'Olins: Part 3

The following is a continuation of our list of various types and forms of racemic and actual ventolin-tyes (o'lins) that we doctors keep esoteric from respiratory therapists so they continue to have procedures to justify their existence.  Oh, and the treatments actually do help for the various disorders listed below. Seriously, we are not making this up.

235.  Medicine:  Historolin

Diagnosis:  Asthma

Frequency:  Q4-6

Effect:  It is proven that keeping beta 2 receptors saturated with ventolin particles will keep asthma in remission.  Such therapy may be deemed profligate in the out of hospital setting.

236.  Medicine:  Abdomnolin

Diagnosis:  Had surgery on belly

Frequency:  QID

Effect:  Only works when prescribed by surgeon to prevent atelectasis and pneumonia caused by the surgeon.  Warning to physician: side effect to second hand ventolin types is respiratory therapy apathy and grumpiness, so stay out of their way. Still order it, though, we're just saying; they are lazy and will try to convince you it's pointless, but we know it is not pointless.  Yes, a study of 100 post op patients showed that, of 100 post op patients who were treated with QID ventolin, they all eventually got better.  So we know some form of ventolin must be ordered.  Note: not ordering Abdominoilin for post operative patients was not shown to decrease length of stay.  Side effect to patient may be increased desire to go home, agitation, and possible irritation with the therapist who continues to wake them up for breathing treatments when they already know they can breathe just fine.

237. Medicine:  Desatolin

Diagnosis: Aspiration Pneumonia

Frequency:  QID

Effect:  Once inhaled the ventolin particles join with a chemical called humidolin acetate to form H2O molecules.  As these accumulate over the course of many days the patient will become filled with increased fluid so that oxygen molecules can float to the surface of the lungs so they can be exhaled. May be tried with regular or faux pneumonia, although studies show that it works best for pneumonia that was caused by reflux of stomach contents. Helicobacter pylori (H. pylori), a common bacteria found in the intestinal tract, might actually plunge out of the water and be exhaled during the exhalation phase due to helicopter-like rotors that have previously eluded the vision of scientists but may be seen when the bacteria is attached to ventolin-like substances in the air.  It's a site worth seeing when hundreds, thousands, millions, even billions of H. Pylori escape their human captors in search of life on Mars.  The good news is they die within seconds of exhalation.

238.  Medicine:   HEALButerol®

Diagnosis:  Bone fractures

Frequency:  QID

Effect:  Rather than just giving albuterol to open up the air passages that are already open, this provides Orthopedic physicians a medicinal supplement proven to diffuse into the bloodstream once inhaled and seeps into bone material to cause fractured areas to rejoin and heal faster. The exact methodology is unknown, but a study showed that of 100 post op patients given HEALButerol® all eventually got better.  So this was indication enough to confirm that the medicine magically heals bones as well as opens up airways, even if the airways are already open.  You may also wish to try Knitolin.

Medicine:  Knitolin

239.  Diagnosis:  Bone Fractures, especially fractured ribs

Frequency:  QID

Effect:  It knits bones so they heal better and the patient breathes better at the same time.  If neither of those work, try tryagainolin.  It works best when given in tandem with an incentive spirometer  (IS)and acapella. Increased turbulence created by inhaling a deep breath with the IS pushes the knitolin particles deeper into the bone (sort of like hammer nail, so to speak) thus making the medicine particles work like a filling in a tooth to further supplement healing.  The acepella helps to loosen and free any bacterial particles that might collect inside the fractured portions of the bone and inhibit healing and/ or cause an infection.

