Creed: Croup now to be treated as asthma

I couldn't help getting frustrated the other night as one of my infamous ER doctors ordered Q30 minute breathing treatments for a croupy kid. Since I'm having a much better night tonight I decided to do some research and found nothing on the Internet.

For some reason I gallivanted down to the physicians lounge, and lo and behold what do I find? Sitting right there on the end table next to a couch in all it's fresh white with blue letters naked glory was letter written to one of our physicians.

Here is what the letter said:

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From: Dr. Hein Olin
Sent: Thursday, July 30, 2009, 4:50 P.M.
To: Shoreline Medical Physicians
Subject: New changes to the Real Physicians Creed

As you guys and gals were informed in my last memo, the 2010 edition of the Real Physician's Creed has already gone to print. Since we don't want you to wait until next year to implement the new changes and recommendations, and since we know you want to continue to piss those pesky RT varmints with new "stupid" (snicker) doctor orders, I am sending this memo to inform you of the latest change and recommendation.

In the past we recommended treating croup as inflammation of muscles in throat and give the patient racemic epinepherine. We now recommend you change that old habit. What we want you to do now is treat all croup as asthma. Likewise, we recommend you give Pedonephrine once, followed by Croupenex Q30 minutes X 4. If after four Crouponex treatments stridor persists, follow this with one dose of Pedonephrine RN, and then Q30 minute Croupenex until discharge.

If that don't get them riled up nothing will.

Thank you for your consideration. Good luck irritating 'em. Maybe you'll even get one of 'em to roll their eyes at you.

Hein Olin DO
Vice President Real Physicians Creed Association

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Well, there you have it. This pretty much clears up the recent trend toward Xopenex for croup.
Those doctors are on to our frustration and are trying to dig a deeper wound. I think it's time we take a stand.
Thanks to my secret sources, I now have the definition of the medicines listed in the above letter. In the next few days I will list them in the Ventolin Types section at the top of this blog.

Real Drs Creed: Hypoxic Drive Hoax Revisited

What follows is what will be added to the new addition to the Real Physician's Creed: How to take care of Pesky RTs. Again, this is TOP SECRET information for physician use only, and was never intended to be released among the RT community.
My source for this TOP SECRET information will be kept anonymous, because if his peers find out he is the leak, he will be banned from the medical community at best, or ridiculed at worse. 

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Page 10,400

Appendix 8

Real Physician's Creed: Hypoxic Drive Hoax Revisited

Date: April 9, 2012
From: Dr. Al Buterol, M.D., President of physiciansrock.com
To: Dr. Ven Tolin, president of the Dr. Creed Association

Basically the hypoxic drive theory was created as an excuse to get physicians off the hook for when a patient dies of hypoxia.  It was originally intended to cover COPD patients, although we have extended it to include patients with severe asthma, lung cancer, cystic fibrosis, etc. It also includes every person who ever smoked, whether they are a CO2 retainer or not.

Since most people smoked in 1962 when Mr. Campbell gave his great presentation to the physicians of the American Medical Association, this theory seemed like a very good idea -- it made us all feel good.  And just think about it, if our own fake theories make us feel good, that's a bonus.  This new hoax pretty much got us physicians off the hook in most cases where we were sued for a patient dying of anoxia (for those who barely graduated medical school, that means lack of oxygen to the brain).  This new hoax pretty much got physicians off the hook in most cases.

However, the bimbo heads in Washington continue their quest to get people to quit smoking, and this has put a damper on our profession.  Since fewer people smoke today, this has resulted in increased litigation, and there be your reason for all the increased medical costs and all the warnings on medicine that most people ignore.  We owe it all to evil lawyers who now have an open door to suing us because our hoax is no longer valid as often as we'd like due to people no longer being ignorant.

Now it also appears that some incompetent physicians and nosy respiratory therapists are on to our hoax, and are out to expose our efforts. This would be terrible because it would make us out to be wrong, and you know the medical profession is always right.

So my effort by sending out this memo to all my fellow physicians is to remind you of the importance of the hypoxic drive hoax, and the importance of the efforts to ignore RT efforts to inculcate the idea the Hypoxic Drive Theory is really a hoax.  We know it is, but we don't want lawyers catching on to this, because that would result in lawsuits when when we intentionally keep COPD patients hypoxic.

Keep up the good work fellow Dr. Creed members.  We must continue our quest to keep anyone outside the medical profession ignorant.

Real Physician's Creed

1. Page 76: The Physicians Creed, how to take care of pesky RTs
2. Page 78: The Creed: Length of therapy and ABGs
3. Page 79: Creed updated to account for EKGs
4. Page 79: Real indications for EKGs
5. Page 80: Real indications for bronchodilators
6. Page 81: Bronchodilators treat inflammation too
7. Page 82: Real Dr's Creed: Bronchodilators treat CHF too
8. Page 82: Dr's Creed: Bronchodilators now lowers Fever
9. Page 83: Dr. Creed: Ventolin increases lung tissue
10. Page 84: Dr's Creed: Beta Blockers and pulmonary fibrosis
11. Page 85: Here's how bronchodilators treat hypercapnea
12. Page 86: Here's how bronchodilators treat lung cancer
13. Page 87: Dr's.Creed: Beta agonists & unrespiratory ailments
14. Page 88: Here's how bronchodilators treat pulmonary embolisms
15. Page 91:  The feel good policy of oxygenation
16. Page 98: The Ventolin Types
17. Page 99: The noninvasive ventilation (BiPAP) creed
18. Page 122: Treatment plan for man with lung cancer
19. Page 123: Croup now treated as asthma
20. Page 767: Discharge = Serevent, Admitted = Preventolin
21. Page 2,142: Real Physician's Creed Products
22. Page 9,435: The 17 Real Indications for Tylenol
23. Page 9,436 Politics and beta adrenergics
24. Page 304,403:  The three types of pneumonia
25. Appendix: New Scrubbin-family Black Box Warning
26. Appendix 2: The Bouncing Molecule Theory
27. Appendix 3: Why order SVNs over MDIs
28. Appendix 4:  The Kreb Cycle Theory of Oxygenation
29. Appendix 8: Hypoxic Drive Hoax Revisited
30. Appendix A: How to deal with Brovana
31. Appendix B: RTs Now Required to do gun cessation programs
32. Appendix Z: Section 982: Faux Study: One Budesonide Amp should cure stridor
33. Dr. Creed Updated for Obamacare

Dr. Creed: How to deal with Brovana

In light of my post, "So why is Brovana feared by RTs, RT bosses and doctors?," the medical director for Shoreline Medical Center, Dr. Hein Olin, sent a letter to the professor, physician and editor in charge of the Real Physician's Creed, Dr. Ven Tolin, who in turn sent the following letter to Hein Olin.  

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To: Dr. Hein Olin
From:  Dr. Ven TolinSent: Thursday, November 15, 2012, 3:50 P.M.Subject: New changes to the Real Physicians Creed

Thank you for your letter of concern regarding that pesky Rick Frea.  He has been nothing but trouble since he started his blog in October of 2007.  His lies about bronchodilators have many of us on the defense as we are receiving letters on a daily basis from respiratory therapists concerned that most of the treatments we order are a wasted of time.  We have made attempts to get his blog off the net, but unfortunately we have failed in our attempts.  If you would fire him that would make our job much easier.  So why don't you just do that?  Of course it's probably too late anyway, as he would just keep "doing what I love to do," as he says on his despicable blog.  

Yet I digress.  Regarding this new medicine called Brovana.  All it is is an attempt by the home care industry to get rid of Albuterol and Duoneb breathing treatments that we feel are necessary.  These home care people are just lazy, and trying to get out of work.  The respiratory therapists who think Brovana can just be given twice a day without any Duoneb in between are using fake science.  Phooey on them.  As we have discussed many times, what feels good and sounds good is much more valuable than science.  So we have decided long ago that it sounds good to give Duoneb to all patients with lung problems, so we will continue onward with this policy.  To change it would make us look like we are indecisive.  I suppose it's for this same reason the President (Bush and now Obama) won't get rid of secretaries who perform poorly.  We agree it would look poorly on them.  

In our 31st edition of the esoteric "Real Physician's Creed" to be released in January of 2013, we will add a new section on Brovana.  We will ignore the fact that Brovana is a fast acting medicine that works similar to the rescue inhaler Albuterol.  We will continue to deny that giving Duoneb at the same time as Brovana is similar to giving two Duoneb treatments at the same time, and not necessary.  We know it is necessary.  It's necessary because it feels good.  Who cares about science?

Yes we will deal with this Brovana nonsense in the new book.  Until then we recommend you simply ignore that evil respiratory therapist Rick Frea. He is nothing but a piddling fool.  
_____________
Thankfully I have my sources for getting this information, and I will not reveal my source.  Ahahahahahahahahahahahahahahahaha

Dr. Creed: Pulmicort: the new miracle medicine

To: Dr. Ven Tolin
Company: Doctors Creed Association of America
From: Dr. Sloof Lirpa
Date: 1/14/2013
Subject: Pulmicort

The planning committee for the 64th edition of the Real Physician's Creed met last night, and the hot topic was the use of Budesonide (Pulmicort) on all COPD patients.  Dr. John Carlton of The Royal London Hospital reported that he gave pulmicort to a COPD patient suffering from severe shortness of breath, and the next day the patient was better.  He tried this again a month later on a patient with a similar condition, and that patient got better the next day too.  So he recommended to the committee to add pulmicort as a front line medicine for all patients admitted with asthma, COPD, or pneumonia.  He believes that instead of waiting until the patient has been admitted for two weeks, that we start it right away. This way the patient will eventually get better and we can discharge him.  I personally would like to endorse Dr. Carlton's idea.  Certain pulmonologists in Europe have already begun their own experiments with the medicine, and I highly encourage us to send the memo to pulmonologists in the U.S., and then to add it to the Real Physicians's Creed for the next edition.  I would like to see this medicine used with increased frequency throughout the year.  I do not feel as though any further testing is indicated.

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Real Dr's Creed: Bronchodilators treat CHF too

Many of the following might seem like nonsense to thinkers like you and me, but the Real Physician's Creed teaches doctors more than what we RTs learn in RT school. Heed, what follows is suruptitious wisdom previously shared only with physicians.

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Page82

Section B7

While heart failure was mentioned in section B5 as an indication for bronchodilator, we decided to add this section due to questions ad nauseum regarding the use of bronchodilaotrs for such a purpose.

It is believed that bronchodilators are merely bronchodilators, although we as physicians know that can't possibly be true. Since heart failure causes a wheeze, a bronchodilator is definitely indicated.

The known scientifically proven fact is that heart failure can often cause a prolonged expiratory wheeze and shortness of breath similar to asthma.

This wheeze is caused by increased pressure in the lungs due to pulmonary fluid overload, secondary to left heart failure. Since the increased pressure basically causes the fluid to squeeze the lungs, symptoms mimicking asthma occur.

Now while it might appear a bronchodilator will not resolve this problem because this is not real bronchospasm per se, it sure makes us physicians feel like we are doing something, and it also makes the patient and family feel like we are doing something too.

Yet we are doing something. While it is not scientifically proven, it only makes sense that the 0.5 micron particles of the bronchodilator reach the bronchioles and bind to beta receptors there, these magically shrink to 0.1 microns and reach the alveoli.

From there we know that by a magic osmosis process the Ventolin particles cross over into the blood stream and take up a spot on hemoglobin and sits next to the oxygen molecule, and then it is transported to the kidneys, which have a known affinity to Ventolin.

