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Wednesday, July 31, 2013

I saved a life with a neb treatment... read on

So the basics of the Hippocratic Oath is that a doctor must DO NO HARM.  I think no doctor (other than Jack Gevorkyan) means to do harm to a patient (actually, even Jack means to do well by his patients, it's just the rest of us don't see his help as actually good).  So you can see, the definition of "harm" can be a major discussion in any medical ethics class.

For example, last night I had a nurse call me because a doctor ordered a one time Albuterol breathing treatment because a patient was in severe respiratory distress.  The nurse said, "The doctor yelled at me because I put the nasal cannula to 6lpm."

I said, "So, what was the sat?"

He said, "Seventy-Seven percent."

I said, "I will stand by you then. If I would have seen a sat of 77%, I would have got the doctor even madder at me, because I would have put him on a non-rebreather."

The nurse, a relatively new nurse, was relieved by what I said.  Needless to say, the breathing treatment was a waste of time, because the patient was obviously wet.  But I didn't care about that: I wanted to give this guy some oxygen, so I ran the treatment for well over a half hour, until the Lasix took effect.  Seriously, and I didn't chart that either.

Later, I talked to the doctor.  I had to call ABG results to him.  I asked him about the oxygen thing, and told him not to be mad at that nurse.  I told him I would have well over oxygenated the patient.

He said, "I was just concerned about the patient being a retainer."

I said, "The patient is not a retainer, and even if he is, he would have died if that nurse didn't turn up the oxygen.  I think he did the right thing."

He said, "You think so?"

I said, "I know so."

He said, "Okay."

I said, "Besides, the bicarb is only 27, a clear indicator the patient is not and never was a retainer."

He said, perhaps to amuse me, "Okay."

Okay, so he could have chewed my head off like some doctors would have, but I didn't care.  My point here  is that sometimes, as RTs, we save patients, and prevent our doctors from getting sued, and never get credit.  Thoughts.


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