One of my favorite things to do is educate. I always thought it would be cool if either all doctors went to RT school before they went to DR school, because that would teach doctors some good assessment skills, and how to know when a breathing treatment is indicated.
Either that, or perhaps it would be good to have an RT teach at DR school the indications of bronchodilator therapy and stuff like that. That in mind, this I am starting a new subject I will return to from time to time here at the RT cave: DR wisdom. And that is what this post is: Dr. Wisdom.
This will include information that I think doctors could use to become better doctors, or little things doctors can do to improve the DR-RT relationship. Heck, this will not only benefit the patient, it will make RTs happier, and make it so you doctors don't have to be bothered all the time.
First, let us consider RT Cave Rule #13
RT Cave Rule #13: In order to know that a breathing treatment is needed, you have to actually assess the patient.
So, that in mind, here is RT Cave Rule #12:
RT Cave Rule #12: Just because a patient has pneumonia is NOT an indication for a breathing treatment.
You came into the hospital, you assessed the patient and you saw the same thing that I saw when I assessed the patient, that he is in no respiratory distress and he even denies SOB. So why do you insist on ordering breathing treatments. Why?
Here is what you need to know. Ventolin is a particle size of 5 microns. That's a perfect size to work down into the bronchioles, bind with the beta 2 cells receptor cells, and relax the muscles of the bronchioles.
Now, note that pneumonia is not in the bronchioles, and therefore Ventolin will do nothing for pneumonia. Ventolin will not magically shrink to 1-2 microns and get into the alveoli and scrub the alveoli clean of pneumonia. That will not happen.
And even if the ventolin could somehow get into the alveoli, it would basically bounce off the alveoli and be absorbed by the body, because B2 receptor cells that it attaches to are not in the alveoli, they are in the bronchioles.
Thus, bronchodilators do nothing for pneumonia. In fact, I can tell you if that I never did one treatment on that guy you just ordered treatments on in CCU33, he would still eventually go home.
Please don't waste my time and make me wake up that poor guy every four hours round the clock for some stupid quacky uneducated theory you have.
Better yet, here is DR wisdom #11, of which I will be referring often in this class. So you better know this rule upside down and backwards:
RT Cave Rule #11: NOT everything pulmonary should be treated as bronchospasm. Ventolin does not work like Scrubbing Bubbles bathroom cleaner and scrub the lungs clean of all that ails them. It is for bronchospasm only.
We'll touch up more on this rule in our next session of DR wisdom.
That concludes today's class.
Note: I am aware that most doctors do not order bronchodilators for stupid reasons. And most who do are simply not aware of the real value of bronchodilators. That's exactly why we will hold these classes from time to time. Remember, we here at the RT Cave are leading the charge for bronchodilator reform. Thank you.