Once there, the Ventolin attaches to the beta adrenergic receptors that we just know have to be there. Thereby to treat the renal muscle spasm. This also works to undead necrotic kidney tissue and improves the kidney's ability to clean blood and excrete secretions. Thus, along with being a bronchodilator, Ventolin is also a distal tubular dilator.

It can only be stated that while RTs will complain that our methods are not scientifically proven, we know that even with all the data, studies, hypo-the-sisses and hoax theories 'round and 'bout, lets add another.

Note: Like the rest of this Real Physician's Creed, this information must never be mentioned verbally in front of RTs. They can wonder, but must never know.

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The Four Types of Pneumonia

A 1930 edition of the Real Physician's Creed.
It's now so huge it's non-photogenic.

In medical school, most physicians learn from the Real Physician's Creed, which by now is about 300,000 pages and still growing. I only found out about it because one physician is a friend of mine who used to be a respiratory therapist. But he is now retired, so he has given me permission to release some of the contents thereof.

On page 304,403, of edition 4,432, is a note describing the three types of pneumonia.  Listed they are as follows:

1.  Walking Pneumonia:  Don't have it but something must be ordered to make everyone happy.  

2.  Pneumonia.  They really have it and you can see it on the x-ray and everything.  Or, as noted, sometimes you can hear it via crackles before you can see it on x-ray.  Or, the white blood count is elevated, indicating there is an infection somewhere so it might be pneumonia.  It is generally lobal and caused by a bacteria. Treatment is antibioitic to treat the infection and systemic corticosteroids to treat the inflammation.  However, you may also treat it with ventolin because one study showed it enhances sputum production which, uh, somehow is twisted into making some doctors think it... well, it does help, errr, bring up the pneumonia... IT JUST DOES!!!

3.  Faux-pneumonia.  The patient doesn't have it, but you need a better diagnosis than walking pneumonia in order so that the patient may meet criteria.  You can see it on the x-ray only if you have the superior vision abilities only taught in medical school, which can be found on page 3,133 of the Creed.  (I at present do not have a copy of that page, as this part of the book I have has been destroyed by too many coffee stains).

4.  Double Pneumonia.  They have twice as much pneumonia than the average person who actually has a diagnosis of pneumonia, which some call real pneumonia as compared with faux pneumonia.  It is generally caused by a virus and is deadlier than regular pneumonia.  Treatment is to hit it with everything, including systemic corticosteroids to treat inflammation, antibiotic to treat the infection, ventolin to help the patient cough up the pneumonia, and anything else you feel like throwing at it. Usually it involves treating the symptoms.  Treatment is generally supportive.

Further reading:

1. The real physician's creed
2. 999 types of ventolin

New Super Strength Ventolin discovered

A friend of mine from Orlando, Florida, recently shared a story about a doctor about his discovery of a new super strength Ventolin with a duo purpose.  It's a medicine that the infamous Dr. Q1 would appreciate.

My friend described an 88-year-old patient who presented in high fowlers in respiratory distress. Upon auscultation he learned the patient's lung sounds were raspy with an upper airway wheeze.  There was minimal air movement.  He also had a productive cough with thick yellow and greenish sputum.

The doctor initially ordered one breathing treatment.  My friend said this made sense to him, especially considering I shared with him my copy of the real physicians creed. When the treatment was finished the patient indicated no effect, and the post treatment assessment concurred.

His initial impression was CHF or pneumonia, however no tests had been performed at this time. He said he then walked up to the doctor and said, "So, Dr. Fakename, are you thinking this is bronchospasm and want another treatment, or are you thinking it's something else."

"Oh," she said, "I'm thinking he has a combination of CHF and pneumonia. Why don't you go ahead and give another treatment."

My friend said she was perplexed, and wanted to know if I had an explanation as to why this doctor would order breathing treatments when she knew it was not asthma, nor COPD, nor any other disease that caused bronchospasm.

I wrote back to my friend that the new version of the real physician's creed has some new ventolin types that we RTs are not privy to yet, and they are a combination of Absorbolin, Osmosolin and Pneumonuterol. These medicines have properties that absorb both fluid in the lungs and the alveolar sacks via magic osmosis process.

The new medicine, a combination medicine, is mixed with Duoneb and is called DuoAbsorboOsmosoPneumobuterol.

I recently asked a my undercover doctor friend, who so happens to be one of the hundred or so editors for the creed, if he had any further information about this medicine.

He said that name was too much of a tongue twister in recent fake studies, and doctors were unable to say it.  So the name was changed to DOAPuterol.

It's a new magic mist that can be used for nearly all lung complications, all irritating lung sounds, and has relatively no side effects. Like the above mentioned drugs, no change in lung sounds and no change in respiratory status is normal.

So check out my new list of 'olins.

Study: EKG goo soothes like VapoRub

The goo on the back of these stickers
 proven to work like Vick's VapoRub

A new study that was conducted at the University of Medical Creed Hospital showed that the goo on the back of EKG stickers works similar to Vick's VapoRub and makes breathing easier.

As a part of the study, 8 people complaining of shortness of breath and chest tightness were given an EKG upon admission to the emergency room, followed by two more every two hours, followed by one each morning until discharge.  The control group of 2 patients all did not have EKGs done, except for the initial one in the emergency room.  

All the patients who had serial EKGs eventually got better, except one male who developed nosocomial COPD and was disqualified.  Both the patients in the control group developed physician acquired pulmonary edema and were both disqualified.  

Not these!
These don't resemble
Vick's VapoRub

Dr. Bill Senseless, who heads the Faux Pulmonary Research Project at the University, said, "The only conclusion we could make from this was that EKG therapy works to open up airways by osmosis through the skin to the airways.  It works similar to Vick's Vapor Rub, only it's more profitable for physicians as we get $40 for just looking at the interpretation already on the EKG."

This study verifies the newly formed belief among the medical community that serial EKGs actually have therapeutic effects.  It was for this reason that many health organizations have recommended a minimum of three minutes door to EKG time for all patients complaining of chest pain.  

Further studies will not be performed to verify the results.  However, a future study will be eventually prove EKG goo has real or perceived cardiac benefits.  

Nausea, arm pain, hang nails, and rancid smelling patients are generally treated the same as chest pain and tightness. ACLS recommends a door to EKG time of 10 minutes for chest pain. The Real Physician's Creed recommends a door to EKG time of 10 seconds. Based on these recommendations, the Keystone Collaborate has succeeded in increasing the door to EKG time to three minutes so they have another reason not to pay if they don't want to.

Vick's VapoRub
Not recommended.
Makes stickers not stick

Dr. Senseless said that he has already sent a recommendation to the Real Physician's Creed Association to look into adding an EKG as a top-line treatment for all patients who come to the emergency room complaining of shortness of breath.  This should be performed immediately before or immediately after a bronchodilator, repeated Q2 times 3, then Qam.  

"And this is the minimum we require," Dr. Senseless added, "If it makes a doctor feel better, more can be ordered.  We actually had one nurse recommend an EKG because a patient had a stuffy nose, and it worked like a charm. She said the respiratory therapist complained about wasting his time and that this only worked because it made the patient feel like something was being done.  We're used to such sniveling by RTs.  We just know it works because because of the Vapo Rub Effect."

New Study ignored in favor of Duoneb/ Pulmicort Neb Combination

A study presented today at the 53rd International Conference of the Real Doctor's Creed Association in Orlando shows adult pneumonia patients given a certain inhaled corticosteroid had a 29 percent lower risk of ending up back in the emergency department (ED) or being admitted into the hospital, following admittance with a diagnosis of pneumonia.

The studied drug, PULMICORT RESPULES(R) (budesonide inhalation suspension), uses a nebulizer to deliver the medication to children, making the delivery more consistent. It is the first and only inhaled corticosteroid approved for children with asthma 12 months to 4 years of age. 

A second studied drug was Duoneb, a medicine that most studies show is no longer relevant now that Spiriva has been proven to improve lung function better, and also to reduce air trapping in adult asthmatic and COPD patients.  A study of physicians show that 93% of us do not believe Duoneb is less efficacious than studies show, and 90% of whom continue to order it regardless.  

The recent study was performed using a control of patients who were given just Duoneb, and a study group given both Duoneb and Pulmicort.  The study showed there was no difference in outcomes, as both groups were eventually discharged to home.  Likewise, about 30% of patients in either group were eventually readmitted, some for a diagnosis other than pneumonia.  

Despite the study results, the physicians at the Conference voted to accept the belief that Duoneb is a much better medicine than Spiriva.  They also voted to recommend giving Duoneb and Pulmicort together as a standard treatment for pneumonia patients, for no other reason than to make the treatments last longer, thus giving respiratory therapists something to do.  

The following have already been approved for addition to the 2015 edition of the the Real Physician's Creed: 

1. Seizurebuterol sooths and relaxes the myelen sheths in the cerebral cortex to minimize spasms of the head and shoulders. May be alternated with headandshouldersuterol. The medicine should be given at a frequency of QID. Pulmicort should be given BID to lubricate the albuterol particles to help crossage of the blood-brain barrier.
2. Pulmilubricort: Should be given with any ventolin product whereby the desired action is to cross the blood brain barrier to generate some type of calming effect within the mind and body. This medicine smooths and lubricates albuterol products so that they can easily squeeze through the blood brain barrier without being seen by the blood-brain police.  May have best effect if given with abscondlin.  Some examples of 'olins that would benefit with the addition of pulmilubricort: Palbuterol, Hiccuputerol, Exorcistobuterol, Revivolin, etc.  It may also be trialed with Muchtolateagain in an effort to stimulate the brain of a patient in cardiopulmonary arrest.  

The theory of why Duoneb should be given with Pulmicort (Pulmilubricort) is that the Pulmicort molecules, when combined with Atrovent molecules, helps to further lubricate the ventolin molecules so that ventolin scrubbin bubble buddies can transport themselves into the smaller air passages of the lungs (or, rather, just slip right in), and even into the alveoli.  The deep scrubbin bubblin action of ventolin has already been proven to wash all lung ailments away.

Dr. Olin said, "We need to take heed of the fact that not sometimes what is observed in the clinical setting matches what is proven in the laboratory.  So it's hard for physicians with a long standing belief that Ventolin scrubs the lungs clean as the sink to buy into modernism.  It has, however, that in the presence of a respiratory therapists patient's are happier, so it would only make sense to keep the RT in the room for an extended period of time."

The results of this new recommendation has been emailed to all pulmonologists working as hospitalists. 

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Dr. Creed: Here's how bronchodilators treat lung cancer

The scrubbin bubblin powers of Albuterol have been proven to scrub away all ailments in the lungs, except cancer.  However, the soothing soap like substance left behind following subsequent breathing treatments has been proven to decrease the spread of cancer.

Internist Richard Funk reported to the 53rd annual meeting of the International Conference of the Real Doctor's Creed Association of America that it has been discovered that cancer cells generate certain molecular interactions between cells and the scaffolding that holds them in place (extracellular matrix) cause them to become unstuck at the original tumor site, they become dislodged, move on and then reattach themselves at a new site.  He said this is a significant finding because only 10% of cancer deaths are caused by the primary tumor.

Dr. Funk likewise reported that a new theory proposed by himself is that a residue is left in the lungs after a good washing by ventolin scrubbin bubblin foaming action (a.k.a. albuterol).  The coating remains in the lungs for up to four hours, which is why it is very important that lung cancer patients receive ventolin therapy every four hours even when there is no evidence of bronchospasm.  

