My response to your websearch queries

Here is my weekly response to Internet search engine questions that lead someone to my blog.

1. side effects of respiratory therapy: I will consider a side effect as something negative that could happen. I think that the #1 side effect is burnout, followed closely behind by frustration at not having more control over who gets respiratory therapies, not having more protocols, etc. In some rare cases there has been seen complete animosity toward this profession, which is probably no different from any other career.

2. can i take only serevent for asthma: It's recommended that if Serevent is indicated, Flovent should be taken with it. Thus, if both are prescribed, the patient should talk to his or her doctor about taking Advair, which is a combination of both drugs and only requires one puff in the morning and one at night. For more information regarding Serevent, click here.

3. mixing mucomyst with albuterol: It is mandatory that if Mucomyst be given that Albuterol be given with it. While Mucomyst is supposed to break up thick mucus, it can also cause bronchospasm.

4. what do people think of respiratory therapists: I think that most people don't even know who RTs are until they see us in the hospital. But, once they get to know us, I think we are highly thought of by most patients. We do our own surveys here at shoreline, and most of the comments are excellent when it comes to "what do you think of your RT services."

5. albuterol steam machine: I think you are thinking of an air compressor and a nebulizer. When the air passes through the nebulizer, it forms a mist not steam. And, breathing in this mist is what causes the medicine to get into the lungs and do what it's supposed to do, which is relax bronchial muscles.

6. what are post-op crackles in the lungs caused by?: Can be caused by a lot of things actually, but the general idea is that they are caused because abdominal or thoracic pain from the surgery is preventing the patient from taking in deep enough breaths and stretching the alveoli in the bases of the lungs, and thus making them more prone to pneumonia. Likewise, some pain medicines and sedatives can also make a person take shallow breaths, and this too can cause crackles. It is for this reason we encourage post op patients to use an incentive spirometer and to do cough and deep breathing exercises, of which I wrote about right here.

7. what to do when you dread going to work: We all have those days. What I do is go to work and hope for the best. It's also a good idea to get a good nights (or in my case days) sleep.

8. respiratory school formulas printout: I actually have a list of the relevent formulas I can post if you want me to.

9. how often should a patient use combivent: Recommended QID or no more than Q4. If you need it more often see your doctor. However, there are exceptions to this guideline.

10. how does ventolin work in the respiratory system: The Ventolin particles are nebulized into a particle size of 0.5 microns and work their way into the bronchioles, where they bind with beta adrenergic receptor cells and cause bronchodilation.

11. does nasal cannula make pneumothorax worse in children : Why would it?

12. advantage of using a mist tent over nasal cannula : A mist tent is good for use with a child with croup in that it provides a cool mist to help reduce swelling in the throat. However, at Shoreline we've decided the mist tent more or less just gets in the way of caring for the child, and we've pretty much scrapped them. If a child need oxygen, we use nasal cannulas. However, the mist tent is still always an option.

13. which is stronger ventolin mdi or ventolin aerosol mask: According to scientific data obtained, an MDI used with a spacer and used correctly should be just as effective as a Ventolin nebulizer treatment. And, a nebulizer taken with a mouth piece is more effective than via a mask, and a mask is more effective than a blowby treatment.

14. does singulair make it easier to cough up flem from lungs? : Not that I know. Singulair blocks the release of leukotreins which cause bronchospasm.

15. which should be given first if both are ordered serevent or flovent: Good question. Check out my answer to #2, and then I'd have to say Serevent because it's a bronchodilator. Considering neither has an immediate effect, I would guess that it doesn't matter. Any one else care to chime in here?

16. best respiratory therapist: Who decides? Is the person who loves button pushing really better than the RT sage? I wouldn't think so.

17. using bipap in place on ippb : I have debated this with some of the older RTs who will defend the IPPB machine to the death, but I think that all the IPPB does is over distend the good alveoli. I can produce some reliable studies that have come to the same conclusion.

18. continuous albuterol with bipap vision: Connect the neb as close to the mask as you can get it and have at it.

19. what does a respiratory therapist wear: Well, I wear scrubs and a white lab coat. Boring hey?

If you have a question I have not addressed here, or if you want an answer right now, feel free to contact us anytime and we'll get you an answer ASAP. You can contact me at Freadom1776@yahoo.com.

My response to your websearch queries

Here is my weekly response to your Internet search engine questions.

