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Friday, July 16, 2010

Politics and Beta-adrenergics

Warning: What follows is top secret information surreptitiously leaked to me via one of the nations elite pulmonologists from an elite teaching hospital. Read at your own risk. This is not edited, yet explains the reason for needless bronchodilators for patients admitted to a hospital with no respiratory disorders.

One of the greatest complexities of modern medicine is what to do for the patient who has no fathomable medical ailment and thus no need to be in the Emergency Room or clinic. Likewise, the patient presents with complaint he or she should have stayed home with.

Perhaps it's a child or an adult with a stuffy nose which presents as a common head cold, where there really is nothing we can do for them. To prevent the risk of the patient, or guardian of child, or family members, or lawyers, asking inexplicable questions, it is recommended that said physician (typically the emergency department doctor) order a breathing treatment with 0.5cc Ventolin.

While this therapy has no "perceived" benefit to the patient, it will make the patient (or family members) feel as though you are doing something as they can actually SEE the breathing treatment, hold it in their hands, caress it, watch the mist flow through the air for some time. This treatment regimen may be best demonstrated by some an example.

Example: A patient presents with runny nose, congested cough, maybe mild shortness of breath you attributable to nasal congestion, clear lungs with good air movement and no history of respiratory ailments such as asthma.

You know there is nothing we can do for the common cold, so we order a breathing treatment so the patient thinks we're doing something useful, and then we discharge the patient. It is your discretion whether you want to sent patient home with a Ventolin inhaler.

Now, say for example the nurse comes to you and says, "The mom thought the breathing treatment worked quite well, and was wondering if she could get these treatments for home." You say, "Well, the only reason I gave the treatment was so she thinks we're doing something."

A nurse is in the same boat as you and I, and she'll understand completely. But do not EVER let a respiratory therapist hear you say this.

The following are chief complaints this applies to:
  1. Common cold
  2. RSV
  3. Bronchiolitis
  4. Influenza
  5. Croup


TOTWTYTR said...

We brought a CHF patient into one of the better hospitals in our area the other night. How did we know that he had CHF? CC, HPI, PMH, Meds, and he told us. He was also a non smoker. Never, ever, smoked.

He was only moderately sick, didn't need CPAP, didn't need Lasix (from us). All he really needed was a little NTG and a ride.

Oh, his breath sounds were diffuse wheezing with clearly heard rales at the bases.

We gave him one NTG spray and he got a lot better.

When we got to the hospital the newly minted resident told the nurse, "He's wheezing, I think we should give him steroids." The nurse demurred, so the resident ordered... Albuterol via nebulizer.

I know it's July, but they have to learn this from someone who should know better.

Lung Lover said...

Every day I say I am saving lives with Ventolin, because some days it feels like all I do is hand out ventolin, and I have to make myself feel better.

Robbie said...

I think that tere is alot of truth to this. Being a RT student who has a background in EMS, I see where this applies.

Warrented or not, people come to you for what they percieve as a need for help, and expect you to do something. And a simple breathing treatment does exactly that, makes them feel as though we have done some grand thing for their "ailement".

Rick Frea said...

I actually had one of my favorite doctor admit this to me recently. "Hey," he said, "There's nothing wrong with that kid. Give her a treatment so the mom at least thinks we're doing something."