I swiftly replied to the nurse, my fingers flying across the screen: "He just had a breathing treatment."
Her response came back quickly, tinged with concern: "But his sat is still low."
I felt a surge of alarm. This patient's directive was clear-cut: maintain an SpO2 of 88-92. A saturation level of 87 was not just below par—it was critically low. Without hesitation, I dashed from the RT Cave. Up flights of stairs, down long, echoing halls, through bustling corridors that seemed to stretch for miles, I raced towards the critical care unit—way on the other side of the hospital, out in BFE. Determined to intervene before his sat plummeted to the even more perilous 86%, I pushed myself to reach him in time.
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He lay there covered in blankets, his head slightly raised. Glancing at the monitor, I noted his saturation was at 92%, a perfectly acceptable value in my book — just as acceptable as the 87%, which was within our margin of tolerance (give or take 2%). He looked at me with a wry grin peeking out from under his mustache and said, "Hi John. How are you doing today?" A sparkle in his eyes gleemed as if to say he wasn't the in a critical care room with
"I'm doing well," I replied. Then, noticing the elderly lady by the window -- his wife, I greeted her, "Hi there. How are you doing?"
"I'm doing fine. What's going on?" she asked.
"Just came to check in," I said casually, glancing over at the TV tuned to Fox News. "You guys going to watch the debate tonight?"
In the world of respiratory therapy and home healthcare, the distinction between BiPAP machines and ventilators has significant implications for patient care and logistics. One particular type of BiPAP machine, known as AVAPs, has sparked controversy due to how it's classified and billed.
AVAPs, a variation of BiPAP, stands out because it guarantees a specific tidal volume for patients. This feature sets it apart from traditional BiPAP machines, which provide varying levels of pressure support but do not guarantee tidal volume. Despite this distinction, home healthcare companies often refer to AVAPs as ventilators. Why? Because this classification allows them to bill Medicare and other insurers at higher rates, similar to how ventilators are reimbursed.
As a result, discharge planners often face the daunting task of finding suitable nursing homes located hours away. This situation not only complicates patient transitions but also places undue burden on caregivers. Consider the story of one elderly wife who visits her husband daily, driving four hours round-trip. Such journeys are physically and emotionally taxing, particularly for someone in their eighties.
In essence, AVAPs and traditional BiPAP machines serve the same primary purpose: providing respiratory support. Both are typically positioned at the edge of a patient's bed, and in most cases, patients can independently manage their machines. Nurses generally only need to assist occasionally, such as with putting on or removing the mask, which is no different from BiPAP machines.
It seems that nursing homes use the term 'ventilator' as a reason to reject patients, despite AVAPs functioning similarly to BiPAP machines. This trend poses challenges for the community at large and particularly for individuals like the 80-year-old wife who visits her husband daily regardless of how far away the nursing home is that he is stationed in.
Fortunately, it's not something I've had to deal with because I've never accidentally poked myself.
I have poked myself with the needle, however, Thankfully, each time I have done this it was prior to the poke, not after. I have poked my finger, usually my left pointer finger, probably less than five times. I try to avoid it for the same reason I don't want to poke myself after the draw: It's a waste of time.
So, you get the needle all ready. And you have the patient all prepped. And you poke yourself, and inside your head you mutter the words, "SHIT!" You mutter these words silently, because on the outside you keep your cool. You want no one to know what happened.
If you accidentally poke yourself with a needle, promptly dispose of it. Apply a bandage if there's any bleeding, and then wash your hands thoroughly. Prepare a new needle and proceed carefully. That's what I've always done. I'm certainly not wasting my time reporting something especially when the needle was clean -- and plus it would be embarrassing to make an issue out of a simple clean and harmless poke.
How often do you find yourself in this situation? What's your usual response when it happens? No judgment here—we all make mistakes sometimes.
However, it's probably time for me to start using the prescription glasses I already have, or even invest in a new pair. At my age, wearing glasses regularly is likely overdue. Alternatively, I might consider buying several pairs of inexpensive reading glasses from the dollar store and keeping some in my locker to help with my vision issues.
However, there are times when we encounter a patient with no palpable pulse. I recently had such an experience with a COPD patient. In such cases, I rely on feeling for the slight nudge of the wrist where the artery lies, a landmark familiar to us RTs. I was able to successfully draw blood almost immediately after piercing the skin. Upon hearing of my success, a co-worker jokingly remarked, 'How many times in a row now, about 200?
However, their necessity has been questioned by doctors in recent years, and Lidocaine breathing treatments have been used less often for this procedure—at least where I work. Nonetheless, Lidocaine nebulizers are still prescribed occasionally, primarily aimed at alleviating cough symptoms, and typically in the emergency room (ER)