1. usually what do an rt do for a patient with pneumothorax: You mean what does an RT do? We pretty much provide supportive care. We might be at his side in case airway management is indicated until he is stabilized with a chest tube. Some of my co-workers have assisted in inserting one before, I haven't.
2. what is the difference between albuterol and atrovent: Albuterol is a rescue inhaler, while Atrovent is used more as preventative bronchodilator.


3. challenges in respiratory therapy: There are many. Any part of the medical field can be challenging. This is what makes it so fun.


4. advair how many days does it take to take effect: 7-10


5. death respiratory therapists: What's your question?


6. respiratory therapist sucks: Here's this statement again. I'll just ignore it.


7. what happens to a copd patient if given too much oxygen: Only 10 percent of COPD patients are CO2 retainers. So, for 90% of COPD patients nothing. However, I have found much research to counter the


8. advantages of mist tents over nasal cannula: None. I see no reason why not simply use a nasal cannula.


9. how many respiratory therapists does a community hospital need? Depends on size of community.


10. copd confused with something else: It happens.


11. why use ventolin to bring down potassium: I ask the same question.


12. dread going to work': Sometimes. That's normal I suppose.


13. how long does it take albuterol to get out of ur system: It should have a relatively immediate effect.


14. copd peak flow: Not recommended. Usually the peek flows get worse after treatments.


15. albuterol weight loss: I wish.


16. duoneb given with spiriva: I've seen it done on occasion, but it's probably more of an oversight. If a patient on Spiriva happens to have an exacerbation, I see no problem giving Duoneb in the emergency room. However, I've seen no studies done on this.


17. ventolin suicidal thoughts: I've never heard of it.


18. respiratory therapist are stupid: Are we?


19. singulair ards: I have never heard of a connection.


20. singulair blood brain barrier: Ventolin is the only medicine that can cross the blood brain barrier. Just kidding.


21. what is normal for 22 years old peak flow meter?: It depends on how tall he is. However, he can determine his own normal value by blowing into it daily for two weeks when he's healthy to get his own personal best.


22. a paper on respiratory therapy: I will not write it for you.


23. what make one respiratory therapist better than another respiratory therapist: Expereince, patience, the ability to use common sense, ability to prioritize, personality, etc.


24. did teddy roosevelt have asthma: yes

If you have a question I have not addressed here, or if you want an answer right now, feel free to contact us anytime and we'll get you an answer ASAP. You can contact me at Freadom1776@yahoo.com.

Monday's class: My response to your queries

This post is my weekly attempt to answer Internet search engine queries that lead someone to clicking onto my medblog.

I know that most people click on my site and leave two minutes later frustrated that my site is not what they were looking for. When, in actuality, if they would have hung around a bit, had a cup of coffee with me, they may have found the answer they were looking for.

Here we go:

1. giving mucomyst iv : I had never heard of it. However, upon doing a quick Google search, I found that it can be given IV. Here's what RXmed.com had to say: "Administered orally or i.v., as an antidote to prevent or lessen hepatic injury which may occur following the ingestion of a potentially hepatotoxic quantity of acetaminophen."
   
2. asthma attack albuterol nebulizer : The medicine has the ability to generate instant relief when a person is having trouble breathing. This and COPD are the two main indications for this medicine.


3. how are asthmatic attack in adults graded : Adults can use a peek flow meter just like children, and they and their doctor can adjust their therapy according to how well they do on their peek flow, likewise pulmonary function testing can be used for this too. Likewise, all asthmatics should maintain an asthma diary to keep track of your symptoms so the next time you see your doctor she knows if current medicines are working, and so she can change the plan accordingly. For more information, click here.
   
4. copd and ventolin treatment : Check out my answer for #2.


5. vaponephrine : This medicine is the watered down version of Epinephrine that can be used as as a bronchodilator like Albuterol, but it has a greater effect on the heart, and if this medicine is given, it is recommended the doctor keep the patient for 1-2 hours after therapy to watch for rebound. Vaponepherine (Racemic Epinepherine), is mostly used for croup, which causes swelling of the upper airway above the vocal chords. At our hospital, it is used only as a last resort, and whether or not it really has the desired effect here is still open to debate. Personally, I don't think it does anything. Vaponepherine is also used on occasion in adults with swollen upper airways, which is usually due to post intubation. Again, it is used here as a last resort. Some doctors do not like using it, and some do. There is one other illness that studies show this medicine to have some efficacy, and that is for young children with RSV. New RSV guidelines recommend trying this medicine to see if it has a benefit, and if not, to discontinue it. Studies have also shown that severe asthma patients do respond to Vaponepherine, especially among patients who have been puffing on their inhaler all day and have saturated their beta receptor cells with Albuterol.


