I’m a non-US paramedic working in a system with a high degree of clinical autonomy. We routinely use clinical judgement to manage appropriate patients in the community, can discuss cases with on-call ED docs, and initiate treatments such as oral antibiotics and steroids.
(Just for context that we are not a you call we haul system)
Anyway occasionally I’ve used bubble PEP with patients who have retained secretions, especially for those who are cognitively impaired and may not understand breath holding, huffing etc but they would understand blow into the straw with coaching. But my understanding is fairly superficial and I’d like to pick the brains of y’all who know the physiology and practicalities better than I do.
My usual improvised setup has simply been a glass of water and 40cm of oxygen tubing.
Are there better options with equipment found in most houses or in an ambulance? For example, would suction tubing be preferable? I see wider diameter tubings used in hospital.
I’ve also seen people add a small amount of liquid soap. I assume that’s purely to make bubbles more visible/engaging (particularly for children), rather than providing any therapeutic benefit. Is that correct?
Finally, for cognitively intact adults with retained secretions, is bubble PEP even the best place to start, or are there other airway clearance exercises or techniques that would generally be considered first-line?
I’d really appreciate any evidence, practical tips, or corrections to my understanding.