Cancer cells will still become unstuck from the original tumor site, yet the residue that now coats the cancer cells that are dislodged will not adhere to other places around the body.  This will help to prevent metastatic cancer.  This new theory, if it is true (which we know it has to be because it sounds good), will allow time for physicians to better treat the primary cancer.

Dr. Funk said that scientists from the Massachusetts Institute of Technology say that finding a way to stop cancer cells from sticking to new sites could interfere with metastatic disease, and halt the growth of secondary tumors.

Dr. Funk said the findings are especially important considering the medical community has believed for years that MalaNOmolin would get rid of cancer, as noted below from page 87 of the Real Physician's Creed:

Any Cancer: So you've tried everything, it's time to start the bronchodilator melaNOmolin regime you've tried for every other illness. Bronchodilator properties are known to break up unwanted tissue, at which time it is absorbed by Ventolin particles in the blood stream, screened by renal tissue, and excreted out the urethra. Note: see #6 below. It's important here to keep the renal system in tip top shape

Despite the application of melaNOmolin to lung tissue, cancer morbidity and mortality persists.
In 2007, cancer claimed the lives of about 7.6 million people in the world. Physicians and researchers who specialize in the study, diagnosis, treatment, and prevention of cancer are called oncologists.

Malignant cells are more agile than non-malignant ones - scientists from the Physical Sciences-Oncology Centers, USA, reported in the journal Scientific Reports (April 2013 issue) that malignant cells are much “nimbler” than non-malignant ones. Malignant cells can pass more easily through smaller gaps, as well as applying a much greater force on their environment compared to other cells.

Professor Robert Olin and team created a new catalogue of the physical and chemical features of cancerous cells with over 100 scientists from 20 different centers across the United States.

The authors believe their catalogue will help oncologists detect cancerous cells in patients early on, thus preventing the spread of the disease to other parts of the body.  The addition of ventolin scrubbin bubblin thereapy QID will further aid in the preventing of the spread of this disease.

Dr. Olin said "By bringing together different types of experimental and made up theories by intelligent Internists, expertise to systematically compare metastatic and non-metastatic cells, we have advanced our knowledge of how metastasis occurs and how to prevent it."

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The Noninvasive Ventilation Creed

What follows is what will be added to the new addition to the Real Physician's Creed: How to take care of Pesky RTs. Again, this is TOP SECRET information for physician use only, and was never intended to be released among the RT community.

My source for this ESOTERIC information will be kept anonymous, because if his peers find out he is the leak, he will be banned from the medical community at best, or ridiculed at worse. 

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Page99

(Section B-3)

Physician's Real Creed: The Noninvasive Ventilation Creed:

Noninvasive ventilation (NIV)systems are complicated systems that require extensive training physicians don't have time for.  So, in lieu of spending thousands of dollars better spent on cigarettes and alcohol, allow me to simplify NIV so it's easy to memorize and requires little thought.  

There are essentially NINE rules for NIV: 

1. Know the types of NIV and when they should be ordered:

• CPAP: prescribed for observed apnea or just simply obesity
• BiPAP: for everything else

2.  Know the indications for NIV and how it works: 

• Pulmonary Edema: it forces fluid out of the lungs
• Respiratory Failure: it breathes for them
• Hypoxic hypoxemia: it forces oxygen into the lungs
• Hypercarbia/ CO2 >45:  It sucks CO2 out of the lungs.  Warning: Do not wait for CO2 to rise above 47.  If it's 46, it's time for BiPAP.
• Annoyed physician:  If either the patient or RT annoys you

3.  Know there are no contraindications, especially if you're too busy to consider intubation: 

• DNR: put it on anyway
• Unconscious/ Obtunded: fluid rarely builds up inside the mask, so it's well worth the risk.
• Restraints: same as unconscious
• Apneic: use BiPAP because it breathes for them

4.  Know that you can adjust the settings at any time without notifying a respiratory therapists. In fact, this can be done occasionally to boost your ego or tick off annoying RTs.  If they suspect you did it, deny, deny, deny.  

5.  Settings: Always order 10/4.  Increase settings aggressively to reach and maintain a pH of 7.40 and CO2 of 40.  FiO2 should start at 40% and adjust to maintain a PO2 of 106. Or, just pull any numbers out of your head and stick with them no matter what RT says. 

6.  Special considerations:  The increased pulmonary pressure will keep fluid out of the lungs and prevent pulmonary edema.  Works well for the following situations.

1. Unable to give lasix on dyspneic patient 
2. Need to give fluid bolus on dyspneic patient you are afraid to give lasix to due to hypotension (or any other reason)

7.  Length of time on BiPAP for effectiveness to be reached is two hours.  For this reason, it's important to talk patients into it, or have respiratory therapy force the BiPAP mask onto the patient, for at least two hours.  It's rare, although fine, for the patient to be anxious during this time. After the two hour time frame is up the patient may be allowed to refuse. A proper order for this is "Intermittent BiPAP." 

8.  May be indicated for low blood pressure.  Yes, we know that respiratory therapists keep saying that BiPAP is proven to decrease cardiac output and reduce venous return in order to reduce fluid in the lungs. When they say stuff like that just sigh and walk away. We KNOW that BiPAP can piss a patient off, and in this way raise blood pressure. It works well even better when combined with a continuous ventolin infusion. 

9. You do not need to order an ABG to prove BiPAP is necessary.  If the patient looks like a COPDer or CHFer, order BiPAP.  Here's what RT might say, "Dr. Do you want me to do the ABG before setting up BiPAP so we can verify that it's needed?"  To this you respond, "Do 'em in whatever order you want, just put the BiPAP on at some point so he can breathe better." So then the RT comes at you with the following ABGs: pH 7.4, CO2 40, HCO3 24, PO2 51, SpO2 86."  The RT says, "He says he's breathing great now that I increased his nasal cannula flow to 3lpm from 2lpm.  His SpO2 is now 95%."  Look, it doesn't matter what the RT says, nor what the numbers say, in this case you must stick with your initial hunch.  It's BiPAP all the way baby! 

10.  Know that BiPAP therapy is basically a glorified IPPB therapy. So, again, it may  be ordered as "intermittent BiPAP" for PaCO2 >45.  It also may be ordered as glorified BiPAP (i.e. Intermittent BiPAP) to ward off evil spirits. 

11.  CO2 Retention with normal or normalizing pH. So ABG results show a pH of 7.29 and a CO2 of 79. You know the CO2 is normally in the mid 50s. This is an ideal place to order BiPAP intermittently. This way you can gradually get the CO2 down to the patient's normal range. It's okay to order even if the patient is awake and alert and in no respiratory distress. It's okay to order this especially if the RT grumbles and gripes about it. 

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The Ventolin Types

Updated January 2, 2011

Go to Preventolin

The following list has been prepared to further specific aid to the respiratory therapist's understanding of breathing treatments that have been clear to registered nurses and doctors for years.

1. 0.5cc Ventolin

Symptom: Wheeze/ SOB

Diagnosis: Bronchospasm

Frequency: Q4 & P

Effect: Bronchodilation to relieve air trapping. For the most part, all pulmonary problems should be treated as bronchospasm.

2. 0.5cc Ventolatorolin

Symptom: Cardiopulmonary arrest

Diagnosis: Cardiac &/or pulmonary failure

Frequency: Q4

Effect: Creates more laminar airflow. This medicine works as a lubricant. Cough spasms and patient agitation during treatment may be considered as secretion enhancer.

3. 0.5cc Osmosisolin

Symptom: Wheeze/ SOB

Diagnosis: Pulmonary Edema/ CHF

Frequency: Q4 ATC

Effect: Relieves pulmonary edema via magic osmosis process. No change in breath sounds is normal, but we know it's helping.

4. 0.5cc Preventolin

Symptom: Surgery

Diagnosis: General

Frequency: Q4

Effect: Injudicious use of Preventolin following surgery will prevent pneumonia, atelectasis, pulmonary embolus, pulmonary effusions, MI and rickets. It's also proven to enhance appetite and improve patient vigor.

Likewise, the beta-agonist effect of Preventolin not only keeps the heart rate of the patient from bottoming out, it also prevents the patient from ever being bronchospastic by shocking the system with massive amounts of un-needed stimulation!
If ordered outside RT protocols those silly RTs can't change it. (They'll call us Dr.s weasles, but we always get the last laugh.)

5. 0.5cc Mystolin

Symptom: Fever

Diagnosis: Non-specific

Frequency: Q4

Effect: A study showed 100 people with low grade fevers received Mystolin treatments and they all recovered.

6. 0.5cc Stridorolin

Symptom: Stridor or upper airway congestion, may sound like a wheeze.

Diagnosis: Laryngospasm

Frequency: Q2-4

Effect: Should have same effect as for a wheeze. Again, no change in breath sounds is normal.

7. 0.5cc Cardiacolin

Symptom: Cardiac Wheeze. We docs simply call this a wheeze to make things simple.

Diagnosis: Pulmonary Edema/ CHF/ MI

Frequency: Q4 ATC

Effect: Even though pressure of fluid buildup outside the bronchioles is causing the wheeze, patient will benefit from oxygen boost during therapy.

8. 1.25mg Cardiaconex

This is the isomer of cardiacolin, and can be used to generate the same effect as described in #7. Which one used is up to the preference of the physician

9. 0.5cc Meetcriteriolin

Symptom: vague complaints

Diagnosis: usually pneumonia, although normal x-ray, labs and lung sounds.

Frequency: Q4 ATC

Effect: No effect is really sought out here. Utilization review insists therapy be given to receive reimbursement.

10. 0.63 NoShakenex

Symptom: Shakes

Diagnosis: Side effect to Ventolin

Frequency: Q3-4

Effect: RT will complain this drug is same as Ventolin. Patient may still shake, but this is merely a coincidence. Note: Do not use if patient has self-diagnosed allergy to Ventolin.

11. 0.5mg Alupent

Symptom: Vomiting, nausea during or shortly after Ventolin treatment.

Diagnosis: Allergy to Ventolin (Note: RT will complain there is no such thing.)

Frequency: Q4

Effect: Respiratory therapist will complain that nausea occurring during Ventolin therapy was mere coincidence, and that patient is self diagnosed with allergy. Note: In case of emercency use Ventolin.

12. 2.5mg Atrovent

Symptom: Nothing or anything

Diagnosis: Anything, allergy to Ventolin

Frequency: Q4-6

Effect: Back door bronchodilator. May order without Ventolin nor Xoponex to irritate RTs. Don't let these silly RTs tell you there's no point in giving a treatment with just Atrovent. May also be given if patient has a made up allergy to Ventolin and Xopenex.

13. 0.5cc Betalbutoblocker

Symptom: Fever

Diagnosis: MI

Frequency: Q3-4

Effect: With Beta Blockers a front-line treatment for MI, Beta-agonists are automatically indicated. Persistent or exacerbated wheezing following this therapy is an indicator of the efficacy.

14. 0.5cc Microlin

Symptom: Fever

Diagnosis: Atelectasis

Frequency: Q4

Effect: Ability to assume gas-like qualities to seek out and re-inflate collapsed alveoli. Especially effective when used in conjunction with Absorbolin.

15. 0.5cc Absorbolin

Symptom: Crackles

Diagnosis: Pneumonia, fever, lung CA, pneumothorax (post-op)

Frequency: Q4 ATC

Effect: Patient does not have to be SOB to use this. The medicine sits in the bronchioles and, using its magic osmosis effect, absorbs fluid from the alveoli for the patient to cough up. Works best in conjunction with Coolovent and Microlin

16. 0.5cc Coolovent

Symptom: Fever

Diagnosis: Post op

Frequency: Q4

Effect: Exact methodology unknown, but it has the ability of blending with nerve endings in the pulmonary system to cool the body. Has the effect of making Dr.s think they are doing something productive when they don't know what else to do.

