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Sunday, August 16, 2009

Ventolin now indicated for low pressure

The patient presented to the emergency room with an Spo2 of 80% on room air, and he was taking rapid deep breaths as though starving for air.

The respiratory therapist was called to duty and placed an NRB mask upon the patient's face, improving the SpO2 reading to 95%.  The air hunger of the patient immediately subsided.  The RT then auscultated the patient and heard rhales in the bases, a sign that the patient was probably wet.

Right then the good doctor came into the room and, before listening for lung sounds, he told the RT to give a Duoneb to the patient.  The RT said, "No problem."

While giving the treatment the RT pondered as to why the physician ordered albuterol, especially when it was obvious the patient was wet.  He wondered how adding 0.5cc of albuterol solution, 2.5 mg of ipatropium bromide solution and 3cc of normal saline to the the fluid already present in the patients lungs would resolve this man's heart failure.

He looked away from the patient and at the monitor, where the vitals showed a heart rate of 112, a respiratory rate of 32, and a blood pressure of 90 over 20. That is when the aha moment occurred.

The therapist slapped himself alongside the head, and thought:  "Duh!  I should have figured this out earlier. The physician figured the low pressure could be treated by the side effects of albuterol  This made sense.

In this case the albuterol was lowpressorolin.  This made sense considering low pressure is best treated with lowpressorolin.

The RT snickers, and the nurse in the room looks at him funny.  "What's so funny?" she asked.  "Oh, nothing," said the enlightened RT.  He then rushed up to the RT cave and added yet another 'olin to the long list of Ventolin Types.


David in Houston said...

It would be interesting to learn to learn if any of the treatment modalities ordered by this Doctor have a rationale, or if she has some favorite drugs that she prescribes based on random selection.

Does she have Albuterol inhalers for all patients in her office waiting room? That would save her the trouble of actually having to diagnose and select an appropriate treatment.

Anonymous said...

As a RT student who has previously posted - I intend, during my last few clinicals at "teaching" hospitals, to ask any and all doctors that I have access to why a specific treatment/drug was ordered i.e. what CRITERIA they used to determine their course of action.

Luckily I will be able to hide behind the moniker of naive, stupid RT student.

UNluckliy for the docs, I am not a 19 year old, new to the world, green youngin'.

Being older, I have a very good BS Meter.........curious to see what kind of work-out my BS Meter gets!

Rick Frea said...

B.S. meter. That sounds like a product you should write about for the RT Cave when you finish your clinical and I'll publish it,or at least let us know how things go and what you learned. This is your assignment, if you so choose to accept.

Anonymous said...

I shall report back!

Anonymous said...

I used to work PRN at a local hospital several years ago as a second job on the nightshift and had a Hospitalist order an Albuterol neb for an 80 year old female who had a B/P of 88/50 and was asleep and no symptoms. The Dr wanted to give the Albuterol for the "side effect" to try to raise the pt's B/P. Since I work full time at a level one trauma center, I questioned the Dr and told her that you never give a med for the side effect. She D/C'd the order. The regular RT staff at that hospital were used to being told wnat to do and they would have just given the neb and never questioned it.
I also had an ER nurse at that same hospital "write me up" because an 88year old female complained that the ABG stick I did hurt.

RRT in Central Virginia.

Rick Frea said...

I think that ignorant orders like that happen so much where I work, that RTs simply become lazy and just do it. Educating doctors takes a lot of effort. I commend you on your efforts. I think more RTs should be like you.