6. obtunded with ards : I do not deal with ARDS patients much at my hospital, so I will have to defer answering this question. The most important thing I would recommend regarding obtunded patients is that they not be given tidal volumes according to their actual weight, but ml/kg ideal body weight. At Shoreline we use 6-10 ml/kg ideal body weight.


7. acute renal failure; respiratory therapist : We do deal with these patients on occasion, and the most pressing respiratory issue here would be pulmonary edema and the patients inability to excrete urine. How these patients are treated is up to the physician, and is usually based on the patient's signs and symptoms. If the patient is in respiratory failure, RT may be required to draw an ABG or, if need be, intubate the patient and set him or her up on a ventilator. At shoreline, if the patient needs dialysis, we ship.


8. pneumothorax : I had a COPD patient with severe respiratory distress once who was initially ordered to receive continuous Albuterol treatments. I started the treatment, listened to the patient, and thought I heard a rub on the right side. Since that can be a sign of a pneumo, I reported my findings to the doctor, who put in a chest tube. Soon thereafter the patient was transferred to the floor and was breathing easy.


9. respiratory therapy teaching materials for kids : You mean for asthma? There is plenty of it. When I was a kid I got a big box of fun stuff to play with that taught me about asthma. I even had this cool game that nobody wanted to play with me. I think I even still have it somewhere in my basement in a box. Perhaps I should try selling it on EBAY. For a good website, click here.


10. respiratory floor charting form : We actually had a good one when I started working at Shoreline, but we've been doing computer charting the past eight years or so. I don't know about other hospitals, but our computer charting is very cool.


11. 90 cartoons large dragon in a cave : Technically speaking, there are no dragons here.


12. are blow-by treatments effective for pediatric patients : Yes. You do lose a lot of medicine to the atmosphere, but I think they are still very effective. That's my personal opinion. I know there is a lot of research that says otherwise, but my personal opinion says yes. We use blowby treatments with almost all of our young kids.


13. protocols of hypokalemia : There is nothing in the RT bag of tricks for this.


14. protocol for bi pap : We do not have a written protocol, however doctors usually write the order for Bipap, and we determine the settings on our own. I wish we were provided this same responsibility with vents.


15. how much does an hour of respiratory therapy cost? : The hospital charges for the procedures we do, not for our time. I wish that I was paid for each procedure I did. If that were the case, I would never complain about a useless breathing treatment, and we RTs would be rich.


16. as a respiratory therapist should i cross over in nursing : If you think you can handle it, I would highly recommend it. The pay is better and there are far more opportunities.


17. does albuterol have alcohol in it : I wish.


18. how many days should it take to know if singulair is working : It usually takes 7-10 days to get into your system. This is one medicine you need to keep in your system, unlike other allergy medicine.
    
19. how long does advair stay in your system : Advair should never leave your system. It is one of the preventative medicines you take on a regular basis and never stop unless your doctor says otherwise.
    
20. give ventolin before atrovent : A good question. Ventolin opens up the bronchioles immediately, so it only makes sense to give Ventolin first. However, one of my teachers argued that Atrovent opens the large airways, in which case, if he is right, then Atrovent should be given first. You decide. What do my fellow RTs think about this?
    
21. vents bipap nursing : I think it's important for RNs to understand some of the basics of both these machines. I don't think RT needs to be called every time a BiPAP patient wants to take off his mask, so the RN should know how to do this. The same with the vent. Especially being the lone RT at night, I teach my RN friends how to do certain things on the vent, like preoxygenate, turn it on standby during suctioning, etc.

If you have a question I have not addressed here, or if you want an answer right now, feel free to contact us anytime and we'll get you an answer ASAP. You can contact us at Freadom1776@yahoo.com, or RTcave@yahoo.com.

That concludes today's class.

Monday's class: My response to your queries

This post is my weekly attempt to answer Internet search engine queries that lead someone to clicking onto my medblog.

I know that most people click on my site and leave two minutes later frustrated that my site is not what they were looking for. When, in actuality, if they would have hung around a bit, had a cup of coffee with me, they may have found the answer they were looking for.