17. CVA-Albuterol

Symptom: Rhonchi

Diagnosis: Loss of swallow, inability to generate good cough, weak.

Frequency: Q2-4

Effect: Frequent treatments followed by suctioning will stop sounds Drs and nurses find annoying.

18. 0.5cc Scrubbin-bubblin

Symptom: Cough

Diagnosis: Productive cough

Frequency: Q4

Effect: The medicine magically turns into a soap-like material and actually cleanses the airways, and even gets down into the alveoli to give them a good Scrubbin too. May be used for all pulmonary diseases when all else fails. May alternate with Sputumolin.

19. 1.25 Scrubbin-bubblinex

Twice as many bubbles and twice the scrubbing action as Scrubbin-Bubbles at twice the cost.

20. 0.5cc Sootholin

Symptom: Cough

Diagnosis: Harsh productive cough

Frequency: QID

Effect: Coats airway with soothing balm to prevent painful cough. Ignore or repeat for ensuing cough spasm.

21. Viralbuterol

Symptom: Cough

Diagnosis: Common cold

Frequency: One dose will do

Effect: Patient thinks we're actually doing something to relieve symptoms. This therapy only works if patient is in the emergency room, and NOT when patient using home nebulizers.

22. 5cc Sinuseuterol:

Symptom: Sinus drainage, mild shortness of breath, stuffiness, sinus headache

Diagnosis: Sinus drainage, sinusitis, stuffy nose

Frequency: Usually 1 dose

Effect: This is a very popular medicine to use, especially in emergency rooms. It's actually been used for years by many doctors but hasn't had an official name other than just Ventolin. The idea here is that 0.0000000005% of the medicine particles waft to the sinus passages to relieve nasal congestion and inflammation. Patients usually says that she doesn't notice a difference after treatment, but that doesn't mean the sinuses won't eventually return to normal.

23. 0.5cc Assessolin:

Symptom: Patient doesn't quite look right. Pt may or may not have annoying lung sounds.

Diagnosis: Generic, but often cardiac or pulmonary history. May have been on vent in past, or and some type of failure in past.

Frequency: No less than Q4 hours. Q4ever may be the best idea here.

Effect: It really has no effect, you see. Even though RT isn't qualified to know when a treatment is indicated, we know they are the best assessors in the hospital. So, when you want to make sure the patient gets a good assessment every so often, there is no better option than to order Assessolin. Hey, there is an old saying: An RT a day kept the code away.

24. 0.5cc Snorebuterol:

Symptom: snoring

Diagnosis: sleep apnea, obesity, other

Frequency: Q4

Effect: Well, the snore sounded like a wheeze when we did our assessment, so better to be safe than sorry. May alternate with any variety of Q4ever treatments.

25. 0.5cc Viralbuterol

Symptom: Cough

Diagnosis: Common cold

Frequency: One dose will do

Effect: Patient thinks we're actually doing something to relieve symptoms. This therapy only works if patient is in the emergency room, and NOT when patient using home nebulizers.

26. 1.25 mg Nexacold

Isomer of Viralbuterol. We believe the studies that show this medicine is more powerful and has fewer side effects than Viralbuterol, even though the studies were done by the company selling the product.

27. 1.25 Pneumonex & 2.5cc Atrovent

Symptom: Crackles in bases

Diagnosis: Usually pneumonia

Frequency: Q4

Effect: While a xoponex aerosol releases a particle size of .5 microns to reach the bronchioles and relax the muscles there, some of these particles magically shrink to 1 microns in order to reach alveoli and break up pneumonia. The Atrovent assists with this process by binding with the Ventolin particles (how this happens no one knows).

28. 0.5cc Sputumolin
Sympton: Wet non-productive cough

Diagnosis: May vary

Frequency: One dose will do

Effect: Might stimulate a cough so RTs can obtain sputum sample. If doesn't stimulate a cough it should cure other ailments anyway. Works opposite of Sootholin, but has same effect as Scrubbin-bubblin and Scrubbin-bubblinex. (May also use Scrubblin-Bubblin and Scrubblin Bubblinex)

29. 0.5cc Transfutil
Symptom: SOB

Diagnosis: Fluid overload

Frequency: Q4 ATC

Effect: Relieves wheezing and inspiratory crackles along with congestion following blood transfusions and rapid IV infusions. May substitute Absorbolin or F###onex if patient critical.

30. 1.25 F###onex

Symptom: Crashing

Diagnosis: Failure of unknown origin

Frequency: 1 dose will usually suffice

Effect: Given when you don't know what else to do, and mostly on patients that appear to be circling the drain. When the doctor says, "What the F###!" You hold up a vial and say, "F###onex?" Patient will miraculously be cured by morning.

31. 0.5cc Carcinolin

Symptom: Hypoxia

Diagnosis: Cancer

Frequency: Q4

Effect: Action and effect uncertain, but anyone with pulmonary problems this severe should have an aerosol of some sort.

32. 0.5cc Medivent
Symptoms: Not really sure

Diagnosis: Probably pneumonia, even though lung sounds and X-ray appear to be perfectly normal, and there's a possibility no tests were done at all.

Frequency: Q4 ATC

Effect: Prevents patient from untimely discharge. This is a revenue enhancer. Should be used for Medicaid and Medicare patients only. May alternate with Meetcriteriolin.

33. 0.5cc IPPButerol

Symptoms: Hypoxia

Diagnosis: Atelectasis

Frequency: Q4 ATC

Effect: Acts contrary to the law of physics by directing turbulent airflow away from areas of lower surface tension to areas of higher surface tension. Silly fears of pulmonary trauma and alveolar oer-distension can be dismissed as the rantings of egotistical pulmonologists. This also has the advantage of acting as effective a bronchodilator as PO Albuterol. Also see Distendolin.

34. 5mg aluPPB

This works the same as IPPButerol although a slight change in texture that allows sooths the irritation of RTs who cry that IPPB therapy has been outdated for 20 plus years.

35. 1.25 XopIPPB

The isomer of aluPPB and IPPButerol. In other words, it's the same medicine marketed another way.

36. 0.5cc ARDSerol

Symptom: Hypoxia

Diagnosis: Pneumonia

Frequency: QID and PRN

Effect: Able to obtain elemental size and deposit directly on AC Membrane. Will soften and increase permeability of same, decreasing possibility of ARDS.

38. ARDSenex

Works same as ARDSerol but to prevent tissue fibrosis from occuring. May also have the ability to absorb fluid similar to absorbolin.

39. 0.31-0.63 Humidonex

Symptom: Stridor, harsh upper airway, barky cough

Diagnosis: Common cold

Frequency: One dose via blowby

Effect: New medical study shows a low dose of ventolin, once it enters the throat, enlarges to 10 microns and turns into steam. The medicine then coats the cells within the throat and soothes them. Persistent croup is not an indicator of ineffectiveness.

40. 0.5cc Interstitial

Symptom: HypoxiaDiagnosis: Sepsis

Frequency: QID & P

Effect: Specific for interstitial pneumonia. Absorbed through the bronchioles, lubricates and soothes inflamed connecting tissue.

41. 1.25cc Sepenex

Same as Interstitial except some studies show it may also work to reduce fever

42. 0.5cc Crackling

Symptom: Hypoxia

Diagnosis: Generic

Frequency: Q3

Effect: Action and effect uncertain. Generic cure all for lung sounds that "just aren't right." Should be RN requested.

42. 1.25 RNex

The preferred drug of choice over Crackling if heart rate is greater than 80, or if the patient becomes nervous or is extremely skinny.

43. Sputumolin DNR

Symptom: Weak cough, gurgling, rhonchi in throat

Diagnosis: Any diagnosis, usually DNR patient

Frequency: Q4

Effect: Believed to work similar to Morphine to ease patient pain and suffering. May have strange effect to ease family, nurses and Drs. suffering too. It's perfectly normal for treatment to appear to have no effect. Caution: (side effect) May cause RTs to cringe about ineffectiveness of therapy. Just ignore them.

44. Sputumolin STD

Symptom: Agonal breathing, obtunded

Diagnosis: GrimFrequency: Q4

Effect: If someone is swirling the drain (STD), what better way to assure a smooth transition to the afterlife than to make sure there's a good dose of Ventolin on board. Hey, if there's a family member sitting by the bed, that's a good sign you better call RT. May alternate with Sputumolin DNR if patient has Rhonchi. Side effect: 72.5% chance RT will cringe

45. 0.5cc Disolvolin

Symptom: dyspnea, wheeze

Diagnosis: Usually Cancer, but sometimes pneumonia

Frequency: Q4 ATC

Effect: The magic mist elements of this medicine land on any forein substances in the lungs and, via chemical reaction, causes them to break up and disolve.

46. 0.5cc Sputumolin NG

Symptom: phlegm in back of throat around NG

Diagnosis: Any surgery

Frequency: QID

Effect: The medicine magically changes from a mist to a humidity to soothe and break up secretions from around NG tube. It can also turn into a moisture at RNs desire.

47. 0.5cc Distendolin

Symptoms: Fever, crackles, weakness

Diagnosis: GenericFrequency: Q4 ATC

Effect: Used in conjunction with IPPB therapy to over-distend good alveoli and thus increase lungs ability to ventilate in that way. This may sound like corny therapy to RTs, but, again, don't listen to their silly fears about over distention being a bad thing.Note: May alternate with IBButerol or use XopIPPB and alternate that with Expandonex.

48. 0.5cc Telekinolin

Symptoms: Boredome

Diagnosis: Acute exaggeration of COPD or Asthma

Frequency: Q4 W/A

Effect: Has telekinetic ability to transfer Ventolin powers to help relax worn out family members or guardians of long time COPD patients.

49. 1.25 Extrasensenex

Isomer of Telekinolin that is used primarily to ward off evil spirits. Works similar to placing a ventilator outside the patient's room.

50. 2.5mg PotAtrovent

Symptoms: None other than post-op pain

Diagnosis: General post-op

Frequency: QID

Effect: 1. Patient has been on Preventolin post-op and the potassium has dropped. By adding PotAtrovent and discontinuing Albuterol, the Atrovent works to reabsorb potassium molecules lost to the room during Albuterol treatments. 2. This is the bronchodilator of choice when patient on beta-blockers.

51. 0.3cc Pedonephrine

Symptom: Stridor

Diagnosis: CroupFrequency: Q2-4

Effect: Works to relax the smooth muscles of the throat and, supposedly, open the upper airways

52. 0.5cc Happinessolin

Symptoms: Stress

Diagnosis: Depression

Frequency: QID

Effect: Via magic osmosis process crosses the blood brain barrier to ease nervousness.

53. 0.2cc-0.5cc Neonatalbuterol

Symptom: Rhonchi, junky

Diagnosis: RSV

Frequency: Q2-4

Effect: Well actually, it has no effect other than to make doctors and nurses feel like something progressive is being done. May often be the only medication patient receives while in hospital. Also believed to be effective for adults for a variety of diagnosis's, especially CHF, post-op atelectasis and skinny little people with pretty much any diagnosis. May alternate with Meetcriteriolin on neonates and Medivent for adults who qualify for Medicare or Medicaid.

54. RSVenex

Isomer to Neonatalbuterol and recommended for children. May alternate with Meetcritereolin.

