers, especially because quite a few of them were a) designed for kids over 8-12 (YMMV on the inhaler) and b) we'd be unlikely to see them because most RESPONSIBLE parents would ensure that junior takes his preventer or symptom controller or combined medication AT HOME?!

And let's not even GET into the spacers....SO MANY!

I also heard a VERY disgusting story at training, courtesy of said trainer. It involved a spacer.

He was doing a training session at a football club and came across the club's spacer in their first aid kit. Said spacer was OPAQUE WHITE.
He wondered WHY it was opaque white and whether they had painted their spacer or not. If so...why?
Turned out that no, they had NOT painted it. It was in fact opaque white because it had been sitting in the first aid kit for 10 years...and nobody had cleaned it after use. Over time, the powder had slowly caked on the inside of the spacer and built up.

Needless to say, he gave them a thorough lecture on washing your spacers, having your OWN spacers and not letting it get to that stage!

[Seshat]

Sometimes the controllers/preventers need to be taken on a frequent enough basis that the kid can't get through the school day without needing another dose.

Some parents aren't responsible.

You may well end up with an asthmatic co-worker, or someone has an asthma attack in the same train carriage as you, or on a bus, or in a shopping centre.

Lord knows I can't go out when it's smokey from the damn bushfires without risking an asthma attack - and not everyone has the luxury of being disabled enough to be on a pension. There are asthmatic adults who have to try to work even when there's a smoke cloud over the city for a week.

So yes, it's DAMNED useful for as many members of the general public as possible to be able to help an asthmatic of any age to use their inhaler. And even though you work with children under 8, you're part of the General Public as well as a teacher.

Just think of it as helping to potentially save Seshat's life when you visit Melbourne.

[fireheart]

Sometimes the controllers/preventers need to be taken on a frequent enough basis that the kid can't get through the school day without needing another dose.

See, I could understand this part for things like school camps and whatnot, but the controllers are meant to be long-lasting (and not fast acting). The idea is you take it before you leave.

You may well end up with an asthmatic co-worker, or someone has an asthma attack in the same train carriage as you, or on a bus, or in a shopping centre.

Lord knows I can't go out when it's smokey from the damn bushfires without risking an asthma attack - and not everyone has the luxury of being disabled enough to be on a pension. There are asthmatic adults who have to try to work even when there's a smoke cloud over the city for a week.

See, I could understand if it was a general course...this was childcare-focused.

And even though you work with children under 8, you're part of the General Public as well as a teacher.

Technically I currently work with children mostly up to age 10. (One of my sites caters up to 12/13 year olds)

Just think of it as helping to potentially save Seshat's life when you visit Melbourne.

That's what I'm looking at it as. I was just more amazed at the sheer number of inhalers and spacers that were out there and my mind just went .

If anyone's curious, the four "styles" of inhalers I was referring to are:

-Metered-dose inhaler (your "stereotypical" inhaler, what you see being used by asthmatic characters in movies)

-Turbuhaler (looks a little bit like a fat tampon, you take the cap off and go from there)

-Accuhaler (looks like a fat disk, you "load" up the device and go from there)

-Autohaler (looks a little bit like the metered-dose inhaler, but is entirely breath-controlled rather than having to coordinate the breathing)

[Shalom]

In my store, we mostly use the Optichambers. These are essentially generic versions of the branded Aerochamber. . Sometimes we will dispense the Vortex instead.

There were other types, once, involving expanding bellows and the like; haven't seen those around lately.

These work only with the MDIs, but that's basically what we dispense here. The Turbuhaler only comes on Pulmicort around here, and most of our Pulmicort patients are young enough to get it through a nebulizer rather than a handheld unit. Likewise the Autohaler is only found on Maxair, which we don't dispense much of. What you call an Accuhaler is known in the USA as "Diskus"; most of the drugs using that format also come in MDIs, which are preferred by the local doctors. About the only ones we dispense in that format are Advair (Flovent+Serevent). and occasionally Flovent. Problem with these is that once you cock it, you have to hold it horizontal until you inhale from it, or the powder just falls out.

There's a fifth kind of inhaler called a HandiHaler; this is used with Spiriva (tiotropium). It's similar to the Diskus, except that it uses individual capsules which have to be placed into the inhaler one at a time, rather than a wheel with all the doses on it. I'm still waiting for someone to call me and say that he swallowed the damn thing instead of punching a hole in it and inhaling the powder (despite the stickers all over it that say Do Not Swallow).

I was once trying and failing to explain to one customer how he uses his Aerochamber. For those of you who haven't seen this thing, it's basically a tube with a mouthpiece (or a mask for the paediatric size) at one end and a socket at the other where you plug in your MDI. The idea is, many people have trouble coordinating the spritz with the inhalation (you have to spray the inhaler just after the beginning of the inhalation. Most kids will take a deep breath and then spritz, which does nothing to get the medicine down the lungs where it needs to go) so instead you spray into the holding chamber, then inhale SLOWLY and hold your breath for a few seconds. If you hear a whistle coming from the vent, you're doing it too fast. (If there's a mask, you hold it over the child's nose/mouth, spray, then hold it there for 5-6 breaths.)

So this guy seemed to not understand what the holding chamber was for, despite my best attempts at show-and-tell. Finally I in desperation said, "Look, just think of it as a hi-tech version of a bong." It was almost comical the way I could see enlightenment spread across his face. He said "Oh, yeah! I get it now..."

Oh, and this.

[Sakka]

Sometimes the controllers/preventers need to be taken on a frequent enough basis that the kid can't get through the school day without needing another dose.

When I was little, that was me. I had to take a pill in the morning before school, that according to the doctors would last twelve hours before I would need another dose. On a good day it'd last eight to ten hours. Usually lasted six or less hours. Fortunately, the teachers knew my symptoms of an asthma attack, usual triggers (at that age would be covered by 'being a kid' ). Once I was put on an emergency inhaler, there was a partially filled spare in the school office (and during summer one at the local pool where I spent a lot of time), as well one that I carried with me all the time.


I also learned at a very young age, do not take the particular preventer pill I used with gravol for motion sickness at the same time. I would get very very hyper, then crash and sleep a good fifteen hours.
(There is a picture in one of the family photo albums of me around six or seven years old, sleeping one of those crashes off, feet dangling just above the floor, folded in half over a bar at my waist, with my head turned sideways on the seat of a wooden chair, my arms hanging limply.)