This is what I'm going to make an effort to do every Monday.

1. vomiting bipap: This is a good question and something that was covered extensively in RT school. There are two types of masks patients can wear who are using BiPAP. There is a nasal mask, and a full face mask. If the patient is wearing a nasal mask, then there's no problem. However, in the hospital setting we use full face masks probably 90% of the time. And, if someone is throwing up with a mask on their face, their risk of aspiration (inhaling the vomit into the lungs and risking pneumonia) increases big time. Take the mask off if a patient is vomiting. If the patient is in the hospital and is on BiPAP to prevent him from needing a vent, intubation might need to be considered to protect the airway.
2. giving mucomyst without a bronchodilator: Mucomyst has the ability to break up thick secretions and making them easier to spit up (theoretically). It can cause bronchospasm, and should always be given with a bronchodilator, such as Albuterol.
3. vaponephrine dose for kids: At Shoreline we use 0.5cc Vaponephrine on all kids. It's safe. I have rarely ever notices an increase in heart rate as a result of this medicine, and usually if the heart rate does increase, it's because of the kid crying because he's annoyed by the RT.
4. efficacy of albuterol with chf: I've repeated this many times on this blog, but Albuterol will do nothing for CHF unless -- UNLESS -- the patient also has an underlying bronchospasm component. If you want to try one treatment to see if it does anything, go for it.
5. is a nurse above a respiratory therapist: Absolutely not. We are a team. Now, RNs are know to have a little more respect in society, but that is slowly changing. The reason is that nurses have been around since the Civil War, and RTs are only just getting started. RNs also get paid more than RTs, but that's only because of the nursing shortage and, partially, because of the respect thing. But, all in all, we are a team.
6. azthmacort: I took asthma cort for about 15 years, and never had much success with it. The main reason for this was compliance, as I was prescribed to use it four times a day. I think it's better to use a steroid inhaler that allows you to use it twice a day to increase compliance. I have better success with Flovent or Advair, but there are other options.
7. barriers to being a good respiratory therapist: Lack of respect I think is the main barrier. And lack of protocols that allow us to really excell at providing the best care to our patients at the least cost to the hospitals. However, due to lack of respect by doctors, many hospitals still do not have respiratory therapy or patient driven protocols. That's a shame, I think, and is the biggest barrier in my mind.
8. albuterol blow-by neonates: I find that most babies do not tolerate masks, however the results of using a mask may vary from patient to patient. If the child is sick enough, he or she might not care. Also, a blowby may result in the loss of 80% or more of the medicine to the atmoshphere. That said, giving a blowby is often better than doing nothing for a child who is having true bronchospasm.
9. should i give my daughter albuterol for croup: Only if there is underlying bronchospasm. Albuterol does absolutely nothing for croup.
10. cpap therapy for copd how it works: CPAP works to improve oxygenation. It helps a patient oxygenate better, and thus allows more oxygen to get into the bloodstream.
11. congestive heart failure croupiness: We hear this a lot in CHF patients. And, more often than not, RNs and RTs mistake this for a wheeze and recommend or order breathing treatments. Actually, this is caused due to increased secretions or fluid in the upper airway, and will not go away with a treatment. I would say that abaout 80% of CHF patients, patients with pulmonary edema, will have this harsh, upper airway, stridorous, croupy sound. This is something they should teach in school, but I'm not sure they do.
12. what is my internet time: Huh?
13. extra shift incentive pay respiratory: What do you mean by extra shift? Do you mean overtime. We get paid overtime for anything over 40 hours just like everybody else.
14. bad experiences with advair: Some people have bad experiences with Advair mostly becaue it has Serevent in it, which can make a person shakey and irritable. I would recommend weaning yourself onto the Advair slowly, instead of starting right out taking it twice a day. I'm patenting that idea. I recently wrote a post about this, check it out by clicking here.
15. stridor and aerosol therapy: See my answer to question #9.
16. duoneb and hyperkalemia: It would be the equivelent of taking an asprin for a heart attack. Need I say more.
17. why respiratory therapists are disrespected: I tried to explain this in my answer to #7 above. Maybe one of my fellow bloggers can word it better than me with a comment.
18. my doctor gave me potassium after an asthma attack why and what does potassium do f: Hopefully he gave potassium because lab results showed hyperkalemia, not because of some frivolous idea that one treatment of Albuterol will decrease Potassium. However, for a further answer, see #16 above.
19. definite sign of impending alcoholism: Okay, sorry sir or maam, but you had to read all of the above to learn that I do not have an answer to this question. Now, I could gather a pretty good educated guess, but I'm pretty sure you'd rather hear from a professional in that area rather than a lowly RT.
20. respiratory therapist 12 hours: I do not know of any hospitals where the RT does not work less than 12 hour shifts.
21. does albuterol breathing treatments make baby sleepy: Actually, it can be soporiphic. I know for it fact it puts some babies and even some adults asleep. Ah, maybe this gives me another idea for an 'olin.

