Answers to your web search querries

Here are my responses to Internet search engine questions that lead someone to my blog.

1. do respiratory therapists still do floor bronchodilator therapy: It really depends on where you work. In most hospitals I'd say yes. But I have a co-worker who used to work in Detroit, and he said the RTs didn't have time to do floor therapy. After the initial set-up, floor therapy was basically done by the RNs. At most hospitals, though, RTs do floor therapy.


2. serevent and pneumonia: I don't see what good Serevent would do for pneumonia. Serevent is a bronchodilator, and bronchodilators dilate bronchioles. Bronchodilators are not made to go into the alveoli where the pneumonia is. So, unless there is some kind of underlying bronchocontriction going on, I see no benefit from using Serevent. That's my humble opinion based on scientific research. Some doctors, however, will disagree with me, and they have a right to.


3. overdoing albuterol: How do you define overdoing? Is overdoing Albuterol what you refer to bronchodilator abuse? If that's the case, how do you define abuse? Is abuse using it more than the guidelines recommend? If that's the case, guidelines don't take into consideration individual uniqueness.


4. cardiac asthma: To make it simple, this is where the left side of the heart fails, causing fluid to back up into the lungs. This causes an increased pulmonary blood pressure, which in turn squeezes the bronchioles and causing them to wheeze. This is not the same as bronchospasm, and therefore bronchodilators will not work to fix this problem. To solve this problem, cardiac medications and, perhaps, some diuretics are the therapy indicated here. However, since the lung sounds are annoying to most doctors and RNs, a bronchodilator is often ordered, even though it has no effect on cardiac asthma or the cardiac wheeze it creates.


5. i don't want to be a respiratory therapist anymore: You have to remember that this IS a job, and the purpose of any job is to make a paycheck. And, one must also take into consideration that the grass is not always greener on the other side. Likewise, a job is what you make it to be. If you do not like your job the way it is, you can make it what you want it to be. Or, there is always the unpopular option of complaining.


6. body therapy: If you are bored, you can always blow some Albuterol over your skin. It has the effect of smoothing it out and, at the same time, it's relaxing.


7. respiratory therapists frustrated with doctors: It happens. Some doctors write stupid orders.


8. fake acls cards: What would be the purpose of this?


9. lizer liposuction: I don't think Ventolin will help you lose weight. Oops, hold on! It can. Check this link out. So Ventolin might be an option. What should we call this? Liposucion-olin? I don't know much about liposuction (not my game), but I've heard it benefits some people. I have no idea why this question lead someone to my sight.


10. what stops the hypoxic drive: Oxygen. The hypoxic drive is real, it's the hypoxic drive theory that is a fallacy.

If you have any further questions, check out the q&a link to the right, or feel free to contact me anytime: Freadom1776@yahoo.com.

Cardiac asthma should not be treated as asthma

I have spent so much time writing about and educating nurses and students about cardiac asthma that I have decided it needs a post of its own.

And, considering about half of all breathing treatments I do are either for pneumonia or cardiac asthma, I am hereby convinced that even doctors have no clue what the difference between true asthma and cardiac asthma is.

According to the Mayoclinic.com, here is the definition of Cardiac Asthma:

The term "cardiac asthma" refers to wheezing associated with congestive heart failure. It isn't true asthma. As a result of congestive heart failure, fluid can build up in the lungs (pulmonary dema). This causes signs and symptoms — such as shortness of breath, coughing and wheezing — that may mimic asthma. True asthma is a chronic condition caused by inflammation of the airways, which can lead to breathing difficulties. The distinction is important because treatments for asthma and heart failure are very different

Cardiac asthma is mainly caused due to increased pressure in the pulmonary vessels causing fluid to fill the air sacs, "preventing them from absorbing oxygen," and making the person feel extremely short-of-breath.  This same increased pulmonary vessel pressure (increased pulmonary vascular resistance) in turn squeezes the bronchioles and causes the wheeze and other symptoms that mimic real asthma, and this is why this "problem" is quite often mistaken for asthma and treated with bronchodilators. Secretions sitting on the vocal cord may enhance the wheeze, often causing it to be audible. (Keep in mind that a true bronchospasm wheeze cannot be heard sans stethoscope).

When Cardiac Asthma is treated as bronchospasm, all we are doing is putting adding more fluid to lungs that are already filled with fluid. What we need to do is give these patients diuretics to get rid of some of the fluid, or other cardiac drugs to increase the force and contractility of the heart to reduce pulmonary pressure.

Another good strategy worth trialing is CPAP or BiPAP, as the incrased airway pressure has been shown to reduce preload and afterload to reduce the work the heart has to do to pump blood through the body. This can reduce the feeling of air hunger until the medicines take effect.

Other than the heart, there are other diseases that can cause pulmonary edema and cardiac asthma, and these include pneumonia, exposure to toxins, and high altitudes. It is the job of the nurse, the respiratory therapist, and doctor to determine the true cause of the symptoms. It is the doctors job to properly diagnose and treat.

We'll consider this RT Cave rule #26: Cardiac Asthma should not be treated as asthma. Throat wheezes, upper airway wheezes, and dyspnea on exertion are signs of cardiac asthma, and a wise medical specialist will not confuse the two.