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Wednesday, October 29, 2008

My answers to your RT queries

Every week I check my statcounter to see who's typing things into Google or Yahoo and being linked to my RT Cave blog. Assuming the queries were not answered, I provide in this spot each week my humble responses.

And, hey, if the query is comical, it deserves a comical response. If it's serious, I treat it as serious. That in mind, here are this weeks queries:

1. an ideal rsbi prior to weaning from a ventilator: RSBI is VT/RR. A result of anything less than 110 means that the patient has a 75% chance of not being re-intubated according to studies. At our hospital, we use 100. Each hospital is different.

2. soul therapy, stripping class: Soul therapy is good, but stripping in a hospital would be frowned upon, unless you are an old patient with a saggy butt.

3. cheer copd patients up: The company of an RT sometimes does this. There's this neat drug called PalButerol we RTs comically use to Cheer up our patients. If you don't believe me, see my ad on the right. There's a picture of santa.

4. best cigarettes for asthmatics: If you are an asthmatic and smoke you are a knucklehead. However,asthma cigarettes used to be a front line therapy for asthma. Check out this link and read more.

5. side effects of bipap: It's not a drug, so there really are no side effects. The pressures used are usually low, so it's not common to cause barotrauma, but it's still something to watch out for. Basically, the biggest side effect (if that's what you want to call it) is patient driven discomfort or non-compliance.

6. does copd mean your a co2 retainer: No. Most experts predict that fewer than 10% of COPDers are retainers. But don't tell doctors that, because many of them treat all COPDers as retainers, which is unfortunate for the patient because they are unnecessarily kept hypoxic (note: hypoxic means they aren't getting sufficient oxygen to their tissues).

7. what diagnosis use ventimask: A ventimask should be used when a patient has an irregular respiratory rate, or if the patient is labored. The reason for this is a ventimask is a high flow oxygen device that guarantees the dialed in FiO2 regardless of respiratory rate. Ideally, your goal as an RT is to use the lowest FiO2 to maintain an SpO2 of 92% or greater. Now, if you have a CO2 retainer who is laboring, and you want to guarantee an FiO2 to get his sats high as possible, a ventimask can work well. Usually we use 40% FiO2 or less for this to maintain an SpO2 that is appropriate for the patient (I prefer 92% or greater, but some patients live around the mid to upper 80s). For more information on CO2 retainers, check out this link.

8. miracle asthma drug: When I was a kid it was Susprin (I will write about this soon enough on my asthm blog), which is no longer even mentioned in the PDR. I would say that it is Ventolin, but most asthmatics shouldn't even need to use Ventolin if they take Advair. Singulair might be the new miracle allergy drug.

9. prolonged use of rescue inhalers instead of preventative medicines: Is foolish. This is what a Goofus Asthmatic would do.

10. diarrhea and cpap machine: There is nothing in common between the two. And if you have diarrhea, you do not have to take the mask off unless you want. Unless you are talking about diarrhea of the mouth.

Now, if you guys and gals have any further questions for me, serious or not, let me know and I well try to answer them for you. If I don't know the answer, I will seek out a sagacious RT who does, or maybe even a doctor.

You can email me at, or write a comment below.

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