If you have a question I have not addressed here, or if you want an answer right now, feel free to contact us anytime and we'll get you an answer ASAP. You can contact us at Freadom1776@yahoo.com, or RTcave@yahoo.com.

That concludes today's class.

Monday's class: My response to your queries

This post is my weekly attempt to answer Internet search engine queries that lead someone to clicking onto my medblog.

Of the 500 queries in my stat counter's memory, I have picked some of the most interesting queries. Keep in mind I do not answer queries if the page the person landed on would have provided them with an appropriate answer.

Yes, this is supposed to be my Monday feature. For now on it will be. We'll also have class on Tuesday and Wednesday as well starting next week.

Here we go:

1. copd patient with left side chest pain: The emergency room staff would treat this as cardiac related until test results show otherwise.
2. What year was Albuterol invented?: I had to look this up. According to Wikipedia, "Salbutamol became available in the United Kingdom in 1969 and in the United States in 1980 under the trade name Ventolin." I never knew about it until 1993.
3. what's it like to be a respiratory therapist? It's rewarding knowing that your skills saved a life or improved someones breathing. We also get to share our vast respiratory knowledge by educating our patients about their respective disease process, and how to live with their illness. We spend a lot of our time going room to room doing breathing treatments that help patients breathe better. I've met a lot of neat people and have had many great conversations doing this. Another part of the job is taking care of critical patients, maintaining their airway when needed and, if necessary, setting them up on life support. This, in my opinion, is the most rewarding and challenging part of the job.
4. Duoneb croup: First of all, croup is caused by a virus, and typically only effects children. It causes swelling of the smooth muscles of the upper airway above the vocal chords, and, as the child is breathing in, you will hear a harsh sound we refer to as stridor. The child's cough may sound like a bark. Duoneb will not benefit croup. However, if there is an underlying bronchospasm component (asthma) along with the croup, Duoneb will relax the lung muscles and make it easier for the patient to breathe. Usually for croup we use a cool mist aerosol to try to relax the muscles of the throat, or, if necessary, we give a racemic epinepherine treatment. Sometimes this works, sometimes it doesn't. For the most part, whether this is used depends on the doctor's preference. The Racemic Epinepherine will relax the smooth muscles in the lungs, but theoretically it will also relax the smooth muscles in the throat, which is what is causing the croup, and is why this is usually the aerosol of choice for croup.
5. Albuterol potassium: Albuterol can lower potassium if it is given excessively. If you use it as prescribed it should not lower your potassium. This, however, is something that should be watched when a patient is receiving continuous breathing treatments in the hospital setting, and might be a good reason not to overuse your Ventolin inhaler at home.
6. nursing home respiratory therapist: Currently, Medicaid won't pay for an RT in the nursing home in Michigan, but I'm not sure about other states. However, before the law was changed, I did work in a nursing home for a while. It was a very slow paced job where pretty much all I did was breathing treatments and incentive spirometers -- lots of incentive spirometers. Occasionally I'd be called to assess a patient in distress, in which case I'd usually recommend sending the patient to the hospital.
7. still use mist tents: Not at my hospital. We hid them in the basement where they are currently collecting dust. We find that it is better for the patient, the parents and the hospital staff to simply use a pediatric nasal cannula if the patient needs oxygen. If a patient needs the mist, then we simply set up a cool mist aerosol. However, I've only done the later in the emergency room.
8. nebulizer for cough spasm: Sure. You can try it. If there is an underlying bronchospasm component, a nebulizer with Albuterol might help.
9. copd sucks: I imagine it does. However, there are many things you can do to help you cope with this illness. Click here for a good article on coping with COPD. Or click here to check out what the COPD doctors and scientists at National Jewish Medical and Research Center have to say about coping with COPD. And here is a good blog of a COPDer who has written many great posts on how to cope with breathing illnesses.
10. asthma attack every 2 weeks: If you are having an asthma attack every two weeks, then you should definitely be on some preventative medications, and you should learn what triggers your asthma and how to avoid them. There is no cure for asthma, but there is no reason why any person in today's world should'nt live a normal productive life. For more information you can check out this link. Another good link for asthma information I will link to right here. You should fully educate yourself about asthma and talk to your doctor about how best to manage it.
11. oxygen weaning protocol: I've never worked at a hospital that doesn't have one. We are allowed to wean oxygen to maintain an SpO2 of 92% or greater on any patient ordered on our oxygen protocol or ventilator protocol, which would include most of our patients. If the oxygen does not stay above 92%, we may increase oxygen to whatever the original order was. However, if a patient suddenly needs a lot more oxygen, say from room air to a 50% venti mask, common sense dictates that a doctor should be notified.
12. Respiratory therapy stories: This would be a good idea for a post. What is the most exciting thing that ever happened to you as an RT? Or what was the weirdest thing you ever saw? I had a an end stage COPD patient once who was extremely short of breath and she shouted, "I JUST WANT TO BE WITH THE LORD!" She did right then.