240.  Medicine.  Trainwreck-uterol

Diagnosis:  Many, or Trainwreckeeeeism caused by the trainwreck virus that causes many of the organs of the body to become confused and not work right.  Trainwreck-ism is a another disorder caused by the trainwreck virus that causes nurses and respiratory therapists to make poor decisions that wreck things and people.  Trainwreckeeeism should not be confused with Trainwreck-ism.  Because trainwreckeeeism has a lot of e's in it, it can be treated the same way a wheeze is:  with an 'olin, particularly Trainwreck-uterol. Trainwreck-ism has no known treatment, and therefore you must not be anywhere withing 100 miles of such patients.  Usually they are not hired.  If they are, you should fire them immediately, because the disease is highly contagious.

Frequency:  Q4ever

Effect.  It has no effect on the disease processes, although it does attack to faux B2 receptors in throat muscles in and attempt to eeeeee-liminate the wheeze by soothing throat muscles (throatodilation) in order to make nurses and doctors happier.

241.  Medicine. Fusolin

Diagnosis:  Rib fracture

Frequency:  QID

Effect:  Increases tidal volume to prevent pneumonia and atelectasis.  Works similar to the way IPPB used to overinflate good alveoli.  May be alternated with Knitolin,  HEALButerol®, preventolin, postopulterol and tryagainolin.  May also try sputumolin to induce a cough.  Avoid using ventolin for its cough suppressant qualities, as this defeats the purpose.

242.  Medicine:  Lupisolin (aka Aligatoruterol, Sharkuterol)

Diagnosis:  Lupis

Frequency:  At least QID

Effect:  Ventolin particles go into the lungs and join with neutrophils to turn the ventolin particles into little critters that look like very sharp toothed alligators or sharks that kill and digest bacteria and viruses and other potentially harmful invaders so the immune system doesn't have to.  I guess you can say that the ventolin particles formed look and act sort of like Pac Man and Mrs. Pacman.  This works to suppress the immune system and to prevent inflammation caused by the disease, particularly in the heart, lungs, and brain (well, mostly in the lungs).

243.  Medicine:  Flapolin

Diagnosis:  Loose or damaged Mitral valve

Frequency:  Once

Effect:  Mitral valve may be heard flapping, meaning that the valve is leaky.  This form of ventolin causes an infusion of hardened, crystallized substances that are attracted only to the mitral valve to fortify it and assure the patient's safety until the valve can be replaced.

243.  Medicine:  Vasodilatolin

Diagnosis:  Hypertension

Frequency:  Q4-6

Effect:  Dilates vessels to decrease blood pressure. Will require frequent inhalations to assure a high enough dose of the medicine is in the bloodstream at all times. So this is why we recommend it be given Q4-6 rather than just QID.  A bonus is the patient will have to be awakened at least once, and this might make the patient mad and raise blood pressure that way.  It works the same as BiPAP, which has a benefit of increasing blood pressure.  May also place patient on BiPAP.  The more uncomfortable the settings the better the effect. Please, do not admit this to respiratory therapists. Oh, you did already: Doh!

244.  Medicine:  BiPAP-uterol DS

Diagnosis:  CO2 greater than 42 (boy, that's way too high, need to get it back down to normal)

Frequency:  QID, Q6, Q4, or just make something up

Effect:  Lubricates and soothes the vocal cords so you don't hear an audible wheeze (rhonchi, stridor). Works best if tried before BiPAP is ordered.  If doesn't work, order BiPAP.  Works well after BiPAP order too. If you continue to hear lots of noises in the lungs (especially if they annoy you), you probably should order BiPAP.  IN this case, the medicine mayu have a bonus of lubricating the lips and cheeks so you don't hear the BLLLLPPPPPLLLLLTTTTTTTHHHHHHHH due to the fact the seal is not tight enough.  It makes it so nurses don't keep calling respiratory because they don't feel like playing with the Velcro.  May alternate with BiPAPuterol (to ward off evil spirits so you don't have to eventually ventilate this patient).  Note:  For patients with a big scruffy beard, a double dose may be beneficial. Or, just get off your ass and tighten the mask might work just as well.  Or, if you're really brave, shave the beard)

245.  Medicine:  Normal Saline

Diagnosis.  Asthma, COPD

Frequency:  Q4

Effect:  Draws salt out of epithelial cells and Type-II alveolar cells in order to treat bronchospasm due to dehydration.

