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Saturday, August 16, 2008

Questions RTs would love to ask but wont

I walked down to ER because I heard that a good friend of mine's mother was down there. I wanted to see what was up. I talked with my friend and her mother for at least 15 minutes, and her mother gave me no indication that she was having trouble breathing.

The truth was, she was breathing perfectly normal.

Yet, an hour later I was called to do a sputum induction with an Albuterol Nebulizer.

I said to the doctor, "Hey, she's not having signs of bronchospasm, so if I can get the sputum sample before the treatment, do you want me to just skip the treatment."

"Well," the doctor said, "I think you better give the treatment anyway, because she does have pneumonia."

Because she does have pneumonia. "What's Ventolin going to do for pneumonia." It slipped out under my bated breath. I almost didn't even realize this happened until...

"What do you think?"

Are you responding to me? Was that a "What do you think" to my thought, or were you responding to one of the other six people standing behind the nurses station.

I think she was responding to me. She honest to God, actually, really believes that Ventolin really and honestly truly does something for pneumonia.

"Nothing." It did not slip out. Dammit.

It was too late. Her attention was flushed by an RN. My opportunity to clear this issue of Ventolin for Pneumonia had passed. A better opportunity may never present itself again.

Perhaps its for the better. After all, we RTs do need to be political with our doctors. You know how that is. I scratch your back and don't complain about your stupid orders, and you respect me and once in a while agree with something I request.

So, that in mind, I have some questions that some day I would like to sit down and discuss with Dr. Krane, or any other doctor in her boat.

Here are my questions:

1. Why is it that you order breathing treatments Q1. No other doctor besides you does this. So, where is your research that indicates this frequency is best. And why is it that you order Q1 hours on CHF and pneumonia patients, but when someone comes in with a real indication for Albuerol, you don't order them Q1?

2. Why is it that you order breathing treatments on pneumonia patients? Please show me the studies that Ventolin and Atrovent somehow magically shrinks from 0.5 microns down to 0.5-2 microns. Not only that, but show me what it does for the inflammation and fluid in the alveoli that is present with pneumonia. Show me the evidence. That's all I want: evidence.

3. What evidence have you got that provides you with a reason to give breathing treatments to CHF patients? Show me the evidence that Ventolin will Absorb the fluid in the lungs. Show me the evidence that you are not simply adding more fluid to the lungs with the treatment. What, I say, does Ventolin do for pulmonary edema?

I have no problem doing any breathing treatment. I have no problem giving a patient a breathing treatment when they are SOB and the diagnosis is still pending. But, I say, once you rule out bronchospasm, there is no reason to continue those Q1 hour treatments.

And that, my fellow RTs, are some questions a lot of RTs out there have and are -- like me -- probably never going to ask audibly (at least).

It's not that we RTs want to complain, it simply that we do not think it's necessary to do things just because. And, once it is determined that there is no scientific reason behind doing such and such a therapy, it should be stopped.


Glenna said...

Amen. I ask those questions all the time. I'm getting bad. When I have Assess & Mistreat I've started saying to RN's "I have nothing in my bag of tricks for CHF. I wish to God Albuterol cured CHF but it doesn't. It only increases the heart rate and like that patient needs that, eh?" I finish in that "Am I right or what?" tone that steers them to the answer I want and then I walk.

Freadom said...

Yeah, that's about how it is. I find myself using similar tachtics, which usually involves ventolin puns. "I've learned ventolin isn't strong enough for this, so I added a dose of All-betterol coupled with some cracklin and some absorbolin."