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Monday, February 27, 2017

My concerns about getting a respiratory therapy bachelor's degree

The AARC wants every respiratory therapist to get a bachelor's degree. I actually looked into this because I would love to further my education. However, when I brought this up to my wife, she said:
"If you are going to go back to school, you should get a degree in something so you can earn $75,0000 a year. If you get this, you won't make any more money. It may qualify you to be an RT supervisor, but it doesn't guarantee you will get that job, nor that you will want that job."
My wife is smart in this way. And she is right. If I were to go back to school, I would be better off going to be a nurse. They make way more money than we do, plus their profession is far better respected.

I'm not saying I'm going to be a nurse. I'm also not implying I hate my job. But, there is some degree of apathy present. It would be nice to do something different. But, to earn a bachelor's in respiratory therapy would not make me a better therapist nor would it make me more money. It won't even earn me more respect.

I would love to go back to school. However, I would rather do something other than respiratory therapy if I were going to do this. But what?


Further reading:

Monday, February 13, 2017

Smoking cessation programs not funded with tobacco income

Apparently the government makes $26.6 billion from taxes on tobacco sales or settlements from Big Tobacco. So, you would think that a good chunk of this would go towards funding programs meant to educate people about the dangers of smoking, preventing young people from smoking, and helping those who do smoke quit.

But you would be thinking wrong. Big Government does not think the way you and I do. In fact, you might be surprised to learn -- as I was (nah! I wasn't surprised. Nothing the government does or doesn't do ever surprises me. But I digress) -- that less than 2% of this money goes towards youth smoking prevention programs. This is rather pathetic to say the least.

I am not a fan of the government getting involved in most things. When politicians see a problem, their solution is say they feel your pain and then their solutions tend to be programs that involve spending other peoples money. And, worse, these programs usually make the problems they aim to solve worse.

However, when it comes to cigarettes, the governments actions are necessary. I believe this to be true because your right to smoke cigarettes ends with my right to breathe fresh air. Likewise, it was the government that was aware of the dangers of smoking even as they doled them out and got soldiers addicted during WWII.

It only makes sense that, if the government is making revenue from tobacco sales, that a majority of that money should be used to reduce the sales of cigarettes. Of course, if this happened, then this income would be lost. So, that should explain why Uncle Sam is so hesitant to spend this money where it should be spent.

Further reading:

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Monday, February 6, 2017

Mini CPAP approved by FDA

It would be nice if we had a picture of this. But, at the present time, none are available. However, ResMed has announced that the FDA has approved the world's smallest CPAP machine, called the Air Mini. The product will be launched later this year.

The machine is small enough to fit easily into a travel bag. It is also small enough to fit into the pouch on the back of seats on airplanes. The company suggests that it will be an easy to operate secondary CPAP machine.

They will probably market it to medical equipment providers, noting that it will be another means for making a profit. It will benefit patients because it should improve compliance and convenience. They also say it is silent and comfortable.

I wonder how long it will take before we see one of these in the hospital setting. I wonder how long it will be before someone comes up with an iCPAP.

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Monday, January 30, 2017

Prehospital Ultrasounds May Help Diagnose Respiratory Distress

About 90% of breathing treatments ordered in the emergency room are for patients ultimately diagnosed with heart failure. This is according to a non-scientific poll of respiratory therapists

This certainly bodes well for job security, but such injudicious use of Ventolin has also been implicated in respiratory therapy apathy syndrome. It also results in a needless hospital expense, as bronchodilators do not suck fluid out of lungs and do not benefit patients with pulmonary edema and heart failure.

I always thought it would be nice if there was a test to determine who was actually experiencing bronchospasm and who was not. Apparently, researchers have been experimenting with using ultrasounds to find the true cause of respiratory distress, or to differentiate between COPD and cardiogenic pulmonary edema.