246.  Medicine: Retrospectuterol

Diagnosis. COPD, asthma, heart failure, pulmonary edema, kidney failure, lung cancer, etc.

Frequency: Q4-6

Effect:  The patient was short of breath greater than 24 hours ago, therefore albuterol is indicated today. The patient may have been short of breath yesterday, or may have experienced asthma symptoms (at the age of 6) 25 years ago.  Regardless, the retrospective qualities of albuterol-like particles have the ability to travel over the wrinkle in time scrub lungs clear of all past difficulties.

247.  Medicine. Keepmeinolin

Diagnosis. Respiratory failure, hypoxia, pneunonia, heart failure, dyspnea (all of which requires oxygen and IV medications to keep the patient alive)

Frequency. Q once

Effect.  Works similar to exercise in that it stimulates the brain to release a chemical called endorphins. They act like analgesics such as morphine to diminish the perception of pain, cause a sedative effect, reduce stress, ward off anxiety, ward off depression, boost self esteem, and improve sleep. It causes a sense of euphoria similar to that produced from morphine with out the risk of addiction.  Generally, the effect only lasts until the mist in the room clears, so it's usually only prescribed one time, as a last ditch effort, when a patient threatens to leave against medical advice (AMA).  The medicine should calm the patient down just enough to convince her that she really does need to be in the hospital.

247.  Medicine.  Transmitolin, Accousticsolin

Diagnosis.  CHF, Heart Failure, ETOH, Dehydration, old age

Frequency.  QID

Effect.  Prevents upper airway rhonchi from transmitting to other lung fields to prevent specious documenting of wheezes. It's a medicine that was concocted in the laboratory of Dr. Ven Tolin and his assistant, Paul RiTT, with the intent to discourage physicians from ordering breathing treatments due to upper airway noises confused for wheezing. The medical community generally has an aversion to this medicine, and so it has rarely been used to this point.  A Congressional Committee actually discussed this, and it almost made it into the Affordable Care Act in order to cut government spending, only to be cut from the bill at the last moment when it was discovered the individual hospitals have to absorb the costs of wasteful breathing treatments, and not Uncle Sam.

248.  Medicine.  Keepmeawakeolin

Diagnosis.  COPD, Sleep Apnea

Frequency.  Q4 ATC

Effect.  To a nerve cell, Keepmeawakeolin looks like a coffee molecule which looks like adenosine.  It then is allowed to attach to adenosine receptors, thus preventing adenosine from attaching to them.  So instead of adenosine slowing you down so you can sleep, Keepmeawakeolin keeps you awake.  Adenosine dilates blood vessels in the brain, presumably to keep your brain well oxygenated while you are sleeping and your breathing is more relaxed. Keepmealiveolin mimics this effect, thus causing vasodilation of the vessels in the brain to assure adequate oxygenation while you are not sleeping.  A side effect of this is that it may cause a headache, which is where caffeine comes in handy.  About three hours after dosing, keepmealiveolin starts to dissolve, opening up just enough adenosine receptors for caffeine to attach.  This should be enough, however, to constrict brain vessels, thus ridding you of your headache.  Still, once the rest of the keepmealiveoline molecules dissipate, the next dose should be due. A morning dose of coffee is highly recommended, although it should be given about an hour prior to the treatment is due.

A side effect is insomnia that lasts for the duration of this type of treatment.  It is typically not recommended to continue this treatment after discharge to home, as it often results in the viscous and never ending cycle of taking keepmealiveolin to improve oxygenation while you are sleeping and drinking coffee to offset the side effect of headache in the morning.  Another side effect is refractory headache, which is a headache caused by the medicine to begin with.  After doing all this reading (if you are still with me), the brain usually forgets about the bronchodilating effect.  Another idea is to only give the medicine at night, and allow the patient to refuse therapy while awake. Still, because respiratory therapists hate waking people up, an ideal order for this is Q4 ATC (Around The Clock).  This lets the RT know you mean business.

