Warning: What follows is top secret information surreptitiously leaked to me via one of the nations elite pulmonologists from an elite teaching hospital. Read at your own risk. This is not edited.
Page76 (Section B-2)
(Section B-2)Physician's Creed: How to take care of pesky RTs:
To help themselves feel better about spending two stressful years in the silly respiratory therapy program, Respiratory Care Practitioners too often bellow about protocols because they think they know more than Internists and Pulmonologists. This is simply nonsense. The following is a list of how to deal with a foolish RCP who dares speak his or her mind.
1. All respiratory illnesses should be treated as asthma, thus require bronchodilator
2. Or, all that wheezes should be considered as bronchospasm
3. To clarify 1 and 2, all of the following are indications for bronchodilator, no matter what RTs say:
- All annoying lung sounds
- CHF (Pulmonary edema)
- Lung Cancer
- Any surgery
- Coughing too much
- Not coughing enough
- History of smoking
- Cold symptoms
- Bed ridden (MS, ALS)
- MRSA (any origin)
- Mechanical Ventilation
4. The best pressure support is 10. Period
5. Doctors need their rest and should never wean on weekend or between 7pm and 7am
6. Tidal Volumes are best set by keen eye, not kg per ideal body weight bla bla bla
7. Even if patient is using Automode, he is considered to be getting mechanical breaths. Vent changes should be made with this in mind.
8. If RT babbles about therapy no longer being indicated, double frequency, change dose and add IPPB.
9. If RRT annoys you, change Albuterol to Xoponex Q3-4, Atrovent Q6, and consider using Pulmicort, Intal and/or Mucomyst. This will make tx last forever (tee hee hee)
10. By the way, it’s okay to mix Atrovent and Mucomyst into the same treatment
11. Never, ever, ever discontinue breathing treatments.
12. Ignore their silly notes.
13. Complain to cardiopulmonary director that RTs are trying to get out of work
14. Prolocols hahahahahahahahahahaha(See note below)
15. OK, we’ll give them a protocol or two to make them happy. We just won’t order it.
16. If RN calls for treatment, it’s indicated. Period. Besides, this prevents them from calling again.
17. You don’t need to assess patient to know bronchodilator is
18. If you’re worried about side effects, order Xoponex. If RT complains Xoponex is same as Albuterol, see steps 8 and 9.
19. If you have no clue what’s wrong with patient, even if labs and x-ray are normal, the patient has pneumonia.
20. Oh, and if they have pneumonia, then they better get a bronchodilator Q4. Who cares whether or not they have a bronchospasm component.
21. Of course we know the patient will be SOB every four hours. We are that smart you know.
22. If RN and RT work in cahoots to call you because a patient doesn’t look right, and they recommend ABGs be drawn, order Q3 hour treatments and hang up. That will teach them not to bother you.
23. By golly, if you find out a patient has pneumonia and is not on treatments, you better order them right away. Make up for lost time by adding Pulmicort. This speeds effect of bronchodilator.
24. If patient CO2 rises from 40-45, by golly you better order BiPAP regardless of WOB.
25. All COPD patients are retainers. Period. There’s no need to trial patient on higher O2s, because that’s just a waste of time. If the RT complains patient was on 100% FiO2 in ER for 8 hours & was perfectly fine with it, just ignore them, or refer to steps 8 & 9. All of these patients should NEVER receive more than 2lpm or 30% VM, no matter how low their oxygen goes. Yes, we know scientists say fewer than 10% of COPDers are retainers, but they are wrong.
26. Patient should not be allowed to recover in surgery after 7. P.M.; put them on a vent.
27. We don't want our surgical statistics to look bad, so all patient with no hope of survival should be rushed to floor.
28. And, finally, if they call you, act like you are annoyed and in a hurry; grumble, mumble orders, gripe and hang up without saying good-bye.
29. Oh, and as with RN orders (see section B-1, How to take care of pesky RNs), make sure your written orders are illegible.
For further information see section D-3, Why doctors are always right.
Note: Yes, it is true that some of us physicians (myself included) have approved RT protocols at some of our nations elite hospitals in the past. These have proven to be disastrous, and merely work to build up the egos of RTs. Please forgo the insanity, and follow this list to the best of your ability.