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Saturday, April 25, 2009

More new types of Ventolin ('olins)

Here are a couple new types of Ventolin that I'm certain you have seen at a hospital around you. These aren't necessarily conventional uses for a bronchodilator, but -- hey! -- why not!

1. 0.5cc Sinuseuterol:

Symptom: Sinus drainage, mild shortness of breath, stuffiness, sinus headache
Diagnosis: Sinus drainage, sinusitis, stuffy nose
Frequency: Usually 1 dose
Effect: This is a very popular medicine to use, especially in emergency rooms. It's actually been used for years by many doctors but hasn't had an official name other than just Ventolin. The idea here is that 0.0000000005% of the medicine particles waft to the sinus passages to relieve nasal congestion and inflammation. Patients usually says that she doesn't notice a difference after treatment, but that doesn't mean the sinuses won't eventually return to normal.

2. 0.5cc Assessolin:

Symptom: Patient doesn't quite look right. Pt may or may not have annoying lung sounds.
Diagnosis: Generic, but often cardiac or pulmonary history. May have been on vent in past, or and some type of failure in past.
Frequency: No less than Q4 hours. Q4ever may be the best idea here.
Effect: It really has no effect, you see. Even though RT isn't qualified to know when a treatment is indicated, we know they are the best assessors in the hospital. So, when you want to make sure the patient gets a good assessment every so often, there is no better option than to order Assessolin. Hey, there is an old saying: An RT a day kept the code away.

3. 0.5cc Snorebuterol:

Symptom: snoring
Diagnosis: sleep apnea, obesity, other
Frequency: Q4
Effect: Well, the snore sounded like a wheeze when we did our assessment, so better to be safe than sorry. May alternate with any variety of Q4ever treatments.

4.  0.5cc Hypoxolin

Symptom:  hypoxia, high CO2, pulmonary edema

Diagnosis:  Heart failure

Frequency:  Q4-6

Effect:  The patient wearing a 75 percent non rebreather mask to maintain an spo2 of 90% must be given Ventolin because it causes the patient to become hypoxic during the treatment.  Yes, you read that right.  The goal here is  that the 5-10 minutes of hypoxia that occurs during the treatment will increase the patient's respiratory rate in order to blow off excess CO2. Respiratory Therapist grumbling to be expected.  

Note for doctors who barely passed med school:  A breathing treatment from an oxygen source provides approximately 60 percent oxygen.  A nonrebreather does not produce 100 percent oxygen because one flap is always missing due to litigation purposes, and this results in an estimated FiO2 of 75 percent.  

If 75% Fio2 was maintaining a 90% SpO2 you can expect the patient's SpO2 to drop to 85 percent during this highly recommended therapy.  In England this exercise is called hypoxia therapy, yet here in America we don't want to be that obvious, so we just call it an Albuterol breathing treatment.  

For more 'olins, see the growing list at the bottom of this blog. If doctors at your hospital use an 'olin you think would benefit other patients, by God feel free to share it in the comments below.

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