249.  Medicine. Alcurital (See Ad Here)

Effect.  This is the only medicine clinically not proven but believed to by nurses and... doctors (yes, doctors) to cure all that ails you And best of all It works even when You have clear lungsounds Hence the name: Alcurital.

Side Effects: Alcurital.for clear lungsounds. Side effects include anxiety, nervousness, headache, increased heart rate, death if consume more than 55 miligrams in a day, boredom, pissy RTs. However, studies show the medicine cures all ailments, but it has no effect on stupidity. Do not use if you have a wise physician or nurse.  Not expected to result in increased brain cells. Not expected to prevent accidents. While it can be used prophylactically, it will not prevent all ailments. Don't worry, as no studies were done to come to any of these conclusions, it's simply based on feel good: it looks good, sounds good, feels good, then it is a fact. One study of 100 post op patients given Alcurital eventually recovered, so now it only makes sense that it
works.

250.  Medicine.  Mucinexolinuterol

Diagnosis.  COPD, pneumonia, Cystic Fibrosis

Symptom.  Thick secretions; difficult expectoration

Efficacy.  The fact that the suffix olin and the suffix uterol are in the name means it has 10 times the ability to loosen thick secretions as Mucinex and albuterol alone.

251.  Medicine. Diverticulobuterol

Diagnosis.  Diverticulosis

Frequency. QID

Effect.  Bronchodilators have been shown to attach to fake beta receptors in the colon to relax smooth muscles that wrap around the intestines to help release trapped particles.  Similar to pneumonia, the medicine also magically reduces inflammation and smelling to ease pain and suffering caused by diverticulitis.

Further reading:

1. Fake 'Olins Part 1
2. Fake 'Olins Part 2
3. Faux Physician's Creed

More new types of Ventolin ('olins)

Here are a couple new types of Ventolin that I'm certain you have seen at a hospital around you. These aren't necessarily conventional uses for a bronchodilator, but -- hey! -- why not!

1. 0.5cc Sinuseuterol:

Symptom: Sinus drainage, mild shortness of breath, stuffiness, sinus headache
Diagnosis: Sinus drainage, sinusitis, stuffy nose
Frequency: Usually 1 dose
Effect: This is a very popular medicine to use, especially in emergency rooms. It's actually been used for years by many doctors but hasn't had an official name other than just Ventolin. The idea here is that 0.0000000005% of the medicine particles waft to the sinus passages to relieve nasal congestion and inflammation. Patients usually says that she doesn't notice a difference after treatment, but that doesn't mean the sinuses won't eventually return to normal.

2. 0.5cc Assessolin:

Symptom: Patient doesn't quite look right. Pt may or may not have annoying lung sounds.
Diagnosis: Generic, but often cardiac or pulmonary history. May have been on vent in past, or and some type of failure in past.
Frequency: No less than Q4 hours. Q4ever may be the best idea here.
Effect: It really has no effect, you see. Even though RT isn't qualified to know when a treatment is indicated, we know they are the best assessors in the hospital. So, when you want to make sure the patient gets a good assessment every so often, there is no better option than to order Assessolin. Hey, there is an old saying: An RT a day kept the code away.

3. 0.5cc Snorebuterol:

Symptom: snoring
Diagnosis: sleep apnea, obesity, other
Frequency: Q4
Effect: Well, the snore sounded like a wheeze when we did our assessment, so better to be safe than sorry. May alternate with any variety of Q4ever treatments.

