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Monday, March 24, 2008

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.

I know that most people click on my site and leave two minutes later frustrated that my site is not what they were looking for. When, in actuality, if they would have hung around a bit, had a cup of coffee with me, they may have found the answer they were looking for.

Here we go:
  1. giving mucomyst iv : I had never heard of it. However, upon doing a quick Google search, I found that it can be given IV. Here's what had to say: "Administered orally or i.v., as an antidote to prevent or lessen hepatic injury which may occur following the ingestion of a potentially hepatotoxic quantity of acetaminophen."
  2. asthma attack albuterol nebulizer : The medicine has the ability to generate instant relief when a person is having trouble breathing. This and COPD are the two main indications for this medicine.

  3. how are asthmatic attack in adults graded : Adults can use a peek flow meter just like children, and they and their doctor can adjust their therapy according to how well they do on their peek flow, likewise pulmonary function testing can be used for this too. Likewise, all asthmatics should maintain an asthma diary to keep track of your symptoms so the next time you see your doctor she knows if current medicines are working, and so she can change the plan accordingly. For more information, click here.
  4. copd and ventolin treatment : Check out my answer for #2.

  5. vaponephrine : This medicine is the watered down version of Epinephrine that can be used as as a bronchodilator like Albuterol, but it has a greater effect on the heart, and if this medicine is given, it is recommended the doctor keep the patient for 1-2 hours after therapy to watch for rebound. Vaponepherine (Racemic Epinepherine), is mostly used for croup, which causes swelling of the upper airway above the vocal chords. At our hospital, it is used only as a last resort, and whether or not it really has the desired effect here is still open to debate. Personally, I don't think it does anything. Vaponepherine is also used on occasion in adults with swollen upper airways, which is usually due to post intubation. Again, it is used here as a last resort. Some doctors do not like using it, and some do. There is one other illness that studies show this medicine to have some efficacy, and that is for young children with RSV. New RSV guidelines recommend trying this medicine to see if it has a benefit, and if not, to discontinue it. Studies have also shown that severe asthma patients do respond to Vaponepherine, especially among patients who have been puffing on their inhaler all day and have saturated their beta receptor cells with Albuterol.

  6. obtunded with ards : I do not deal with ARDS patients much at my hospital, so I will have to defer answering this question. The most important thing I would recommend regarding obtunded patients is that they not be given tidal volumes according to their actual weight, but ml/kg ideal body weight. At Shoreline we use 6-10 ml/kg ideal body weight.

  7. acute renal failure; respiratory therapist : We do deal with these patients on occasion, and the most pressing respiratory issue here would be pulmonary edema and the patients inability to excrete urine. How these patients are treated is up to the physician, and is usually based on the patient's signs and symptoms. If the patient is in respiratory failure, RT may be required to draw an ABG or, if need be, intubate the patient and set him or her up on a ventilator. At shoreline, if the patient needs dialysis, we ship.

  8. pneumothorax : I had a COPD patient with severe respiratory distress once who was initially ordered to receive continuous Albuterol treatments. I started the treatment, listened to the patient, and thought I heard a rub on the right side. Since that can be a sign of a pneumo, I reported my findings to the doctor, who put in a chest tube. Soon thereafter the patient was transferred to the floor and was breathing easy.

  9. respiratory therapy teaching materials for kids : You mean for asthma? There is plenty of it. When I was a kid I got a big box of fun stuff to play with that taught me about asthma. I even had this cool game that nobody wanted to play with me. I think I even still have it somewhere in my basement in a box. Perhaps I should try selling it on EBAY. For a good website, click here.

  10. respiratory floor charting form : We actually had a good one when I started working at Shoreline, but we've been doing computer charting the past eight years or so. I don't know about other hospitals, but our computer charting is very cool.

  11. 90 cartoons large dragon in a cave : Technically speaking, there are no dragons here.

  12. are blow-by treatments effective for pediatric patients : Yes. You do lose a lot of medicine to the atmosphere, but I think they are still very effective. That's my personal opinion. I know there is a lot of research that says otherwise, but my personal opinion says yes. We use blowby treatments with almost all of our young kids.

  13. protocols of hypokalemia : There is nothing in the RT bag of tricks for this.

  14. protocol for bi pap : We do not have a written protocol, however doctors usually write the order for Bipap, and we determine the settings on our own. I wish we were provided this same responsibility with vents.

  15. how much does an hour of respiratory therapy cost? : The hospital charges for the procedures we do, not for our time. I wish that I was paid for each procedure I did. If that were the case, I would never complain about a useless breathing treatment, and we RTs would be rich.

  16. as a respiratory therapist should i cross over in nursing : If you think you can handle it, I would highly recommend it. The pay is better and there are far more opportunities.

  17. does albuterol have alcohol in it : I wish.

  18. how many days should it take to know if singulair is working : It usually takes 7-10 days to get into your system. This is one medicine you need to keep in your system, unlike other allergy medicine.
  19. how long does advair stay in your system : Advair should never leave your system. It is one of the preventative medicines you take on a regular basis and never stop unless your doctor says otherwise.
  20. give ventolin before atrovent : A good question. Ventolin opens up the bronchioles immediately, so it only makes sense to give Ventolin first. However, one of my teachers argued that Atrovent opens the large airways, in which case, if he is right, then Atrovent should be given first. You decide. What do my fellow RTs think about this?
  21. vents bipap nursing : I think it's important for RNs to understand some of the basics of both these machines. I don't think RT needs to be called every time a BiPAP patient wants to take off his mask, so the RN should know how to do this. The same with the vent. Especially being the lone RT at night, I teach my RN friends how to do certain things on the vent, like preoxygenate, turn it on standby during suctioning, etc.

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, or

That concludes today's class.

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