Keep in mind I receive hundreds of queries a week, and I am limited in space on this weekly column.

If you have a question I have not addressed here, or if you want an answer right now, feel free to contact us anytime and we'll get you an answer ASAP. You can contact us at Freadom1776@yahoo.com, or RTcave@yahoo.com.

That concludes today's class.

Monday's class: My response to your queries

This post is my weekly attempt to answer Internet search engine queries that lead someone to clicking onto my medblog.

We determined last week that 62% of people who click onto this blog stay here long enough to determine it's not where they want to be. Likewise, we also determined that if they would have stuck around a bit, they may have found the answer they were looking for.

Of the 500 queries in my stat counter's memory, I have picked ten of the most interesting queries. Keep in mind I do not answer queries if the page the person landed on would have provided them with an appropriate answer.

Here we go:

1. Frequency of Duonebs: Duoneb is a combination of Atrovent and Albuterol, and ideally it should taken no more often than every four hours. If you need to use it more often you should see your doctor. This medicine can be safe if used more often, but should not be done without the approval of a doctor.
2. am i smart enough to be respiratory therapist: When I first researched the career of RT I found out I had to take chemistry, and I failed chemistry in high school. Based on this, I decided RT school would be too hard for me. I could not have been more wrong. If I'm smart enough to be an RT, you are too.
3. respiratory therapy is not a good career: That kind of depends on how you define a good career. If you want to get rich and buy a bunch of material items, then this is not the career for you. Like any job, there are ups and downs of being an RT. It is what you make of it.
4. xoponex q2: It's safe. However, I would not recommend this frequency outside the hospital setting.
5. albuterol pulmonary edema: Albuterol has absolutely no effect on Pulmonary Edema. Albuterol relaxes the bronchioles, and pulmonary edema occurson the outside of the bronchioles. For more information see #9 below.
6. do respiratory therapists use stethoscopes: Absolutely. If you see one who doesn't you ought to report him or her and wonder if you are receiving good care.
7. what happens to fio2 when using a simple mask and the patient breathes deep: The simple mask is a low flow oxygen device, meaning that the FiO2 is dependent on the patients respiratory rate and tidal volume (minute ventilation).
8. i hate my job, respiratory therapy: It's a free country. Nobody is stopping you from getting a different job. Go for it.
9. does wheezing mean you have copd: Not always. If the muscles of the bronchioles are spasming, this will cause a wheeze. This is called brnchospasm and occurs with COPD or asthma. Albuterol can relax these muscles almost instantly, making it much easier to breathe. Pulmonary edema occurs as a result of the heart pooping out, and fluid backs up and fills the lungs. This can be caused by Chronic Heart Failure (CHF). If the pressure in the lungs gets high enough with CHF, this fluid in the lungs will actually squeeze the bronchioles, causing a wheeze. Because this is caused because of a weekend heart, it is called a cardiac wheeze. Sometimes, however, it is hard to tell the difference.
10. Bipap asthma: I've actually seen it work well for some asthmatics, however when an asthmatic is really short of breath he may actually feel claustrophobic enough without the BiPAP. Thus, if the patient can tolerate it, go for it. BiPaP should always be ordered to tolerance.
11. continuous aerosol with atrovent: I questioned it too, but some doctors where I work have done it with no consequences. Atrovent is similar to Albuterol in that the side effects are minimal. If Albuterol is safe, Atrovent is even safer. Some recent studies show some added benefits to COPD and Asthma patient with giving continuous Atrovent along with continuous Albuterol. As with everything in the medical field, every doctor or RT will have a different opinion on this. With that in mind, I do not see any point in giving a continuous treatment with just Atrovent. If a patient is so short of breath he or she needs a continuous treatment, then you better throw in some Albuterol. (Note: a continuous treatment is when you give a treatment back to back to back until the patient starts to open up.)

