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Friday, March 21, 2008

The saga of the 99-year-old man: part 1

I gave treatment before I went home Thursday morning to an obtunded 99 year old patient who was wheeled into the emergency room with a non-rebreather plastered to his face. I was informed by the nurse the patient was from a local nursing home and was having trouble breathing.

"We are definitely going to need a breathing treatment on him, Rick," Julie, the patient's nurse told me, "he already had a Duoneb in route." They gave this guy a treatment enroute? Why?

Exhausted after perhaps one of the worst nights on recorded memory, one where I did 12 breathing treatments in the emergency room (two of which were indicated) and 12 EKGs in one four hour span while having a nursing student at the same time, I had long lost my ability to just keep my mouth shut and do what I was told.

So I let the nurse know what I thought about giving a treatment to this guy: "Looks more to me like he's in renal failure or is septic or something like that," I said. "More than likely he's probably wet."

I did an EKG, assessed the patient, and decided the patient did have no signs of bronchospasm. More than anything, he looked like a strong 99-year-old who had had a fulfilling life and was now ready to cross through the pearly gates to meet his maker.

So, after doing the EKG, I went upstairs. "Screw that nurse and her breathing stupid treatment," I thought to myself as I exited through the double doors and out of the emergency room. "I have patients upstairs who actually need treatments."

You guessed it, I as much as made it to the patient floors and was called back to do the treatment. What the, "I wanted to say hell here, but somehow managed to refrain myself as the doctor was standing right next to me, "the heck does he need a breathing treatment for," I grumbled. Honestly, though, I didn't mean to sound grumpy, but the exhaustion and burnout had raped me of my ability to control my cadence.

"Well," the all knowing nurse said, "He's short of breath."

You see, this is what's wrong with the medical field. Instead of actually assessing the patient, and knowing the indications for bronchodilators (for which all my blog readers know I am sure), some nurses think every patient who's short-of-breath needs a breathing treatment, including those patients, like this 99-year-old, who are in respiratory failure secondary to a metabolic problem.

I just want you guys to know that most of the time I an equanimitous guy who does what he's told and keeps his mouth shut and feigns a smile and grumbles to himself instead of verbally releasing into the atmosphere his frustration about an unnecessarily ordered procedure. For the most part, I have a mission to be happy and get along with everyone.

The nurse, who more than likely knew full well how miserable of a night I had (because her night was equally miserable) did not say anything back to me like, "This treatment is too indicated you stupid useless RT who thinks he knows everything." Nope, she did not say that.

And I'm glad she didn't, because I just wanted to go home, refuel and collapse. And, after I finished doing that breathing treatment, the nurse was preparing to insert a syringe into the patients newly inserted IV. I smiled and said, "Well, you don't have to give that," Julie.

"Why would that be?" She looked up at me and smiled. She knew what was coming.

"Because my Allbetterol mist just cured him of all his ailments."

She proceeded to smile and pushed her med.

I didn't tell her this, but also tossed into this mixture some Reserectolin to ease this patients transfer across the pearly gates, and some Waytoolateolin to ease the suffering of the nurse.

For more information on Waytoolateolin or Toolateolin check out this link. If you want to know more about Resurectolin, check out my list of 'olins at the bottom of this blog, of which I will update right now.

Oh, and I forgot to inform you guys that this patient was also a full code. Perhaps that will help you to understand my RT frustration a bit more.

(Note: I will continue the saga of the 99-year-old full code tomorrow.)

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