The other night while on ALS rotations I came across the following patient.

Dispatch info: Elderly Male AMS. Diabetic history.

On arrival find an 84 year old male sitting at table in no apparent distress. Wife states that he been sleeping a lot and just woke up after a 20 hour sleep. Patient is AxOx3 denies any pain or distress and states that his wife was nervous because he wasn’t answering properly. Glucose stick reads 119. Hx of HTN, NIDDM and Asthma.

Airway is patent, breathing is eupneic and color and temp are normal. Lungs reveal an end expiratory wheeze in upper left lobe and nearly absent lung sounds in all other fields. SpO2 is 79% on room air. EKG is NSR as is 12 lead. No edema noted.

Turns out patient is taking a strong narcotic based cough medicine for a persistent productive cough x 4 days, possibly the cause of his lethargy (the narcs that is).

My treatment plan was hi-con O2 and transport. (15 lpm had brought his sat up to 98%). My preceptor wanted to treat the wheeze with albuterol and ipratropium which I thought was unnecessary. She got her way and a treatment did nothing for his slight wheeze and sat was already at 98%.

A while later when I returned to the ER I confirmed that his CXR showed a bilateral pneumonia just as I had suspected.

Question; do we really need to treat every wheeze? If o2 corrected the saturation problem do we need to throw a drug in too?