4.  0.5cc Hypoxolin

Symptom:  hypoxia, high CO2, pulmonary edema

Diagnosis:  Heart failure

Frequency:  Q4-6

Effect:  The patient wearing a 75 percent non rebreather mask to maintain an spo2 of 90% must be given Ventolin because it causes the patient to become hypoxic during the treatment.  Yes, you read that right.  The goal here is  that the 5-10 minutes of hypoxia that occurs during the treatment will increase the patient's respiratory rate in order to blow off excess CO2. Respiratory Therapist grumbling to be expected.  

Note for doctors who barely passed med school:  A breathing treatment from an oxygen source provides approximately 60 percent oxygen.  A nonrebreather does not produce 100 percent oxygen because one flap is always missing due to litigation purposes, and this results in an estimated FiO2 of 75 percent.  

If 75% Fio2 was maintaining a 90% SpO2 you can expect the patient's SpO2 to drop to 85 percent during this highly recommended therapy.  In England this exercise is called hypoxia therapy, yet here in America we don't want to be that obvious, so we just call it an Albuterol breathing treatment.  

For more 'olins, see the growing list at the bottom of this blog. If doctors at your hospital use an 'olin you think would benefit other patients, by God feel free to share it in the comments below.

New Ventolin prolongs life -- forever!!

Another usage for Ventolin was discovered by a highly intelligent doctor here at Shoreline Medical today. His name is Dr. Howard Fakename and the new version of ventolin is called KeepMeAlive'olin.

This is a med that has an Atropine, Epinepherine base in it that keeps the heart beating... beating... beating. It also has a Ventolin base that keeps the patient breathing... breathing... breathing.

Pretty neat hey. I have a patient right now on Q4 KMA'olin. He is a frequent visitor from a nearby nursing home who has no signs of respiratory distress right now.  But he does have faux pneumonia (a diagnosis that is reimbursable).

The patient has MS, and has indicated to me he no longer wants to keep living.  However, because his family does not want to let go, and the doctor is aware of this, the patient keeps getting KMA'olin to prolong his life.

Dr. Fakename is currently in the process of writing a paper on the life-prolonging qualities of Ventolin. Yet you have heard it hear first. The medicine is KeepMeAlive'olin.

New Super Strength Ventolin discovered

A friend of mine from Orlando, Florida, recently shared a story about a doctor about his discovery of a new super strength Ventolin with a duo purpose.  It's a medicine that the infamous Dr. Q1 would appreciate.

My friend described an 88-year-old patient who presented in high fowlers in respiratory distress. Upon auscultation he learned the patient's lung sounds were raspy with an upper airway wheeze.  There was minimal air movement.  He also had a productive cough with thick yellow and greenish sputum.

The doctor initially ordered one breathing treatment.  My friend said this made sense to him, especially considering I shared with him my copy of the real physicians creed. When the treatment was finished the patient indicated no effect, and the post treatment assessment concurred.

His initial impression was CHF or pneumonia, however no tests had been performed at this time. He said he then walked up to the doctor and said, "So, Dr. Fakename, are you thinking this is bronchospasm and want another treatment, or are you thinking it's something else."

"Oh," she said, "I'm thinking he has a combination of CHF and pneumonia. Why don't you go ahead and give another treatment."

My friend said she was perplexed, and wanted to know if I had an explanation as to why this doctor would order breathing treatments when she knew it was not asthma, nor COPD, nor any other disease that caused bronchospasm.

I wrote back to my friend that the new version of the real physician's creed has some new ventolin types that we RTs are not privy to yet, and they are a combination of Absorbolin, Osmosolin and Pneumonuterol. These medicines have properties that absorb both fluid in the lungs and the alveolar sacks via magic osmosis process.

The new medicine, a combination medicine, is mixed with Duoneb and is called DuoAbsorboOsmosoPneumobuterol.

I recently asked a my undercover doctor friend, who so happens to be one of the hundred or so editors for the creed, if he had any further information about this medicine.

He said that name was too much of a tongue twister in recent fake studies, and doctors were unable to say it.  So the name was changed to DOAPuterol.