55. 3-5cc PEDonephrine RN

Symptoms: Stridor

Diagnosis: Croup

Frequency: Q2-4 until discharge

Effect: This medicine should be prescribed once pt no longer has stridor or other adventitious lung sounds. This serves 2 purposes: 1) Works to humidify the airway to prevent return of Croupiness, 2) Works to make family feel as though we are doing something productive.Note: Ideally, this medication should be alternated with Meetcriteriolin.

56. 0.5cc PALbuterol

Symptom: Lonely

Diagnosis: Generic

Frequency: Q4

Effect: Drs: It's that time of year to chear up your patients. What better way to do this than by ordering Q4 PALbuterol. Yes, the medicine will have no effect, but the company of an RT will. This medicine is most often prescribed around Christmas time, particularly to lonely and depressed patients.

57. 1.25 Companionex

Symptom: lonely patient

Diagnosis: COPD, other

Frequency: Q4

Effect: Once in the lungs the levalbuterol particles bind together and metamophosize into ne giant thing that looks like a cupids arrow. The patient then exhales this arrow into the air and it is breathed in by the RT and spears him in the heart. He then feels compelled to keep the patient company.

58. 0.5cc Postventilatorolin

Symptom: GenericDiagnosis: Respiratory Arrest

Frequency: Q4 ATC

Effect: Works same as Ventolatorolin as it is believed to actually clean the airway. Typically, if a patient was sick enough to have been on a ventilator they should damn well still be receiving treatments.

59 ) 0.5cc Ventilepticus

Symptom: Ceizure

Diagnosis: OD, Epilepsy, otherFrequency: QID

Effect: Has the ability to cross the blood brain barrier and attach to the Left Vegus Nerve, which conditions the brain to react to interruptions of normal brain function caused by epilepsy.

60. 0.5cc Gamma-olin

Symptom: SOB, wheezing, pain

Diagnosis: CancerFrequency: Q4

Effect: The Ventolin binds to cancer cells large and small in the lungs and the gammolin attacked to it somehow shoots gamma rays at the cancer to break it up. Loose cancer particles are then exhaled or coughed up via thick yellow or brown phlegm. The reason this medicine has become so popular is it kills cancer cells without harming healthy tissue. The thing that experts do not understand is how the Ventolin gets from inside the lungs to outside to the outer lining of the lungs where most cancer exists.

61. 0.5cc KeepMeAlive'Olin (KMA'olin)

Symptom: Anything

Diagnosis: Generic, looks like sgd, hgd, std

Frequency: As often as possible in the ER, and then no less than Q4 hours ATC.

Effect: This is a med that has an Atropine, Epinepherine base in it that keeps the heart beating... beating... beating. It also has a Ventolin base that keeps the patient breathing... breathing... breathing.

62. 0.5cc Telekinolin

Symptoms: Generic

Diagnosis: GenericFrequency: Generic

Effect: Moves unwanted objects out of the lungs by inexplicable means.

63. 0.5cc Miracolin

Symptom: Generic

Diagnosis: Generic

Frequency: AnyEffect: It's simply a drug that works miracles. Works similar to Holy Water.

64. De-Carboxolin

Symptom: Pt. usually on vent or BiPAP due to a high CO2.

Diagnosis: COPD or CHF

Frequency: Q4 ATC

Effect: The osmisis ability of Ventolin draws CO2 from the Alveoli into the bronchioles where the patient is allowed to exhale the exess CO2. The is used to try to get CO2 down.

65. CPTuterol

Symptom: Productive or non productive cough

Diagnosis: Any illness that causes rhonchi or irritating lung sounds, particularly CHF, pneumonia and COPD.Frequency: Q4

Effect: Of course it only makes sense that a productive cough of yellow, green or brown secretions and bad lung sounds is an indication for pulmonary toilet. You may want to throw in a little Sputumolin or Mucomyst to the mix here****Note to Dr.: Ignore silly RTs who say pulmonary toilet should be used for patients who CANNOT expectorate and not those who already can. We have 8 years of med school to prove we know more about lungs than they do.

66. 1cc Mucomyst

Symptom: rhonchi, coarse, or good productive cough

Diagnosis: COPD, CHF, Pneumonia

Frequency: QID or every other treatment

Effect: Best if given with Atrovent to reverse the effects of Atrovent. This drug is also an option if the goal is to piss RTs off by prolonging therapy. Note: Pulmonary toilet is not the only indication for the use of this drug. Oh, and what the hell, you might as well throw in Q4 CPT.

67. 0.5cc Emisisolin

Symptom: Vomiting, possibly cuased by coughing, or simply not coughing

Diagnosis: cold, reactive airway, allergy, aspiration or coughtilyapukeitis.

Frequency: Q1X

Effect: Crosses from trachea to esophagus by magic osmosis process, thereby soothing stomach muscles and easing nausea. Also numbs the gag reflex to ease the desire to cough. Don't be surprised if patient feels better before therapy is started. Treatment should be given anyway to prevent any future vomit from forming. Vometerol is simply a stronger variety of Emisisolin.

68. Xopukonex: The isomer of Emisisolin provides a nice alternative for physicians to use on gaunt elderly patients to ease the headache following a massive emissis. A certain percentage of the medicine crosses to the intestinal track by magic osmosis process, while the other half crosses the blood brain barries and thus easing the pain there.

69. Vomuterol: This is simply a stronger variety of Emisisolin.

70 . 0.5cc Cigarbuterol

Symptoms: Generic

Diagnosis: Generic

Frequency: PRN when cigarette is desired

Effect: Gives smokers something to do with their fingers, and soothes the desire for the need to smoke. Only effective while patient is in hospital, and in a non smoking environment. Side effects include desire to smoke, irritability, anxiety and stress.

71. 1.25 Xopenette: A good supplement to alternate with Cigarbuterol to ease the withdrawl effects of not smoking anymore. Note: Only effective within the walls of a certified hospital.

72. 1.25 Effusionex

Symptoms: Possible SOB, CP, cough, rapid breathing

Diagnosis: Pleural effusions

Frequency: Q4

Effect: Med travels via magic osmosis process across pulmonary viscera, picks up excess fluid in pulmonary spaces. This new yet to be scientifically names molecule is somehow absorbed into the bloodstream and is excreted via the Renal system.

73. Thoralbuterol: Does the same thing as Effusionex.

74. DOAPuterol (DuoAbsorboOsmosoPneumoniabuterol)

Sypmtom: May have any of the following: low spo2, crackles, rhonchi, diminished, labored, cyanotic, wet sounding, upper airway wheeze that the nurse will say is bronchospasmDiagnosis: pneumonia or chf

Frequency: In the ER anywhere from continuous to Q1 hour. Admitted pts Q4 and prn

Effect: This med is a combination of Absorbolin, Osmosolin and Pneumonuterol blended in with a high quality dose of Duoneb. It was scientifically named DuoAbsorboOsmosoPneumoniabuterol. Initial studies showed doctors had trouble with that mouthful, so the name was shortened to DOAPuterol. The combination of these meds allows the Albuterol qualities to absorb both fluid from the lungs and the alveolar sacks at the same time via magic osmosis process. Therefore, this med is ideal for doctors too lazy to diagnose, or too lazy to read that Albuterol is really just for bronchospasm. No change in lung sounds is normal.***

75. 0.5cc Pneumoniabuterol

Symptom: possible CP, possible SOB or labored, possible productive sputum (may be colorful), possible diminished or crackles, possible rhonchi, possible isolated crackles, posible temperature, possible clear, possible cyanotic, possible nothing wrong at all.

Diagnosis: pneumoniaFrequency: Q20 minutes in the ER or continuous or Q1 hour if Dr. Q1 is working. Admitted patient will require Q4 ATC and Q1 prn. For standard pneumonia protocol this medicine is a must, and may be ordered Q6 hours if given in conjunction with Atrovent.

Effect: Absorbs pneumonia via magic osmosis process. No change in lung sounds is normal, but we know it is helping.***

76. 1.25mg Lasonex

Symptom: Patient wet but too sick to receive diuretics

Diagnosis: CHF, pulmonary edema

Frequency: Continuous, then Q2-4

Effect: Continuous until patient urinates one Liter of fluid, or cardiac wheezes stop, or patient no longer SOB, or patient admitted to floor. Absorbs fluid in the lungs and then travels with the added H2O molecule to the kidneys (exact process unknown) where it is excreted.

77. 0.5cc Diuruterol: Same as Lasinex, except this medicine absorbs some of the fluid in the lungs and causes it to be exhaled. This is actually a slightly different variety of Absorbolin (see below).

78. 1.25mg Reabsorbonex

Symptom: Possible SOB, hypoxia, CP rapid heart rate

Diagnosis: Pneumothorax, trauma

Frequency: Q4

Effect: Med travels via magic osmosis process across pulmonary viscera, attaches to air molecules in pulmonary spaces causing reabsorption of this air, eliminating need for chest tube.

79. 0.5cc Absorbolin

Symptom: sob, chest pain, respiratory disterss

Diagnosis: chf, pulmonary edema, flash pulmonary edema

Frequency: Best if continuous. Best results if alternated with Lasinex or Diuruterol.

Effect: The ventolin particles magically absorb pink-frothy secretions from the alveolar sacks to eliminate the pressure and thus diminish that cardiac wheeze. Studies from back in 1980 proved this medicine has no true effect, but it makes physicians and nurses feel like they are doing something. Usually this medicine gets credit for making patient feel better when a diuretic should get the credit. Therefore, it is highly recommended Absorbolin should be used in conjunction with a diuretic.

80 & 81. 0.5cc Deflatonex with 2.5 mg SpironolAtroventone

Symptom: SOB, diaphragm pushed way up, distended

Diagnosis: AscitesFrequency: Whatever

Effect: Deflatonex is a diuretic specific for deflating excess fluid from abdominal cavity. Given via aerosol, the med crosses into the blood stream and attaches to cells in the abdominal cavity, then reenters blood and excretes excess fluid via kidneys, eliminating the need for abdominal drains. Spironolatroventone enhances adhesion of Deflatonex to cells in the abdominal cavity.

81. 1.25 Viagranex

Symptom: Patient complaint of impotence

Diagnosis: LimplilliesFrequency: Prn as desired

Effect: Useful in relieving the frustration of limplilleitis, crossing the blood-penile barriers to open arterioles (like alveolar sacs) increasing massive blood flow to the limplilly extremity. May use Fuckonex if these meds fail.

82. 0.63 Screwtonex: Same as Viagronex with fewer cardiac effects. Warning: The FDA has now placed a black label warning on this medicine, as it has been proven to increase affinity of opposite sex to the one taking it. Warning: Should not be used in hospitals as you may find the patient performing certain duties you wouldn't expect a sick person to perform. Highly recommend no girlfriends in room if desire to provide adaquate rest for patient.

83. 0.5cc Openex

Symptom: General

Diagnosis: General

Frequency: Any

Effect: No matter what the ailment(s) of the patient is, Openex opens up the airways. It's actually the isomer to All-beterol

84. 1.25 Decongestionex

Symptom: stuffy nose

Diagnosis: General

Frequency: Q1 time

Effect: The medicine acts like an antihistamine and releaves sob due to stuffy nose.

85. 0.63 Afibonex

Symptom: palps?? generic, mild sob??

Diagnosis: Atrial fibrilation, pneumoniaFrequency: Q4

Effect: This medication has to be for the A-fib and not pneumonia because it is 0.63. If it was for pneumonia, it would be regular dose. 0.63 dose specifically targets the heart.For more effective medication for pneumonia, see pneumonex, absorbolin or other therapies as listed above or below.

