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Sunday, November 11, 2007

I violated RT Cave Rule #3 and now I must pay

RT Cave Rule #3: If you are trying to get a protocol passed, you have to keep your mouth shut about treatments not being indicated. You must be diplomatic.

I think I got Dr. Krane our ER doctor mad at me tonight. And I suppose that's not good news considering she's the main obstacle to us getting an ER protocol

Dr. Krane was back in her cubby behind the ER desk, and one of the ER nurses said, "So, other than us nobody is bothering you tonight, hey."

"Pretty much you're it," I said, "Except for this one professional COPD patient who calls me every 3 or 4 hours for a treatment."

"Oh, that's pretty good then."

"Yep, He's a pro. I don't even really need to check in on him, he just calls me when he's ready for one."

"That's cool."

"Yep," I said, "And those are the kind of patients that I really like to give treatments to. You know, patients that are really having bronchospasms and need them, as opposed to... just because."

Dr. Krane walked out of her cubby and past me without as much as a look my way. She went to ER Room 1 where I was currently giving the 10th treatment to a patient who came in with a cough and was never short-of-breath.

I followed her into the room, "So, you think you got her cured yet."

Dr. Krane gave me a smile. I'm not sure if that smile was her acknowledging my humor, or her annoyance at my comments. Or if I was just imagining things, because maybe she never heard me in the first place.

However frivolous I think some of the therapies we do are, like this current series of treatments, I rarely say anything to the nurses or doctors about it. I save comment for this blog and make humor of it. I think that'a far better therapy than complaining.

When I'm tired, or have too much time on my hands like tonight, my tounge sometimes slips,
and they give me this look like, "Um, you're trying to get out of work. You're just saying that because you're lazy."

I'm serious. It happens every time I mention something like one of my 'olins, or if I tell them my true opinion of a treatment I'm doing.

The first treatment on this patient was Duoneb X2 and then again in an hour.

"Are you short of breath?"


"Do you have asthma?"


"Have you ever gotten short of breath?"

"Only when I go into a coughing jag, of which I've had many tonight."

"But you're not short of breath now."


The patient appears to be in no respiratory distress, and before and after every treatment she has denied short of breath, even after several Duoneb treatments and one Xoponex the wonder drug.

I think DR. Krane is privy to knowledge esoteric to even the other doctors here, because she not only orders Atrovent with every treatment, she will know that someone will be short of breath an hour later.

To me, it would make more sense to have me come back and assess for the need. Then again, if that were the case, I probably would have done maybe one, and the nurses would complain that I was just being lazy.

Okay, so there goes our ER protocol.

I need to be more political. I need to be more diplomatic. I need to keep my mouth shut.

I know there is new research on Atrovent. I'm going to try and tackle this in the next few days. I might even talk to Dr. Krane about it; that is, if she still likes me.

If she follows RT Cave Rule #2 we'll be just fine, although, as we RTs so well learn, Drs don't always follow the rules.

RT Cave Rule #4: Hospital workers, especially one's that work nights, do not hold grudges.You can't hold coworkers accountable for what they say under stress, pressure or lack of sleep -- especially lack of sleep.


Glenna said...

This along with your post following it reminds me of some of the calls we get for treatmetns. Had one just the other night. I got a stat assess and treat and albuterol neb treatment written up by a nurse because THE PATIENT IS COUGHTING. What??? yeah, for real. The nurse said "Well, sometimes breathing treatments help that." I said "Not the albuterol. Albuterol only helps bronchospasm. But how about a bubbler on the cannula for humidity?" "Oh," she said. "I didn't think of that."

Yeah, let's give meds a patient doesn't need instead of a little humidity running into the cannula. That makes sense. Right?

Freadom said...

I had almost the exact same situation occur tonight. Only this time I had to give a treatment to make a patient cough to induce a sputum just before I gave this treatment to make this patient stop coughing Being a good RT I didn't make light of the irony here.