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Saturday, August 8, 2009

Have you noticed some RNs, Drs don't assess?

Let me know if you guys have ever observed this behavior by certain nurses and doctors by contacting me ( or leave a comment below). Yet I've noticed in my 12 years as an RT that bronchodilator therapy is often ordered without the patient even being assessed.

If I had a quarter for every time I talked to the doctor over, or had the nurse relay the message, that a patient is short of breath, and the doctor simply said, "Well, why don't you have RT give a breathing treatment," I'd be rich -- I could quit my job.

You see, it is my humble opinion (and perhaps yours too) that in order to know if a patient is having bronchospasms (the sole purpose of bronchodilators is to dilate broncholes after all), is to take your stethoscope off your neck and listen to lung sounds.

Yesterday I was working with Dr. Q1. An ambulance was headed in. The EMTs said over the speaker he was getting continuous Albuterol nebs for his shortness of breath. The doctor turned to me and said, "As soon as they get here I want you to continue the continuous nebs."

I said to her, "Um, how do you know the patient is having bronchospasm."

She shrugged her shoulders.

Later that same day I had a patient a patient come in with pretty severe stridor (probable croup). The doctor stood in the room and said, "Give Xopenex."

Well, first of all, I've always thought if a patient has obvious upper airway inflammation the medicine of choice is racemic epinephrine. But, still, I noticed something even more stunning: the doctor never once took her stethoscope off her shoulders.

"Another Xopenex, please," she said. Like a good RT I did as I was told. However, I'm wondering, where, where, where is the doctor wisdom coming from that allows doctors to know -- just know -- without even assessing a patient that a bronchodilator is indicated.

I want you to know I've figured it out, and I will provide the latest new RT Cave product next Saturday.


Anonymous said...

So how do you recommend a last year student respiratory therapist prepare themselves for the uneducated doctors/nurse2 they will encounter???

I recently had a patient transferred from the floor to critical care because their nurse was "uncomfortable" that their sats were fluctuating between 65 and 89 (on 2L) even after the ABG (on RA) showed everything within normal parameters and an SaO2 of 92%. You could have heard a pin drop when I suggested maybe there was an issue with the bp/pulse ox unit the nurse was using.

I did not get into this field to roll my eyes and shrug my shoulders for the next 30 years....

Rick Frea said...

Unfortunately, there are always going to be stupid doctor orders and stupid people that you'll have deal with no matter where you work in the medical field. It's part of the job, and a part of life.

Thankfully, there are an equal amount of intelligent doctor orders and great people we work with, for, and take care of.

It's the later that makes the job rewarding and worthwhile.

Anonymous said...

You know what really annoys me? It bothers me when I'm examined by a doctor, and they chose to listen to my breathing sounds through my shirt. I always feel like why bother if the shirt muffles everything...beside you're a doctor, and you're supposed to touch me in that way? I agree with you absolutely. I feel better when my docs take the time to actually check me over instead of assuming.