86. RT-buterol

Symptom: Generic. Pt. may have no respiratory problems (NARDN, denies SOB often charted here)

Diagnosis: ANY ONEFrequency: As often as you want, but usually Q4

Effect: Maximum annoyment for RT. Order stupid treatment to make RTs annoyed.(****)

87. 0.5cc Osteoclast-olin

Symptom: sore joints, particularly the right knee

Diagnosis: Osteoarthritis of the knee

Frequency: Q4

Effect: Stimulates growth and re-attachment of cartillage. It's not really known how the Albuterol gets to the knee joints, nor how it stimulates this re-attachment, but we know it must be working because a study showed that 100 post op patients were given Albuterol, and they all went home eventually. So, it only makes sense to try it with this diagnosis.(****)

88. 0.5cc Duration-olin

Symptom: Generic

Diagnosis: Generic

Frequency: Q4

Effect: The general effect is unknown, but the idea here is that "The next one just might be the one." Yep, we can't stop giving these treatments, because that next one might just be the one that cures whatever is ailing the patient.(*****)

89. 0.5cc Ventolin

Symptom: Coughing

Diagnosis: Generic

Frequency: 1 dose

Effect: Used to make a patient stop coughing

90. 0.5cc Suppressolin (I.S. olin)

Symptom: Not coughing but looks sick

Diagnosis: GenericFrequency: 1 dose

Effect: Used to make a patient cough. May also be used in conjunction with Q4 hour incentive spirometry (IS).

91. 0.5cc Humidolin

Symptom: Generic

Diagnosis: Respiratory FailureFrequency: Q4

Effect: Works to humidify airway in a patient on a ventilator.

92. 1.25 Hydrogenex

Symptom: Generic

Diagnosis: Dehydration, but also history of CHF

Frequency: Q3

Effect: Works as a slow infusion of fluid into the body. Used when increasing fluids by IV would be too much to fast for patient.

93 . 0.5cc Inducacough

Symptom: Rhonchi, good productive cough & may or may not sound coarse. Usually no respiratory distress.

Diagnosis: GenericFrequency: Q4

Effect: If a patient is coughing, then a treatment is indicated. Period.

94 & 95: 5mg Pulmicort, 1.25 pneumonex

Symptom: SOB, hypoxia, crackles in bases

Diagnosis: pnuemonia

Frequency: BID

Effect: The Pulmicort instantly works to allow more bronchodilator to attach to bronchioles. By osmosis, the bronchodilator then travels to the alveoli to help break up fluid. This should be used in conjunction with pneumonex, which has an attraction to the Pulmicort. It should also be given with Atrovent. See Atrovent above.This should only be used if Absorbolin doesn't work.

96. 0.5cc Treat-a-nut-olin

Symptom: Stress

Diagnosis: DepressionFrequency: QID

Effect: Via magic osmosis process crosses the blood brain barrier to ease nervousness.

97. 4mg Albuterol PO

Symptoms: Obesity

Diagnosis: Obesity

Frequency: QID

Effect: Drinking albuterol stimulates beta receptors & causes vasodilatation (increased blood flow), which increases heat produciton of the cell's powerhouse (the mitachondria). This increases your basal metabolic rate, and causes you not to be hungry. Stimulation of beta receptors also stimulates the break down of fatty acids into the blood stream for use as fuel, which causes a reduction in stored fat.This is more popular with body builders, but as soon as doctors find out about this, we RTs will no doubt be doing continuous breathing treatments for this effect.

98. 0.5cc Nosocomial-olin

Symptom: general, smoker*

Diagnosis: COPD of courseFrequency: NO less than Q4

Effect: If a patient is in the hospital, and he smoked once, then he should be diagnosed with nosocomial COPD and given Q4 breathing treatments even if he has no signs of respiratory illness.*A smoker is defined as anyone who has ever lit up a cigarette, even if it was only one time. They should all be treated as potential COPD patients. They should also be considered as retainers (see hypoxic drive theory link above).

99. Xanaxolin COPD

Symptom: Exhausted and stressed out family members who take care of patient. Usually the patient will be fine.

Diagnosis: Mostly COPD. Sometimes the fake diagnosis is pneumonia. RTs refer to these patient’s as exaggeration of COPD

Frequency: Q4 ATC. May alternate with Telekinolin

Effect: Works similar to Xanaxolin, but it combines with CO2 in the lungs and is excreted when the patient exhales into the air around the patient. When family members of patient breath in this aiir, they are instantly relaxed. In essence, this med is specifically formulated to help COPD family members.Note: It has no effect on the family member other than the comfort of knowing they will be given the much needed break from taking care of their COPD family member.***

100. 0.5cc Soaponex

Symptom: GenericDiagnosis: May vary

Frequency: Q4-8

Effect: Scrubs luns clean like Scrubbin Bubbles cleans out the sink. this is the isomer of Scrublin-Bubblin.

101. 0.5cc Confusolin

Symptom: Confusion

Diagnosis: General

Frequency: Q4 (have to keep it in the system) May alternate with OTL-olin (Treatanutolin should be ordered PRN just in case)

Effect: This is indicated because the improved airflow and B2 agonist effects of the Albuterol work to open vasculature in the brain and reduce confusion – hence CONFUS-OLIN

102. 0.5cc Silencolin

Symptom: Annoying lung sounds. Junky sounds or noisy lung sounds also qualify here.

Diagnos: Generic

Frequency: Q4

Effect: If a patient has annoying lung sounds, a breathing treatment is indicated, no matter what the noises are secondary to. No change in ls is not an indication that therapy is not working.

103. 0.5cc Damitall

Symptom: Generic

Diagnosis: Generic

Frequency: Dr. Descretion

Effect: This should be used when all else fails

104. 2.5mg Peptolin

Symptoms: cp, heartburn

Diagnosis: Nausea (tests still pending on heartburn, indigestion, upset stomach and diarrhea)

Frequency: Generally, once will do the trick, especially if you give it time.

Effect: The excess molecules that go down the esophagus instead of the trachea work to settle many tummyaches. It is completely coincidental that deep breathing and time passing are associated with giving the treatment. These factors do nothing to settle the stomach.

105. 0.5cc Respiratory Acidosolin

Symptom: Denies sob, but has a ph less than 7.3 or greater than 3.0.

Diagnosis: COPD or CHF, and probably a CO2 retainerFrequency: Continuous, and then Q2-3 ATC

Effect: We are really not sure how this works, but the only thing that could possibly cause a CO2 >50 with a correspondingly low pH must be having bronchospasm. Pt may notice no effect following the continuous treatment, but we know that after 24 hours of being on bipap and Q2 treatments, that pH will be normal.

106. 0.5cc Mucobuterol

Symptom: Crackles in one base, mild sob, perhaps a dry, harsh barking, non-productive cough.

Diagnosis: Mostly pneumonia, but possibly a little pulmonary edema

Frequency: Q1 time and then again in one hour

Effect: Why waste your time writing the order for mucomyst with Ventolin when all you need to do is order Mucobuterol, which works more quickly and easily than Mucomyst. The bonds of Albuterol blend in with the mucous and the receptor cells of the Albuterol turn into little tiny scissors and chop up the mucous to make it easy to cough up.Note: Usually patient will be discharged to home without being able to expectorate anything, but that doesn't mean the therapy might work at some point in the next couple weeks.

107. 0.5cc Insulinolin

Symptom: Various. Basically doctor has no clue.

Diagnosis: Various

Frequency: Various

Effect: The patient's just not right, so we better just do a treatment. Who cares that the patient's Insulen is 40.

108. Insolinex: Same as Insulinolin except this medicine stays in system longer to stabilize Insulin and glucose. Exact methodology unknown.

109. Babysittolin

Symptom: cold

Diagnosis: General. Usually bronchiolitis, however we could have a good debate over this.

Frequency: Q4

Effect: Congested kid with parents who smoke, are poorly kempt, are incabable of taking care of their child. The baby is ok, but parents just can't take care of it. So, what do you order, Q4 Babysittolin. When RT breaths in Ventolin particles in the air, the Ventolin travels via the typical magic osmosis process across the blood brain barrier to stimulate certain parts of the brain, and thus inducing a feeling of guilt. Thus, when the RT leaves the room he will feel guilty, and thus be forced to stay in room and snuggle with the child. Works like a charm.

110. 0.5cc Washolin

Symptom: Not sob, no signs of respiratory distressNote: patient may have been in hospital for 3-4 days with no difficulty breathing, and all of a sudden Dr. will have an epiphany and say, “Hey, this patient’s got pneumonia. I’m ordering Washolin.”

Diagnosis: PneumoniaFrequency: Q4, QID or TID

Effect: A specially formulated version of Scrubbin-Bubblin designed specifically for pneumonia patients who show no signs of respiratory distress and are not short of breath. This medicine forms a sud-like material, shrinks from 5 microns to 1 micron (exact methodology unknown) finds its way to the alveoli and washes the pneumonia right out.Warning: We know RT will bicker, but the patient will say something like, “What the hell do I need that for, I’m not having trouble breathing, and never have in my life.” This is a normal side effect.Warning #2: By the way, if Dr. accidentally forgets to order Washolin, the patient will still get better and eventually go home.

111. 1.25mg Geriatronex

Symptom: general

Frequency: generalFrequency: Q4 or QID

Effect: The theory here is that if a patient is over 90, are sick enough to be in the hospital, then they have to have some pulmonary compromise. Or, the patient is old, and therefore MUST have emphysema. May alternate with OTLolin for best results.

112. 0.5cc Elderuterol: Similar to Geriatronex. Which medicine is used depends on what studies which doctor has been reading. Some physicians prefer to flip a coin.

113. 0.5cc OTLolin (Outtoluncholin)

Symptom: Any out to lunch patient, any patient who has no clue where he is, is not orientated to time or place, doesn't care what you do to him or her

Diagnosis: Quite often pneumonia, UTI, or generalFrequency: Q4 or QID

Effect: Really has no effect on the patient, but creates more work for RTs and causes them to cringe, gripe, grumble, groan and, on some rare occasions, even cry because they are so overwhelmed with useless breathing treatments.

114. 1.25 mg Companionex:

Symptom: Usually pt nardn, denies sob, has history of COPD or asthma

Diagnosis: COPD, sometimes asthma

Frequency: Q4

Effect: None. Giving the treatment draws the RT in the room so the patient can socialize. Often given in conjunction with Loquaciosonex or Garrulousuterol.

115. 0.5cc Visituterol: Same as Companionex only produced by a different company.

116. 0.5cc Garrulousuterol: Same chemical components as Loquaciousonex (see below), only this causes patient to talk a lot more because of the S-Isomer component.

117. 1.25 Loquaciousonex

Symptom: Usually patient NARDN and denies sob

Diagnosis: Chronic Obstructive Pulmonary Shit, which may include anything from asthma, COPD and even lung cancer.

Frequency: Q4 ATC

Effect: The therapy really has no effect other than to ease the mind of the doctor, who can rest assured because an RT is visiting the patient often. May stimulate the Broca's area of the left hemisphere of the brain to cause patient loquaciousness. Mist particles spewed into room may also have similar effect on RT.

118. Xanaxolin FAM

Symptom: Worn out and exhausted family members.

Diagnosis: Usually asthma, pneumothorax, pleural effusion, pulmonary embolism, post op or any disease where the patient is relatively younger, is not a DNR, and is relatively otherwise healthy and will eventually recover and go home.

