DR Creed: How much medicine to give

Date:  7/11/2003

To: R. Smart, Director of Cardiopulmonary Department

From:  Dr. False, ER physician, M.D., Medical Director

Re:  Combining nebulized solutions

Memo:  Thank you for bringing to my attention lack of scientific evidence to support the efficacy of combining nebulized solutions. We have such great medicines like Atrovent, Mucomyst and Pulmicort, and now we must come up with a policy for when to administer such medicines.  

In lieu of any scientific evidence, we've decided we must follow the progressive strategy of using a one size fits all policy for treating pulmonary ailments.  Our old policy created in 1960 was as follows:

1. Treat all annoying lung sounds with a bronchodilator
2. Treat all lung diseases with a bronchodilator

With all these new medicines we must now consider the following strategy for determining how many medicines to combine with the bronchodilator:

1. One medicine is good
2. Two medicines are great
3. Three medicines are even better.

We shall here on out refer to this strategy as the throw everything in the neb with the belief that it's gotta do something.  Think of it this way:  "What else can I put into that neb?"

Again, there is no science, but this strategy sounds good.  If it sounds good and makes you feel good it must be fact and it must work.  

It is important to remember not to listen to respiratory therapy mumbling and grumbling things like the following:

• The patient's already full of secretions and is coughing up plenty, why add mucomyst and add more secretions?
• The patient's lung sounds are clear so why do we need mucomyst?
• I was taught in RT school that Atrovent should be given non more frequently than every four hours.
• I was taught in RT school that Atrovent is not a rescue medicine to be used in the ER.

Please, ignore such pesky whines.  This is merely an attempt by RTs to waddle at our autonomy.  If you hear such a complaint, or if you "feel" like you need to do something, add one of the following medications to the bronchodilator:

• Atrovent
• Mucomyst
• Pulmicort
• Brovana

Remember our slogan:  the more the merrier.