slideshow widget

Thursday, October 18, 2007

Ventolin is the medicine used by Angels

"You're my little Angel." She was a middle-aged, dark-haired lady sort of stocky but not really fat. "You're my little Angel. You saved my life." Who in the world are you, I thought as she proceeded to give me a big hug. "I thought I would never see you again, my little Angel."

"Well, uh, hi," I said, "Nice to see you again.

She stepped back and proceeded to peer at me with a big gaping smile. "You probably don't remember me, but I had surgery. I thought I was going to die. When I woke up yours was the first face I saw."

She was right, I had no clue who she was. "Yeah, I remember."

Church was about to begin, so we both took our seats.

Work has picked up tremendously in the past three days. We now have 13 patients on the board, and 2 of them are indicated. That aside, I was sitting in my office in the middle of the night, my feet up on the desk, peering out at the parking lot with its dull orange halo of light set against a pitch black background. The window was open and a cool, refreshing breeze was wafting through the room. It was awesome.

We probably have one of the best respiratory therapy caves in the world, with ours having a huge window with an excellent view. In fact, probably 95 percent of the office and patient rooms in this hospital have views of hospital additions. Otherwise called walls.

That was the best part of the night. It lasted about five minutes. My pager went off. "Need a treatment in 206." He was watching TV. He was "a little" short of breath and I could hear audible stridor.

"He's wet," I said to the nurse.

"How do you know without listening to him, " she asked.

"He just looks wet to me." I had the patient sit up and listened to his backside. No wheezes, but the patient did sound coarse throughout. Then I listened to the neck: It was coarse up there. "And 80% of wet patients have that upper airway congestion you hear."


"The noise you hear in his chest is not a wheeze, it's upper airway congestion you hear radiating throughout the lung fields. Here, listen to his neck."

She did. "Oh."

"What are his I&Os?" I started a treatment just just in case, and we preceded to the nurses station to check out the chart. The patient was 2000cc over in the past 24 hours.

As I was finishing up the treatment she gave Lasix.

Overhead page: "Respiratory Stat to 244."

Upon entering the room the lady was standing aside the bed leaning on the bedside table, naked but for a gown flowing freely in front of her. "I can't take it much longer," she said.

I could hear audible, bubbly crackles, "She's wet."

"You think so."

"I know so." I listened to verify. "I'm positive. Have you called the doctor."

"I already did." I was impressed. "I have Lasix to give her. I don't know why, but Dr. Brave ordered a treatment too."

"That's okay, I have no problem with trying a treatment." Not like it's hard putting a pipe in someones mouth, or in this case a mask over it. Then again, nothing like putting an extra 8cc of fluid into an already wet lung.

I was trying my best to get my 2:00 breathing treatment done when I was called to ER to do a breathing treatment.

"Why does this patient need a treatment," I asked RN Sarah.

"Because she has pneumonia."

By this time I'm exhausted from running around ragged all night, and have had enough of doing senseless therapy when I have two critical patients upstairs. "Pneumonia isn't an indication for a breathing treatment," I grumbled.

"Yes it is!"

"No it isn't."

"Breathing treatments are for short of breath."

"Breathing treatments are for bronchospasm. Ventolin doesn't even get down to the alveoli where the pneumonia is. It's particle size fits in the bronchioles to open up the bronchioles and resolve bronchospasm."

"Ventolin is for shortness of breath."

"Do you ever give Lasix for bronchospasm."

"Just give the treatment, Rick," she said smiling. She obviously knew I was swamped. That's one of the nice things about working in a close nit hospital like this is we usually don't hold grudges when one of us has a bad moment.

I gave the treatment.

"Do you feel any better after this treatment?" I asked the patient.


Finally I got out of ER back up to the floors to check on my patients. The man I described earlier had already peed out 500cc. The lady was back in bed and "much more comfortable." By morning they were both fine.

"You are my hero," the lady said when I entered her room in the morning. Her nurse was at the bedside checking her sugar. "You gave me that treatment and now I feel so good. That stuff you give is a gift from God."

"Thank you." I said. "It's so nice getting a compliment. I really appreciate it."

"Well, you can give me a treatment anytime you want."

"You'll be getting them every four hours." Whether you're short of breath or not for now on.

I checked, and the patient had peed out over 2 liters during the night, and started to return to the room when the nurse met me in the hallway.

I said, "Did you see I got credit for her breathing better."

She said, "Yeah, you prick, my Lasix had nothing to do with it."

We laughed.


Djanvk said...

You rock RT, tell them RN's how it is. But you are absolutely right, Ventolin does nothing for Either fluid in the lungs or fluid from pneumonia, wish more people could understand this concept (Doc's and RN's).

Your a good story teller though keep it up.

jesus_of_suburbia said...

I often wonder who makes fun of the RN's and docs that want albuterol tx's done for CHF patients in countries that don't have respiratory therapists.

just respiratory