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Wednesday, April 16, 2008

the walkin coughin

The other night at Shoreline Medical, I again got called to ER to give a nebulizer tx to a "diff breather". When I arrived I found a sweet little old lady with what sounded like a good case of bronchitis. While talking to her I discovered that she had been in the ER two nights previous and was discharged with home nebs, antibiotics, and just in case, a jolt codiene for her cough. The patient's caregiver told me that she must not have done "it" right as the "sweet little thing" has not gotten any better. " The discharge instructions directed me to give the nebs if she coughed. Well, she didn't cough so I didn't give her any nebs and now she is worse and coughing real bad! "
Now I ask you, when did we start sending every Tom, Dick and Mary home from the ER with home nebs to treat their cough? Do bronchodilators treat a cough? Are the doctors reading something I've missed? The sweet little old lady had coarse rhonchi, no wheezes, and no crackles. And, if you give someone codiene for their cough and then tell the caregiver to give nebs for the cough, just when exactly do you think the patient is going to get around to coughing I ask you? And, where the H--- is the indication for the patient to have nebs at all, let alone home nebs?


keepbreathing said...

That happens here a lot too. Our pedi ED sends kids home with nebulizers for stupid stuff like a cough or GSS Glorified Sniffles Syndrome all the time.

Sometimes I ask them why, but they usually ignore me. Such is life...

Freadom said...

Well, Jane, you'll have to come up with an 'olin for that.

After you left, we had a doctor order home nebs for a baby just because he was diagnosed with RSV. The funny thing was, the doctor ordered this before she had me do a treatment on the child to see if it had any effect on the child.

There must be a blue light special tonight on home nebs.

Wendy said...

Hmmm food for thought. I really wonder about our medical system (on our side of the border too)!
Thanks for your comments on my blog. Sorry, you had to go through what you did last summer. It really sucks.