It's a new magic mist that can be used for nearly all lung complications, all irritating lung sounds, and has relatively no side effects. Like the above mentioned drugs, no change in lung sounds and no change in respiratory status is normal.

So check out my new list of 'olins.

Ventolin now productive mucus thinner

The infamous Dr. Krane has impressed me with her wisdom once again. If you guys remember, she is the one who discovered that Xoponex is more than just a bronchodilator, that it is also a humidifier of the airways.

She is also the same doctor who orders treatments in ER "Now, and again in one hour." She is so smart that she knows before the first treatment is given that it will work, and that the patient will be short of breath again in one hour. Awesome. Brilliant. All doctors and RTs ought to worship this lady as the Einstein of Respiratory Therapy.  She is obviously a strong supporter of the real physician's creed.

Today, I must inform you (and I am very impressed I must add), that Dr. Krane (fake name mind you), ordered me to do a second treatment on a patient who has a cardiac history and renal failure, and who also had crackles in the left base, which is indicative of pneumonia and not bronchospasm.

As the treatment was going, I asked the patient, "Are you feeling short-of-breath."

"No, actually I feel better," the patient mused.

"I ordered the treatment," Dr. Krane intervened, "because her sats were in the mid 80s and I thought the treatment might help with that, and open her up."  Then she added with a snarl: "I also think that she has thick sputum, and that treatment might loosen things up a bit."

So there!!!

I looked at her countenance to see if perhaps she might be smiling. I mean, she was joking right? Nope. No smile. She looked serious as usual.

I did smile, though.

She said, "What's so funny!"

I couldn't answer.  Instead, I bit my cheek to prevent myself from laughing further.  In my mind, I was laughing at the fact that she just reminded me a new 'olin compliments of the real physician's creed.

It used to be called Mucusolin, and then the name was changed to thinolin during the IPPB rush of the 1980s, but more recently it's called Mucobuterol.  It's a revolutionary new medicine, included in ventolin somehow, that has the ability to thin secretions.  It is far more effective than Mucomyst.

To see a full list of 'olins check here.

New 'olin washes pneumonia right out of alveoli

I got to see first hand the other night the revelations that occur to lead a doctor to deciding a patient needs a breathing treatment, as Dr. Mann set down next to me as I was charting on one of the many terminals on 2 Early, the med surge floor. It was real early in the morning, and he started small talk with me. He seemed really cool.

"Hey, hand me that chart would you," he said.

I grabbed the chart he motioned to, and continued on with my charting.

"Hey, you know what?" he said. "This patent's got pneumonia. Wow, I can't believe he's not getting breathing treatments. Well, I'm going to change that."

Wait a minute, I think. That patient has been here for two weeks, and he's breathing fine. I wanted to say that, but I was on such good terms with the doc. I didn't want to spoil a good thing.

I wonder if this is the reason why so many un-needed breathing treatments are ordered, because good RTs like me refuse to face up to a doctor for political reasons. Here I knew for a fact this patient didn't need treatments, but the doctor thought otherwise.

So, why is it that he wanted treatments for this patient. Why? Because the patient had pneumonia. And, somewhere, some time ago, he must have read an article that said that Ventolin goes down deep into the alveoli and washes the pneumonia out.

So, I went in to do the treatment. The patient said, "What the hell do I need that for."

"Are you having trouble breathing?"

"Nope. Never."

"Do you smoke?"

"Nope. Never."

"Hmm," I said, "Let me listen to you." I pulled out my handy-dandy stethoscope and listened to his backside. Perfectly clear.

"So, you agree I don't need that? Or, why do I need it, do you think?"

In this situation, I used to try to make the doctor look good, and lie: "Well," I would say, "It's supposed to help you get rid of your pneumonia, or cough it up at least." I've decided I'm not doing that anymore. I said, "Your doctor ordered it. You have a right to refuse if you want."