Frequency: Q4

Effect: Doctors found out that Sputumolin Morphine and Itstoolateolin worked so well to ease family pain and suffering they wanted RTs to be able to ease the pain and suffering of other non DNR patient's family members as well. Like Sputumolin DNR, this medicine works similar to Morphine to ease patient's non existant pain and suffering and it may have effect of also easing the anxieties of family members too. This is basically the extra strengh version of Xanaxolin.

119. 0.5cc Xanaxolin

Symptoms: Exhausted patient or stress out patient in need of some TLC at the hospital

Diagnosis: Usually asthma patient, but occasionally COPD, usually exaggeration of asthma is the diagnosis given by RTs or exaggeration of COPD.Frequency: Q4 ATC

Effect: The medicine releases a soothing balm that's released into the blood stream and calms the nerves of the stressed out patient. Will have no effect on that fake, forceful, prolonged expiratory wheeze, which usually does not exist until RN or RT is about to auscultate lung sounds.

120. 0.5cc Hourbuterol

Symptom: Bronchospasm

Diagnosis: Clockwatcher, COPD, COPS (Chronic Obstructive Pulmonary Shit) and possible asthma

Frequency: Q4 ATC

Effect: Medicine works similar to Ventolin, however it has an added time release element that acts as an internal clock and reminds the patient to call for RT if treatment isn't started exactly on the four hour mark.

121. 0.5cc Resurrectolin

Symptom: Obtunded, coma

Diagnosis: She's gonna die (SGD), he's gonna die (HGD), swirling the drain (STD)Frequency: one time or up to continuous

Effect: Allows for easy transition across the pearly gates by releasing the soul from the body. Usually given when the family decided, "It's time to go to be with Jesus." The exact methodolgy unknown to all but Jesus. The effect may take place immediately, but don't be surprised if it takes up to 2-3 months or even years. Usually given after a trial of Sputumolin DNR, and may be most effective if alternated with Sputumolin STD. May also alternate with Holy Water.

122. 5cc Somolin

Symptom: Nosocomial change

Diagnosis: GenericFrequency: Q4

Effect: For long term ATC treatments. Counteracts effects of sleep deprivation on debilitated patients. Patients will not show any immediate improvements. To date, the only noted improvement occurs 3-4 days following discharge to home. Important: Do not page doctor to discuss NOC Somolin treatments, for these doctors need their rest to functin properly.

123. 1.25 Soporiphenex: Same as for somolin, except the theory is that this medicine and the drone of the machine will put patinent to sleep.

124. Ventilepticus

Symptoms: Ceizure

Diagnosis: OD, Epilepsy, other

Frequency: QID

Effect: Has the ability to cross the blood brain barrier and attach to the Left Vegus Nerve, which conditins the brain to react to interruptions of normal brain function caused by epilepsy.Note: It is very rare for a medicine to cross the blood brain barrier, or anything else for that matter. Ventilepticus is simply that powerful of a medicine.

125. 0.5cc Ventolatorolin

Symptom: Cardiopulmonary arrest

Diagnosis: Dardiac and/or pulmonary failure

Frequency: Q4

Effect: Creates more laminar airflow. This medicine works as a lubricant. Cough spasms and patient agitatin during treatment may be considered as secretion enhancer.

126. Preventolatorolin

Symptom: Failing, audible forced exp. wheeze, paradoxical breathing, decreasing pH, increasing CO2 and possible decreasing SpO2, etc.

Diagnosis: Generic, pending respiratory failureFrequency: Now

Effect: Must first rule out over medication. If you think patient looks like he's gonna need a ventilator, give this medicine to ward off evil spirits. Works best with ventilator just outside patient's room.

127. 2.5mg Allbetterol

Symptom: General

Diagnosis: General

Frequency: Any

Effect: No matter what the ailment(s) of the patient is, Albetterol makes everything all better.

128. 0.5cc Hypo-K-uterol

Symptom: Cramps

Diagnosis: HypokalemiaFrequency: Q once

Effect: The medicine magically makes it’s way through the bronchioles, to the alveoli, to the blood stream, to the kidneys, and causes potassium molecules to magically form there.

129. 0.5cc Potassuterol

Symptom: Hyperkalemia

Diagnosis: Generic

Frequency: Q1 time

Effect: Miraculously lowers potassium to normal levels. No need to draw labs to verify it worked, because it just does.

130. 0.5cc Myolin

Symptom: General weakness

Diagnosis: Generic

Frequency: QID

Effect: Particles break up in the lungs and enter the blood stream to attach to muscle receptor sites, and increase muscle tone and strength. This therapy remains in the testing phase, and is not yet approved by the FDA.

131 & 132. 2.5mg Xoponoxolin or 0.5cc Oxolin

Symptoms: Hypoxia

Diagnosis: Generic

Frequency: Q3-4

Effect: Given when patient is SOB and RN doesn't know what else to do. Usually, by end of treatment patient feels better. Usually given after exertion to rest room or to commode. Don't listen to RTs when they complain patient only feels better because he or she got an oxygen boost during the treatment.

133. 0.5cc Detoxolin

Symptom: Uncooperative patient, usually presents with upper airway congestion or stridor and other noises nurses don't like.

Diagnosis: ETOH

Frequency: Q4 ATC

Effect: Has the ability to cross the blood brain barrier, and then has a strong affinity for alcohol receptor sites in the brain to help resolve the toxic effects of alcohol. Usually takes 2-3 days for the patient to regain normal mental status.Note: May be used prophylacticly

134. 0.5CC Continousolin

Symptom: SOB, perhaps respiratory distress, labored,

Diagnosis: Bronchospasm, asthma, COPD, CHF, PE, Pneumonia, Lung Cancer, CF, Pleural Effusion, Pnumothorax, etc.

Frequency: Continuous only. May give up to an hour or until desired results are given

Effect: This is a stronger component of Ventolin that produces Venlolin Receptor sites so that the incoming Ventolin particles never run out of receptor sites. The idea here is that the lungs will never become saturated with Ventolin. Note: May have no immediate results, but we know if we give treatment long enough it should start to work sometime. For asthma patients, you may need to give in conjunction with Epinepherine.

135. 1.25 Hoaxanex

Symptom: any annoying lungsound

Diagnosis: Asthma, pneumonia, CHF, pulmonary edema, pleural effusion, Pnueumo, lung cancer, sepsis, post op atelectasis, etc.

Frequency: TID

Effect: The only plausible reason to give/advocate Xopenex is that one believes that the inert isomer isn’t really inert---but is instead pro-inflammatory. A Trojan Horse of Inflammation if you will.

Could it be that in the past every Bronkosol/Alupent/Terbutaline/Abuterol tx we gave to a newly diagnosed asthmatic kid was, while temporarily relieving the bronchospasm, only instilling more and deeper inflammation?And so many RT dept.’s tout how they have reduced their Q4 tx load down to TID and prn. But, as we know, HHN over-ordering is so over the top and beyond the therapeutic range. Along comes TID Magic Beans and desperate RT’s grasp at it. They played our profession.

Meanwhile asthmatics in a study breathed HHN tx’s with ONLY the inert (pro-inflammatory) isomer version of Albuterol. If the inert isomer was so pro-inflammatory as to allow HHN reduction from Q4 all the way down to TID….one would then expect that having asthmatics breath only that vile isomer would send them into outright bronchospasm, some needing on-the-spot intubation, etc.

But NOTHING HAPPENED!
Hoaxanex.

Note: Many RTs and doctors were brainwashed into liking this this drug with free pizza, breadsticks, booze and fake research the drug reps brought in! Since RTs actually give the medicine, they have since caught on to the sham.

136. Hoaxenex Nosideeffex

Symptom: general,

Diagnosis: cardiac ailments, various arythmias, weak heart, skinny old patients (paticularly skinny old ladies), pediatrics, neonates

Frequency: Q4-6, TID

Effect: Has the same binding action as the fully loaded isomer packacked Ventolin products listed above, yet due to one fewer isomer -- and according to studies done by the company -- has no side effects.

Note: Research by the company was later disproven, but that doesn't matter. Once the powers that be read something once, they will never take it away from us.

137. Hoaxenex Strongereffex (Steroidenex)

Symptom: short-of-breath, patient takes Ventolin products at home

Diagnosis: Asthma, COPD

Frequency: anywhere from continuous to TID, may alternate with any Ventolin product

Effect: This is basically Ventolin on Steroids. Add this potion to any Ventolin regime and you will notice twice the scrubbin action.

138. 0.5cc Stopbleedolin,

Symptom: Weakness, abdominal pain

Diagnosis: GI Bleed

Frequency: QID

Effect: The ventolin travels via the typical magic osmosis process to the intestinal tract and binds to bloody area like platelets in a clogged artery and acts like gauze to plug up and apply pressure to bloody area.

140. 1.25 Cauterizenex

Symptom: Weakness, abdominal pain

Diagnosis: GI Bleed

Frequency: Q6, TID

Effect: Once in contact with the pH of the lungs the tiny microscopic particles of Levalbuterol magically come together to form one microscopic cauterizing gun that has a high affinity for GI Bleeds. Eurologists, yo'll love this one.

141. 0.5cc Lopressorolin

Symptom: Low blood pressure, light headed, weak, possible chest pain

Diagnosis: Sepsis, unknown, possible MI,

Frequency: Now and Q1 and then Q4 after the desired bolus is given

Effect: Lopressor aerosols are indicated for the treatment of hypertension. They may be given alone or in combination with other bronchodilator agents such as preventolin or scrubbin-bubbles. If blood pressure does not improve, a continuous treatment of Fu#$enex may be trialed. Lopressorolin is also indicated in the long-term treatment of angina pectoris. The direct mechanism the 0.5micron particles take to improve blood pressure is unknown to intelligent RTs. Ad theme: "Low pressure? Give lopressolin."

142. Loogiebuterol

Symptom: Any

Diagnosis: Doens't even need to be one

Frequency: Q1, or as often as you feel necessary to get desired results

Effect: Now, even though the patient has good lung sounds, good air movement, no wheezes, no prior reespiratory history, and no change in lungsounds after therapy, and no other signs of bronchospasm either, it doesn't matter, because soon as you leave the room the patient just might cough up a loogie. The RT will roll his eyes and say, "Well, it was just a coincidence." When this happens, RNs and doctors must smile and say, "That's why doctors order treatments and not RTs."

Note: Normally there is no effect, but that 2% chance of producing a loogie is worth the effort by RTs to give therapy, and the $80 cost.

143. Supertropium Bromide

Symptom: any general ailment outside the pleural spaces of the lungs

Diagnosis: general

Frequency: Varies

Effect: Has a high affinity of Ventolin type particles in the lungs. This is important, because Ventolin is a great medicine, but at a size of 0.5 microns will only cause bronchodilation unless helped along by Supertropium Bromide. This medicine in effect works like a GPS system and litterally guides the Ventolin to wherever in the body the physician has directed it to go.

Note: In order for this product to work physician must have the newly patented GPSoscope. Physician doesn't have to be present for medicine to work, all he has to do is dial in designation from the comfort of his own home. Recommended use with all above Ventolin Types. Comes individually packaged as Ipatromium Bromide or in combination with the Ventolin Type of your choice in the form of Duoneb.

144. Ipatropium Miculage

Symptom: general

Diagnosis: Any ailment inside the lungs or around the pulmonary pleural spaces

Frequency: as desired

Effect: Once this liquid reaches the pH of 7.30 to 7.50 it turns into a glue-like, gum-like adhesive that binds to Ventolin particles. This new yet to be named molecule has an increased affinity for beta-adrenergic sites, and thus makes the Ventolin work better.

