I am providing today a little test to determine how respiratory therapy wise you are. The following is a test. The answers will be provided at the end of this post, and you can grade yourself.
Okay, here we go:
1. Lacking RT driven protocols, how exactly is it that doctors decide who should get bronchodilators?
2. Lacking RT driven protocols, how exactly is it that doctors decide upon a frequency for bronchodilator therapy.
3. How do most doctors decide whether they should use Xopenex or Albuterol?
4. Why are so many small town RT bosses against initiating RT Driven Protocols?
1. Did you say, "the patient is having bronchospasms." Well, that would seem the logical answer, but if that's what you said you are wrong. The correct answer is, "When you don't know what else to do, you order breathing treatments."
2. This question is easy if you think about it: they simply guess. Some doctors, however, "just know" a patient will be short of breath every so many hours.
3. Dr.s believe Xopenex is twice as strong, lasts twice as long, and is twice as expensive as Albuterol. So, if 20 doses of Albuterol isn't getting rid of the fluid in the lungs, try the superman version of Albuterol: Levalbuterol (Xopenex). Note: Some doctors simply skip right to Superbuterol. Coincidentally, I asked a doctor who usually orders Duoneb but all of a sudden she's ordering Xopenex why the change. She gave me a crooked smile and shrugged her shoulders. "You just flip a coin don't you," I joked. She said, "Yes."
4. If you answered because they want to make money, I'm sorry, but you are wrong. The correct answer is to increase the procedure count. The only patients who pay by the procedure are those who self pay. For all other patients, the hospital gets one lump sum regardless of the procedure count. Therefore, to justify keeping the current RTs and to prevent the RT Cave budget from being cut, needless breathing treatments are sought.
So, how did you do? If you didn't do so well, don't worry. Because when I started out on this job I thought bronchodilators were for bronchospasm; they were given only upon an assessment that showed bronchospasm, and that breathing treatments made money for the hospital.
As the old saying goes, the older we get the wiser we get. The longer you work as an RT, the more RT wise we become.