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Friday, June 11, 2010

Doctors: Albuterol does not increase sats

I dare you to hang this sign on your bulleton board for doctors to see.

Dear doctor:

A bronchodilator breathing treatment will not benefit a patient just because she has a low spo2. If the patient has normal lung sounds, good air movement, crackles in the bases, and is sleeping, chances are she is not having bronchospasms.

Likewise, upon further assessment, if a pre and post peak flows are the same, and the patient says, "I am not short of breath," before bronchodilator therapy and says, "I am still not short of breath," after bronchodilator therapy, the chances are the patient is not having bronchospasm.

If a patient is not having bronchospasm, then a bronchodilator is not indicated. A bronchodilator alone will not make the spo2 go up. However, the oxygen boost during the treatment might.

So, since the breathing treatment did not work, we would recommend you search for other causes for the low spo2 other than bronchospasm:

a) the patient's spo2 normally drops while resting, sleeping, or during shallow respirations, and increased oxygen is the solution.

b) the patient is slowly becoming wet due to all the fluid intake from surgery, IVs, etc. In this case, a dose of a diuretic like laxix or bumex is indicated.

Yes we appreciate the work, and we have no problem sticking a neb in someone's mouth. However, we would appreciate if, when you are not at the bedside, you respect the clinical judgement of the respiratory therapist as well as the nurse when deciding what is the best course of action for your patients.

We appreciate your cooperation in this area. Sincerely, your humble respiratory therapist.

I dare you!

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