"Well, if he ordered it, then I suppose I do need it. What do you think?"

Burned out, I decided to be honest with the patient, "Sometimes doctors order things just out of habit. He may have read some article somewhere..."

"Yep, I know that. That's why it's good to go to the doctor educated."

"Exactly. And don't be afraid to refuse a therapy. Just because a doctor orders something doesn't mean you really need it. Doctors are human beings after all."

"I totally agree," he said. Yet, despite that we both knew the treatment wasn't indicated, I gave the treatment and he took it. And of course we bantered while it was going.

When the treatment was finished, he said, "Well, I'm going to corner that doctor in the morning about this. I don't' fell a bit different after this."

"So, you ever been short-of-breath before"

"Nope. I never even smoked. I really don't think I need that thing anymore."

"Well, be prepared for him to try to talk you into it. He's going to give you a line you know. He'll try to talk you into it."

"I bet he will."

So, we now have a new 'olin. All patients that have been in the hospital for 3-4 days with no difficulty breathing, and all of a sudden Dr. has an epiphany and says, “Hey, this patient’s got pneumonia. I’m ordering Washolin.”

The medicine, according to our fake doctor's creed, is a specially formulated version of Scrubbin-Bubblin designed specifically for pneumonia patients who show no signs of respiratory distress and are not short of breath. This medicine forms a sud-like material, shrinks from 5 microns to 1 micron (exact methodology unknown) finds its way to the alveoli and washes the pneumonia right out.

It works similar to a bronchial wash, only you don't need to bronch the patient. It's an alveolar Wash performed with the magically enhanced formula of Scrubbin-Bubbles version of Ventolin. How about that for a new breath-taking scientific revolution?

Yes, we know RT will bicker, but the patient will say something like, “What the hell do I need that for, I’m not having trouble breathing, and never have in my life.” This is a normal side effect. Don't let that deter you from ordering this highly indicated medicine. If the patient wants to refuse, that's his loss.

By the way, if Dr. accidentally forgets to order Washolin, the patient will still get better and eventually go home.

The list of 'olins on the bottom of this blog has been updated.

Albuterol a cure for annoying respiratory ailments

As part of my usual two week schedule I end up with 6 days off in a row every other week, and right now I'm on day three. To be honest, I'm still not recuperated.

It's not just the burning feet and eyes, but ridiculous doctor orders. It takes 2 days to recouperate from tired feet burnout, and 5 days to recouperate from doctor order's burnout.

I don't have a problem with doctors, but I wish they would actually assess patients rather than looking at them, determining they have no clue what to do, and deciding to annoy respiratory therapy by ordering a breathing un-needed breathing treatments.

I'm telling you guys, if you check out my post, "Physicians creed: how to take care of pesky RTs", you'll see that this is all planned out.

Just before I was called to intubate a patient I honestly didn't think needed to be intubated, I finished doing a second breathing treatment in ER on a 1 YO boy of whom the doctor stated "has obvious signs of RSV."

Upon finishing the treatment, I charted, "Patient happy and playful, no signs of respiratory distress, has audible rhonchi and congestion and runny nose, no observable difference with this treatment."

I had to leave to do an EKG in another ER room, and then, when finished with that, I just happened to walk by the room where the RSV boy was stationed. I overheard the doctor, "He's looking much better. I'll come by in a half hour to see if we need another treatment, and about getting set up for home nebs."

Home nebs? Since when does this child need home nebs. He's full of junk. He needs suctioning if anything. Home nebs? Where the bleep do we get these doctors from?

I rolled my eyes to no one but myself, and waited for the doctor to leave the room. When she did, I proceeded to assess the patient again. He sounded just as junky as the first time I listened to him.

He grabbed at my stethoscope and tried to put it into his mouth. I pulled it from him, and handed him the little blue corrugated tubing from the nebulizer, because I had already discovered he loved to play with it. He smiled at me and placed one end of the tubing into his slobbery wet mouth.