145. Supertropium Miculage

Symptom: general

Diagnosis: any ailment in the body

Frequency: you pick

Effect: Tired of having to figure out whether to order Supertropium Bromide or Ipatropium Miculage, physician's pleaded with fake scientists to combine the two medicines into this one super sticky treat.

146. Do-allolin

Symptom: tight wheeze, throat wheeze, stridorous wheeze, audible wheeze, silent wheeze, anal sphyncter wheeze, no-wheeze-at-all-wheeze, fake wheeze or any kind of noise you can possibly imagine coming out of a human.

Diagnosis: You dream of it this med will cure it.

Frequency: Use your imagination.

Effect: It has Godly powers like Holywater-olin yet works like the Heavenly powers above to cure anything from COPD, bronchospasm, pulmonary fibrosis, annoying death rattles, STDs, and even hangnails. And, yes, it has been observed that if you sprinkle a little of this in your nostrils it will even remove unwanted hairs.

147. Do-allneb: (commonly called Duoneb)

Symptoms: You name it.

Diagnosis: You name it.

Frequency: You name it.

Effect: Similar to Do-allolin except the anticholinergic supplement works to prevent future musculature tension caused by the cholinergic response to prevent future unwanted nose hairs, COPD, bronchospasm, rickets, etc.

148. Holywater-olin

Symptom: generic

Diagnosis: generic

Frequency: Q4

Effect: It seems to enhance the effect of prayers and faith. Exact methodology is mystical. Studies seem to show it has the greatest effect on happy religious patients, but may boost mood of some non religious patients as well. Squirting an amp on nurses may cause laughter.

149. 0.5cc Inflammatonex

Symptom: wheezing, shortness of breath, dyspnea, chest pain, chest discomfort, chest tightness, rhonchi, crackles, etc, etc, etc.

Diagnosis: asthma, copd, bronchiolitis, rsv, pneumonia

Frequency: 3 treatments back to back in the ER or Q2-4 on the patient floors

Effect: Aside from relaxing smooth muscles to ease bronchospasm, the medicine works in conjunction with inhaled or systemic corticosteroids to relieve redness and swelling of the air passages.

Note: There is no scientific proof that this is the case, yet goofy theories like this sound good so they must be true.

150. 1.25CC Trembolembolin

Symptom: Tremors due to detox

Diagnosis: Detox

Frequency: Q4

Effect: Since Ventolin is the only medine that crosses the blood brain barrier, it's scrubbin bubblin effect act as a massage on bodily neurons to ease the troubled, alcohol seeking neurons in the brain.

151. 0.5cc Disinfectolin

Symptom: Fever greater than 98.5, stuffy nose, headache, nausea, vomiting, diahrrea, or other signs of viral or bacterial infection.

Diagnosis: Pneumonia, cold, RSV, tuberculosis, bronchiolitis, croup, sinusitis, or any other infection of the respiratory tract

Frequency: Q4 ATC (must be given round the clock to keep medicine in the system)

Effect: The strong scrubbin-bubblin formula coupled with a secret antibacterial agent creates a microscopic foamy surface that scrubbs the lungs clean of infection. It usually doesn't reach full effect until the day before patient discharge.

152. Rhonchieeeeeeeeeezeuterol:

Symptom: rhonchi

Diagnosis: pneumonia, sepsis, etc.

Frequency: Q4 atc

Effect: Well, if you takeRhonchi, and you realize that it was a word that originated in ancient Greece, yet when it was translated to Latin during the Roman Inquisition the pronunciation of the i's became eeeeeeeeeeeeeeeeeeeee. Therefore, if you pronounce rhonchieeeeeeeeeeeeeeee correctly, the i sounds like eeeeeeeeeeeeeeeeeeeee which sounds like wheeeeeeeeeeze, and there fore a bronchodilator is indicated.

153. 0.5cc Stopthinkolin

Symptom: arrythmia that disappeared upon admittance to ER, low QRS voltage on EKG

Diagnosis: unknown etiology

Frequency: Q once

Effect: Another indication for low voltage on the EKG is because you're thinking too much. If you think too much your brain requires extra voltage to continue functioning, and therefore the brain has to draw some of the conductivity off of the hearts charge. One of the side effects of this is cardiac arrythmias. The course of this process is non-continuous, and repeat EKG are indicated. To resolve this problem the physician will want to order 0.5cc stopthinkolin. Exact methodoogy unknown.

*154. 0.5cc onefortheroad-olin

Symptom: general

Diagnosis: general

Frequency: q1 time

Effect: The theory is that if Ventolin is given just prior to discharge, it will keep the patient from being readmitted. It's kind of like a last horah, or that little bit of oomph the patient needs to get over the hump and stay there. Exact methodology unknown, although it's believed to work wimilar to preventolin.

*155. 0.5cc GoAhead-Olin

Symptom: General

Diagnosis: General

Frequency: General

Effect: No proven effect. The patient usually says something like, "Well, I don't really need that. But I have nothing else to do right now, so go ahead and give it to me."

156. 0.5cc Assess-uterol

Symptom: Any

Diagnosis: High risk post patient, post op, risk for ARDS, ARDS, sepsis, risk for sepsis, or you pick

Frequency: Q4 ATC

Effect: The medicine actually has no effect. While RTs may gripe and groan about the useless breathing treatment, we know that -- other than ourselves -- RTs are the "experts" at assessing respiratory status, and who better than to have us in the room every 4 hours to make sure things are going well. Yes, in this way, we are showing our respect for RTs, and they don't even know it.

257. 0.5cc Discharguterol

Symptom: Generic

Diagnosis: Generic

Frequency: Q1

Effect: The ventolin particles breathed out of the lungs following therapy send waves into the room that are breathed into the physician's lungs, absorbed into the blood stream via the alveoli, cross the blood brain barrier, to the obdula oblongota, and to the processing center of the brain, and in this way "stimulate" the physician to write "discharge" in the orders.

Note: This medicine has a very weak effect.

158. Jumping-bean-Expectoratumuterol:

Symptom: Dyspnea, shortness of breath, unable to expectorate thick secretions

Diagnosis: CF, COPD, Pneumonia, Bronchiectasis, other

Frequency: Q4 or at least QID

Effect: Once the Ventolin reaches the airways of the lungs it mixes with beta adrenergic receptors, which triggers the Ventolin to turn into mini jumping beans that bounce and bounce and bounce and, hence, create vibrations inside the air passages to create an internal CPT-like quality.

159. PopRocks Expectoratumuterol:

Symptom: Dyspnea

Diagnosis: Pneumonia

Frequency: Q4, QID or TID For tough to treat pneumonia may try Q3

Effect: An enhanced version of jumping bean expectoratumuterol allows the particles to shrink and make it to the alveoli where the ventolin particles blend with cultures of bacteria and the bacteria reformulate the ventolin so it becomes flavored poprocks that gently vibrate inside the walls of the alveoli to create a sort of CPT like quality that is "believed" to enhance secretion clearance from alveoli, or, as many doctors like to say, "knock out pneumonia."

160. Snorebuterol

symptoms: Snoring, dry mouth as a result

Diagnosis: Sleep apnea, COPD, diahrea.

Frequency: Q4

Effect: Pt gotta get a little tune up steam so his mouth ain't so dry. Of course you know his mouth got dry from snoring and mouth breathing, and this helps.

161. Dysphagenex

Symptom: White phlegm in throat, cough, difficulty swallowing

Diagnosis: Dysphagia

Frequency: TID

Effect: Erudite studies show venolin-type medicines improve sputum production and thin secretions. RTs claim the study results reveal sputum production resulting from Ventolin is so minute it has minimal effect. They also claim ventolin does not thin secretions. However they have no more proof than we do, and therefore THEY not us are wrong. RT Claims that if Ventolin did work to increase sputum the way we think, it will only result in these patients haveing more sputum they can't swallow and are too weak to spit up. That claim too is simple nonsense as RTs are never right. For proof click here.

162. Preoputerol

Symptom: none

Diagnosis: none ( pt ready for general surgery)

Frequency: Q once

Effect: Works similar to preventolin, although this unique blend of succulant Albuterol-like properties works ideal with anethesia to keep the lungs as pristine as the day the person was born. Note: only lasts for duration of surgery.

163. Glomerulterol:

Symptom: Decreased renal function, pulmonary edema, decreased urinary output, diminished mental status,

Diagnosis: Kidney Failure

Frequency: Q4

Effect: Helps to revitalize and restore kidney tissues by stimulating beta adrenergic receptors that don't exist on renal tissues.

164. Bronchoscratcholin 0.5cc

Symptoms: Patient complaint of itchy lungs

Diagnosis: General, psychotic

Effect: Microscopic fingernails are attached to the ventolin particles to scratch the lungs and relieve some of the itching. Often ordered for psychotic patients to make them feel we are doing something for "the itching." May be more effective if you say something like, "I'm going to give you a breathing treatment to make the itching go away. If it works, you can go home." This therapy is often quite efficatious.

165. admittedtoolong-olin

Symptom: General

Diagnosis: General

Effect: No effect. Yet if a patient has been in the hospital for 2 months they must need ventolin therapy, especially if they have a distended bowel.

166. Throat-uterol

Symptom: Pt has an NG with throat irritation

Diagnosis: Post op

Frequency: QID to Q4

Effect: Ventolin particles stick to fake beta adrenergic cells of the upper airway and sprinkle tiney Ferry Dust particles to ease any discomfort due to NG tubes. May also work for ETT tubes or any other tubes stuffed down the throat. The patient will say things like:

"That was a really nice breathing treatment. That was really good on the throat. It really made my throat feel so much better. I am so thankful! Wow! I can't believe how much better my throat feels after that therapy. Thankyou so much!"

167. Makeupolin

Symptoms: General

Diagnosis: General

Frequency: Any

Effect: The patient is old and has never been in a hospital before and has never even taken any medicine before. We need to put these patients on Ventolin nebs to help get them caught up. Also see geriatronex above.

168. Fusolin

Symptoms: Sore chest, not taking deep breaths, low spo2

Diagnosis: Broken ribs

Frequency: QID

Effect: I'm not really sure how this one works. Yet somehow the Ventolin particles absorb their way into the ribs and bind with cracked or broken ribs to create a gluelike material that fuses the break and fixes the ribs. If patient on PCA may altertate with PCAlbuterol (see below).

169. PCAbuterol

Symptom: Pain control

Diagnosis: anything that causes pain, post operative, broken bones, broken ribs, etc.

Frequency: QID

Effect: When the patients breathing gets low, the Ventolin particles send a message to the brain to instigate a deep breath to increase the SpO2.

170. BiPAP-uterol

Symptom: Sepsis, end stage COPD, pneumonia

Diagnosis: Respiratory Failure

Frequency: Q3

Effect: This works similar to preventilatorolin in that it wards off evil spirits. Since the person is sick enough to need BiPAP we must "prevent" the need for intubation. If patient a DNR this works similar to Keepmealiveolin.

171. Sootholin K-I-D

Symptom: Stridor

Diagnosis: Croup

Frequency: As often as you want

Effect: Studies done in Germany show Ventolin particles calm an upset kids in 20% of cases. The fact the kid kicks, screams and violently wriths this way and that is only a testament to it's efficacy. Best if given by blowby.

More coming soon, so check back often. If you have some to add please contact me.

Warning: This is esoteric wisdom compliments of the the Real Physician's Creed. This Top Secret list is a quentissential example of RT Cave Humor, and is a compilation of ideas from an amalgamate of RT minds, all of whom wish to remain anonymous.