Topical Vasoconstriction and Mucolytic Therapy

Question 1

What topical vasoconstrictors can we use?

Answer 1

Epinephrine, systemic steroids, and heliox.

Question 2

How can we use epi for topical vasoconstriction?

Answer 2

It is an a1 (vasoconstrictor) stimulator so we can give it via SVN to decrease blood flow and therefore fluid leakage that causes edema. Generally used as injection for trachs and instilled for bronchs

Question 3

What mucolytic do we use?

Answer 3

Mucomyst (Acetylcysteine) nebulized via SVN (10 or 20% solution), directly instilled down ETT, or instilled through bronch

Question 4

What are some problems with mucomyst?

Answer 4

Has a very low pH which may cause bronchospasm, and smells like sulphur, and doesn’t mix well with some other drugs.

Question 5

What is an alternative use for Acetylcysteine?

Answer 5

It has liver-protective effects and is used as an antidote for acetominophen overdose. Can also be nephroprotective in pts receiving radiocontrast.