Keep in mind I receive hundreds of queries a week, and I am limited in space on this weekly column.

If you have a question I have not addressed here, or if you want an answer right now, feel free to contact us anytime and we'll get you an answer ASAP. You can contact us at Freadom1776@yahoo.com, or RTcave@yahoo.com.

That concludes today's class.

Monday's class: My response to your queries

Before I went on vacation I wrote a post responding to ten Google and Yahoo searches that linked someone to my site.

The reason I did this is because I know that 62 percent of those who click on my site stay here for less than five seconds and, in many cases, if they'd have just hung around a bit in the RT Cave they would have found the answer they were looking for.

So, with that in mind, here are my honest and not politically correct responses to all your queries. While some queries are so goofy they may lead to a facetious response by me, I will be completely serious when the question is a respectable one. I promise.

1. Respiratory therapy inserting catheters: God, I hope it never comes to that.
   
2. I hate respiratory: Why is it that this keeps coming up? I wonder how much time this person spent on my blog.
   
3. Signs a person might need to use an inhaler: You can do so by using a peek flow meter or by knowing the signs of an impending asthma attack. Another great place to find information about asthma is asthma mom, and National Jewish Medical and Research Center. The later hospital and a research center that specializes in pulmonary diseases. I know three people who spent time their for their asthma. It's an excellent place.
   
4. How to know when an asthma attack is occurring: See question #3.
   
5. What is it like being a respiratory therapist?: The best way to find the answer to this question is to check out what the RT bloggers have to say. It's a great job where you get to meet many wonderful people in need of help with their breathing. Some will need a simple breathing treatment, and others more intense therapy. The greatest parts of being an RT, in my opinion, is being part of a great team. We work together with Drs and RNs to the benefit of the patient. As with any job where you work with people, it can be very challenging at times -- yet rewarding too. This could be an idea for a future post. Stay tuned.
   
6. I'm sick with a cold in my chest bronchospasms: Sounds like you should go see your physician, or get one if you don't have one.
   
7. When to intubate: Here is a good link to check out. Cardiopulmonary arrest is an obvious indication for intubation. And during surgery patients are often intubated to keep them alive during the operation. Other times it's mostly a judgemental call made by the doctor and the care team, which includes us RTs. Here are some other indications: Ventilatory and Oxygen failure that might occur with asthma, COPD or pneumonia; to protect the airway of a comatose patient or patient who has lost his gag reflex; signs of impending failure where the airway will need to be secure, such as a trauma or burn patient.
   
8. Holter wheeze: You lost me.
   
9. What kinds of potassium does nursing homes give patients: I have no clue why this query was linked to my sight. I would have to refer you to one of my fellow RN medblogs for this. Check out the links to the right.
   
10. Can a peak flow meter be used for anything else: They are typically beneficial and helpful for helping asthma patients. Other than that, I suppose you could experiment. You could use it as a cool children's toy. You could have a competition during the last day of school to see who can blow the highest number. The winner gets a lolly pop.

That concluses this session.

Your Respiratory Therapy Search Engine Queries: Here are the responses from the RT Cave

I don't really spend a lot of time checking my stat counter, but about once a week I check it out for fun just to see who's been clicking on my blog. One of my favorite things to do while I'm there is click on "Recent Keyword Activity."

This is where my stat counter records what was typed into a search engine, such as Google or Yahoo, that led someone to clicking on my website. A few of the searches have nothing to do with respiratory, such as "Scratchy Neck," but the majority are respiratory related.

As I glance through the list, I wonder if that person had his question or concern answered. And, I think, they should just email me and I'd give them a legitimate reply, or at least I could tell them I don't know.

The reason I think this way is that some of these questions could only possibly be answered by an RT. So, with that in mind, I have listed some of the "recent keyword activity," and my humble responses.