Rather than just using a stethoscope, which has its limits as a diagnostic tool, researchers developed a ultrasound protocol that takes less than three minutes to perform. In fact, it can be performed by paramedics in the prehospital setting so that an appropriate diagnosis can be made and appropriate treatment started. 

Researchers say that paramedics, using traditional methods, were accurate in their initial diagnosis only 23% of the time. However, once the ultrasound protocol was adapted, they were accurate 90% of the time. If this is true, then it's something that should be adapted sooner rather than later. 

Further reading and references:

Saturday, January 28, 2017

Popular Heartburn Drugs Linked To Dementia

These overprescribed drugs have been linked to dementia.
The link between asthma and GERD and heartburn has been known for quite some time now. There's also a known link between COPD and the stomach. Many of these patients find themselves taking a daily dose of proton pump inhibitors such as Prilosec, Nexium, and Prevacid.

However, a new study suggests that these drugs may cause dementia, with the risk increasing with age. Those over the age of 75 who take these medicines have a 40% increased risk for developing dementia compared to those who do not take them. That's a pretty significant risk, enough so that some doctors are now sharing this information with their patients, giving them the choice whether or not to continue using them. 

Interestingly, another type of antacid, H2 blockers, have also been linked with dementia. These include medicines like Tagamet, Pepcid and Zantac. 

Researchers are not sure why these popular stomach acid reducers might lead to dementia. One theory suggests that they may cross the blood brain barrier and affect brain enzymes. They may impact the gene that encodes the protein beta amyloid, causing increased beta amyloid levels in the brain. 

Beta amyloid has already been shown to builds up in the brains of people with Alzheimer's Disease, and is a biomarker for predicting who will get that disease. They believe that when in abundance, it may destroy synapses before forming plaques that cause nerve cells to die. 

However, what is known is that up to 75% of patients currently prescribed them do not even need them, and 25% of these patients could probably stop taking them without facing any consequences. 

This is another one of those situations where the potential risks must be weighed against the potential benefits. If you stop taking them and experience worsening stomach trouble, then you should probably continue taking it. However, if you stop and feel fine, then you probably could do fine without them.

As usual, do not stop taking any medicine without first consulting with your doctor. 

Further reading and references:

Thursday, January 26, 2017

Study: Eating More Important Than Breathing

Breathing is important. As respiratory therapists, we know this more than anyone. But a new study conducted by the Bronchodilator Reform Committee of the U.S. Government purports to show that eating is even more important that breathing.

The study involved 100 patients at Shoreline Community Hospital, all of whom were prescribed QID breathing treatments with 3cc of normal saline and 0.5cc of albuterol. All of the patients had chronic bronchitis or asthma. They were all typically short of breath when their breathing treatments were due.

Treatment times were scheduled for 8 a.m., 12 p.m., 4 p.m., and 8 p.m. The patients were asked to order a tray of food about 30 minutes prior to the time their breathing treatments were due. This gave the cafeteria plenty of time to prepare the meals and deliver them. The patients were told they would be involved in a study, but they were not told anything specific.

The therapists were asked to enter the patient's room the same time the meal arrived. They were instructed to identify themselves and to say it is time for their treatments. They were then instructed to prepare the medicine and to give the medicine to the patient either with a mouthpiece or a mask. If the patient requested to eat first, the therapists were told to try to convince them the treatment was more important than eating.
Of the 100 patients involved in the study, a whopping 60% requested that the respiratory therapist hold the breathing treatment until the meal was completed. Of these, 48.5% were persistent that they preferred eating over breathing. One such exchange went like this.

Respiratory therapist: "Mr. Smith, I am John from respiratory therapy. I am here to give you your breathing treatment."

Patient: "I will take the breathing treatment, but as soon as my tray comes I'm going to take the mask off and eat."

At this point cafeteria lady brings in the tray of food. Seemingly ignoring the fact that the tray has arrived, the therapist says to the patient: "Are you breathing okay?"

Patient: "Well, I am a little short of breath. But I'm really hungry."