While he was so entertained, I placed my palm on his chest, and I could feel no retractions. With the blue tube, he smacked me on the back of the hand, and smiled at me.

I went to the nurses station, chose a seat in front of one of the computers, and pulled open a charting screen. I did this while two nurses stood behind me, and I made sure they watched what I charted.

"Re-assessed patient at this time. RT notices no signs of respiratory distress. Patient very happy and playful. No breathing treatment indicated."

I was tired, and I wasn't going to dink around. If the doctor is going to order therapy that isn't indicated, the insurance company can read about it via my charting.

Home nebs for this kid! How ridiculous! Why couldn't the doctor have asked me what I think. I've been taking nebs for 25 years; I've been an RT for ten. If I don't know who needs home nebs, nobody does.

Then again, I am bias. And, of course, I'm lazy. I'm lazy because I want to get out of doing work. I'm lazy if I tell the doctor a treatment isn't indicated. I'm lazy because doing the treatment involves actually doing something.

I would love to tell that doctor to look on the Albuterol insert, where no where does it say that irritating lung sounds is an indication for this medicine. But that would involve actually doing research. That would involve going into the room and actually assessing the patient for real signs of bronchospasm.

Then again, another doctor ordered a breathing treatment on the floor. The patient told me she was not short-of-breath and, upon assessment, her lung sounds were clear with good air movement.

She said, "Well, I did tell the doctor I had a little cold."

After doing this treatment I charted: "Patient denies SOB, NARDN, no signs of bronchospasm, no indication for therapy, no difference with therapy."

Read that, Dr. Astro. Read that insurance company, and think about why you have to put out $80 for this procedure.

I would love to tell that doctor to look on the Albuterol insert, where no where does it say that clear lung sounds is an indication for this medicine.

Later I had a patient in ER who was very short-of-breath. I noticed this while doing an ordered EKG, assessed the patient, and thought a treatment might benefit the patient. However, the doctor told me the patient didn't need one.

Whatever! I left the ER and went to my cave, where...

...five minutes later the phone rang. Oh, come on!

"Yeah, respiratory," I grumbled into the receiver.

"We need another treatment down here," the ER desk clerk said.

Okay, fine. So the doctor came to his senses on the patient I thought should have a treatment.

In ER I observed that there was not one order but two, and neither was for the guy I wanted to give a treatment to. Upon assessing the patients I learned that one was coughing too much, and the other was not coughing enough, and the doctor wanted a sputum.

Ah, I just want to go home.

It's amazing a world where the same medicine that can be used to make someone cough can make someone not cough. And the same medicine that can get rid of rhonchi can make clear-er clear lung sounds. And, yet, a patient that's really having bronchospasm has to wait.

You'd be proud to know I was a good boy and kept my mouth shut, but I charted "No treatment indicated," on all of them. Is this legal. I really don't care.

No wonder the cost of medicine is so high. I wish that doctors would look at my charting, at least then we could have a good debate about it. And, of course, I'd lose. I'd lose because these doctors are following the "Doctors Creed: how to take care of pesky RTs."

Doctors are not on a mission to annoy RTs. They are taught in med school that Albuterol nebs are a cure all for all annoying respiratory ailments. Understanding this should help us RTs who study research that shows bronchodilators are for bronchospams and bronchospasm only.

In other words, doctors don't think in terms of "does this patient have bronchospasm or does this patient not have bronchospasm." Heck no. That technique is simply too hard and would involve a full assessment and doing reasearch.

They don't think this way becasue bronchospasm is covered under "annoying respiratory ailment." There may be exceptions to this rule, but not very many.

This is why it's better to just keep RT mouth shut, however hard that might be to do sometimes, expecially when I'm burned.

For more information check out the list of 'olins at the bottom of this blog page. Even while docotrs order Albuterol, they have these 'olins in mind.