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Thursday, November 13, 2008

Crying NOT good during breathing tx's

When I'm giving a breathing treatment I get so tired of RNs and doctors telling moms and dads that it's okay that their kid cry during a breathing treatment. "They take in a deep breath and get more medicine that way."

"Ahhhhhhhhhhhhhhhhhhhhhhh," the RT thinks, hardly able to hold in his rage. He's sooooooooo sick and tired of stupid dummass theories.

NO! WHEN A BABY IS CRYING HE IS SPENDING MOST OF HIS TIME EXHALING. HE IS TAKING IN SHALLOW BREATHS, AND SPENDING MOST OF HIS TIME EXHALING. HE IS CAUSING TURBULENCE WITHIN HIS AIR PASSAGES, WHICH CAUSES THE MEDICINE TO IMPACT IN THE BACK OF THE MOUTH AND THE LARGE AIR PASSAGES. THUS, VERY LITTLE MEDICINE MAKES IT TO THE BRONCHIOLES. FOR BEST DEPOSITION OF MEDICINES...

...Ahem...

YOU WANT A SMOOTH LAMINAR FLOW DURING INSPIRATION FOR THE 0.2-0.5 MICRON PARTICLES IN THE BREATHING TREATMENT TO EASE THEIR WAY TO THE BRONCHIOLES AND CONNECT WITH BETA 2 RECEPTOR SITES IN THE LUNGS.

...Ahem...

A TREATMENT GIVEN WHEN A PATIENT IS CRYING IS ABSOLUTELY USELESS.

Can I make myself more clear? Of course Dr. Stanwich debated me on this, and insisted that I prove it.

Um, okay, so where the heck did I read that? What book was it in? Like you need to look at a book. What about just using some common sense. If you inhale fast, you are feeling more cool air at the back of your mouth.

Ladies and Gentlemen, boys and girls, I have found it in writing. Finally. Finally I can put an end to this Lame theory that it's okay for babies to be crying during a breathing treatment.

The breathing pattern is another consideration in using a nebulizer or inhaler with a child. Quiet tidal breathing is the best pattern for drug delivery. Crying is a problem during a nebulizer treatment due to high inspiratory flow during the short, rapid inspirations and prolonged expiration that result in a significant decrease in medication deposition in the lung.

If you don't believe me, check out this link to original article in the August 2008 issue of RT Magazine. The article is aptly titled, "Kids and Asthma: Making (and Teaching) the Right Choices." The author is Bill Pruitt, RRT, AE-C, CPFT.

Hey, you can base what you say on facts, or some dummass theory that takes a simple mind to repeat over and over and over. Take your pick.

I prefer to base what I say on fact.

Consider this RT Cave Rule #30.

3 comments:

Trauma Junkie said...

I'm glad you're sharing this with everyone. Hopefully it helps.

One of the first things we learned in pharmacology is that giving a bronchodilator when a child is crying or using the blowby method is useless.

However, the way some babies are, I don't know how you could manage to give it without them crying...

Glenna said...

Great job backing that up! I need to do more of this, having those kinds of facts at my fingertips for refuting the "myths" we all face.

Glutton for Punishment said...

For somebody who has a decade of education, they still could not understand laminar flow vs. turbulent flow, re: crying, bawling, whatever, versus SMI breathing.

I remember this sales rep who came to our place peddling Teddy Bear nebulizers. The meds would nebulize out of the bear's tummy, the theory being the kid would hold the bear close to his/her face and then passively inhale the nebulized medication.

I kinda thought that inhalation therapy is everything BUT passive...