Respiratory therapist: "The breathing treatment will only take a few minutes. This way we can get you breathing better so you can enjoy your meal."

Patient: "I am really hungry right now. I need to eat."

Respiratory therapist: "Are you sure?"

Patient: "I am really hungry."

The study was initially published in the Doctor's Creed Magazine. Lead researcher, Dr. Ven Tolin, suggested that the results show the importance of eating. He said, "You need to eat to have the strength to breathe. So, it only makes sense that a patient, especially one with COPD or asthma, would prefer eating over breathing."

Sunday, January 8, 2017

How do you define small-town hospital?

Where I work is relatively considered a small-town hospital. So what is a small town hospital? How is a small-town hospital any different than any other hospital? Are all so called small-town hospitals the same; do things operate the same?

Where I work there are 64 registered hospital beds. Actually, they just closed down the psyche unit, so that eliminates about ten. So, we are down to 54. And some of the remaining rooms are offices. So, is a small town hospital defined as a hospital with less than 100 beds? Can we define it that way. 

I live just outside the city. The City has a population of just outside 10,000. The total number of people in the entire county is about 60,000. The region is set up in such a way that there is a county east, north, and south of us. 

Shoreline (fake name I have always used) is a port city: Lake Michigan is to the west of us. Unlike the city 20 minutes to the North of us, our hospital is centrally located in such as way that we draw in quite a few patients from these surrounding counties. This makes Shoreline quite a bit busier than that hospital to our North. 

I know they are less busy than us, because I worked there and my friends work there. When I worked there all I did was sit and wait for something to happen. Okay, it was that slow. So, is small-town defined by regional population? Does a population of, say, less than 100 define small-town? Or is it defined by how busy you are?

If it's defined by population, then Shoreline is a small-town hospital today just as it was in 1997 when I started working here. However, if it's defined by how busy you are, then Shoreline used to be something else -- something bigger -- and is now considered a small-town hospital. I say this because we used to be very busy most of the time, now we are very busy very little of the time (I can delve into the reason why in a future post). 

At Shoreline we used to be very busy. At hospital-just-north-of us they have never been busy. Okay, so that makes us bigger than them. So, are they small-town and we bigger-town, or medium-town. And another hospital about two hours east of us is probably busier than us, as they have a college to deal with. So, are they considered even-bigger town hospital? 

Our critical care unit holds six patients. When I first started working for Shoreline in 1997, we used to have a vent on a regular basis. In fact, I remember quite a few days we had five, maybe even six, vents. And there was always someone on the vent long-term. 

Those days are gone. The reason is a story for another day. Today, most of the patients in our CCU are probably step-down patients at a larger hospital, or a city hospital. So, the acuity of our patients is not what it used to be. People with heart attacks are immediately shipped. Neuro patients are shipped. Traumas are shipped. Kids, for the most part, are shipped. They go to the experts at the larger hospitals. 

Basically, if you want to put it this way, we are an adult hospital. I mean, that's basically what a small-town hospital is these days. And if you really want to get specific, we specialize in your common surgeries and basic medical issues. That's pretty much it these days. 

For instance, we take care of people in the end stages of COPD to help them get over their flare-ups. We take care of patients with heart failure. We give them lasix. Our doctors order lots of breathing treatments (Not because they are needed, but because respiratory therapists need something to justify their existence). 

Sure, there's a few other things we do. We have an occasional kid. We have an occasional broken bone. We have an occasional diabetic. We have an occasional asthmatic. We have an occasional person with cystic fibrosis (although it's been a long time). We basically, as a respiratory therapy department, dole out breathing treatments for pneumonia and heart failure. We treat that audible wheeze caused by fluid overload with more fluid. 

So, back to the question: what is a small-town hospital? How do we define it? I personally think the definition has changed in the 20 years I've been doing this. Do we define it by geography (less than, say, 60,000 people in the surrounding county? Do we do it by patient load: fewer than 100 beds?  

So, how do you define small town hospital?