1. "blowing into computer for respiratory": Um, I have no clue.


2. "Itchy neck pain": Um, how did that cause Google to link you to me.


3. "Duoneb pediatrics": Some studies show it works well in ER. Other than that I'd recommend just Albuteral. Personally, though, I don't see what it would hurt.


4. "Doctor doesn't believe in Peek flow meters: The doctor is a fool to disregard the benefits of a peek flow meter. It's a great tool to use in asthmatics to measure the effect of a breathing treatment, and to be an adequate tool to determine when to use a rescue inhaler, go to the doctor, or come here to the ER.


5. "Persistent croup": You can try the shower. You can taking the child outside in the cool air because many times it goes away on the way to the hospital. But don't be afraid to come in and get checked out. That's why we are here.


6. "Will Ventolin harm you if taken unprescribed": NO. However, I would not recommend it. If you have a need for Ventolin, you should go see your doctor.


7. "Does Albuterol Help Crackles?": No. The medicine particle size is too large to even get down in to the colapsed alveoli, and even if it did it wouldn't be able to re inflate it. But this is a great question, because often doctors prescribe Albuterol for this.


8. "Needle shot stings": Yes.


9. "How to write BiPap orders": With a pen in the doctors order section. It works best if you write the doctor's name followed by your signature. Plus I'd write "RT to set up BiPap to patient tolerance." Seriously, every patient is different, and every patient tolerates BiPap differently. That's how we write the order where I work.


10. "House filled with smoke from fireplace fever coughing": I would recommend not having the fire in the fireplace if it causes you to have trouble breathing due to it. It may cause you to cough, but it will not cause the fever. However, if you do have a respiratory illness, it may exacerbate your problem. Also note that it is not uncommon for smoke to bother people with respiratory illnesses.


11. "Respiratory therapy one treatment at a time": I would recommend it, but sometimes you will have no choice. If your patient takes nebs at home, or if the nebs are not indicated, then you should be okay doing more than one treatment at a time, just make sure you are only one or two rooms away. This is where it really comes in handy to know your patient. However, if you are new at this, or not sure, then you should definitely do one at a time.


12. "I hate respiratory therapists": What's your point.


13. "Breathing treaments for pneumonia": Same as for the question on atelectasis above: Albuterol does not get down to the alveoli. Besides, Albuterol relaxes bronchiolar muscles, and there are no bronchiolar muscles in the alveoli anyway. However, if the pneumonia causes bronchospasm, the treatment might work. Usually the first treatment in ER does the trick. If I were a doctor, I'd order Albuterol Q4 prn for these patients so we can give a treatment if indicated.


14. "Coughing spasms albuterol": If it's caused by bronchospasm then Albuterol is a good idea, othersise what's the point. Albuterol will not cause someone to stop coughing if it is not caused by bronchospasm. Personally, I'd try one and see what happens. It's a safe medicine.


15. "COPD on BiPAP": It works. And if it keeps them off the vent, you'll be happy and so will the patient. I've kept many patients off the vent by using a BiPaP. The big problem here is patient compliance. You will have to do a good job of explaining and be very patient with the patient.
    
16. "How long are patients intubated for": Depends on how long it takes them to recover. Depends on how sick they are. Many times, with the new microprocessor ventilators, it takes only one or two days. But every patient is different. If you are the family of someone currently on a vent, you should talk to the RT for an explanation.


17. "Do you give breathing treatment for cough congestion?": Yes, many doctors do. But Albuterol is technically speaking indicated for bronchospasm only.


18. "Where should one live with asthma": While there was once an advantage to living in dry areas like Arizona, research shows that this is no longer a benefit due to air polution.


19. "Why do people need to be intubated": I like to tell people that they, or family member, need to be intubated to get over the hump when they are really having trouble breathing. It allows their lungs to rest. Unlike in the movies, it is also indicated when someone goes into cardiac arrest. It is also done during certain surgeries, if someone is comatose to prevent aspiration, bronchoscopy, or you can check Wikipedia for more information.


20. "Tips for being a great respiratory therapist: Be patient. Don't be afraid to let other people take credit for your ideas. Do your homework. Most important, have fun with your patients and enjoy your job.

Well, I could go on, but I figure I had best stop at 20. There were many that I chose not to list here just because I saw via the stat counter that the person was linked to one of my articles where I know they would have found the answer if they read it.

Perhaps I'll make this a regular feature on this blog.