Monday's class: My response to your queries

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

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

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

Here we go:

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

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

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

That concludes today's class.