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Friday, September 24, 2010

Puting the nurse on defense is fun -- sorta

I'm not the kind of RT to complain to nurses, at least most of the time. However, I am known to be honest, and let be known my opinion (the facts, in other words) in more subtle ways.

For example, I just did a breathing treatment in ER on a kid with a runny nose, harsh cough, clear lung sounds and good air movement. After the treatment the patient still had a runny nose, harsh cough, clear lung sounds and good air movement.

As I was leaving the ER, the nurse asked, "Is he doing any better."

"Nope. Lungsounds are still clear," I said.

Then she defends herself, "Well, he had a harsh cough, so I thought a treatment might help."

"That's fine," I say, and smile as I walk away.

I did this with a new doctor once. The patient had an audible wheeze. I could hear it really loud in the throat, and I could hear it radiating through the lung fields. While the patient had really good air movement, I knew that the untrained ear is often fooled into thinking this upper airway wheeze (often called stridor) is bronchospasm or asthma (I wrote about how to hear bronchospasm here)

When I walked out of the room, the doctor said, "So, did the treatment help?"

I said, "Nope. The patient still has stridor."

He said, with a suddenly vexed appearance, "He was wheezing."

"It sounded like stridor to me, and it was radiating throught the lungfields. But I could be wrong."

I was smiling as I left the ER.

Sometimes it's: "Nope, the crackles in the left base didn't go away."

Sometimes it's: "Nope, the patient's lungs still sound wet."

I like to do this, as it puts the person on the defense every time. It's interesting. It beats the, "What the hell does that patient need a treatment!" approach some of my coworkers use.

Yeah, it's tempting to be that way, but I like being on offense better.

Of course you have to leave the unit with a smile right away to stave off any further discussion and so they think you mean no hard feelings. And to leave with them still thinking. It's like the commercial that leads the customer to finish the ad.

Like, "It's the Heartbeat of America..."

1 comment:

Anonymous said...

Is there a trick to differentiating between upper airway sounds and lower? Or is this just something that comes with experience?