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Tuesday, June 3, 2008

Dr. Krane and imaginary wheezes

I work with Dr. Krane (fake name of course) quite often during my night shifts here at Shoreline. I swear to God that she is the best when it comes to crisis situations, and she might even be among the best at fixing patients and sending them home.

And while at first I didn't like her personality, I have found that she is quite pleasant to work with. Yet even as I write this, I know most RTs in this department speak poorly of her, mainly for her unyielding desire to order breathing treatments .

CHF = breathing treatment
asthma = breathing treatment
cold = breathing treatment
runny nose = breathing treatment
cough = breathing treatment

You get the picture. Whether the patient has bronchospasms or not, she hears some sort of imaginary wheezes.

The worst part is that many times when she orders a treatment she orders them now and then every hour times three.

When questioned about this, she said, "I read somewhere that treatments should be given in groups of three."

Out of respect I didn't' say anything back to her. However, what she read was probably the standard frequency for asthma. However, no study I've ever read said the treatments should be given Q1 hour.

And, on a similar note, the recommendation of three treatments is a guideline, not a law. In my opinion, each patient should be assessed individually for a need for a treatment, and a guideline is just that, a guideline. In fact, GUIDE is right in the word guideline.

However, in reality, wouldn't it make more sense to do one treatment, and then if the treatment worked and the patient is now breathing fine, come back in about 30 minutes to re-assess for indication for another treatment, as opposed to just "assuming" they will need one every hour.

Do you see the awkwardness of ordering Q1 hour treatments? I have no problem re-assessing a patient, and I do so often, especially if I think the patient might actually need the treatment.

This is why I often joke that "Dr. Krane is so smart that she knows her first treatment will work, and that every hour the patient will be SOB again."

Again, note to Dr. Krane, you cannot schedule SOB. A good assessment is the best policy.

And you could say the same for most Q2, Q3 and Q4 hour treatments as well.

Regardless, I'll do as I'm told like a good RT.

1 comment:

Intubate Em!!! said...

I have an er doc who always orders duoneb x 3 back to back. He doesn't want all 3 in one neb, he wants them one at a time, right after eachother. Huh?!?!