Monday's class: My response to your queries

This post is my weekly attempt to answer Internet search engine queries that lead someone to clicking onto my medblog.

We determined last week that 62% of people who click onto this blog stay here long enough to determine it's not where they want to be. Likewise, we also determined that if they would have stuck around a bit, they may have found the answer they were looking for.

Of the 500 queries in my stat counter's memory, I have picked ten of the most interesting queries. Keep in mind I do not answer queries if the page the person landed on would have provided them with an appropriate answer.

Here we go:

1. Frequency of Duonebs: Duoneb is a combination of Atrovent and Albuterol, and ideally it should taken no more often than every four hours. If you need to use it more often you should see your doctor. This medicine can be safe if used more often, but should not be done without the approval of a doctor.
2. am i smart enough to be respiratory therapist: When I first researched the career of RT I found out I had to take chemistry, and I failed chemistry in high school. Based on this, I decided RT school would be too hard for me. I could not have been more wrong. If I'm smart enough to be an RT, you are too.
3. respiratory therapy is not a good career: That kind of depends on how you define a good career. If you want to get rich and buy a bunch of material items, then this is not the career for you. Like any job, there are ups and downs of being an RT. It is what you make of it.
4. xoponex q2: It's safe. However, I would not recommend this frequency outside the hospital setting.
5. albuterol pulmonary edema: Albuterol has absolutely no effect on Pulmonary Edema. Albuterol relaxes the bronchioles, and pulmonary edema occurson the outside of the bronchioles. For more information see #9 below.
6. do respiratory therapists use stethoscopes: Absolutely. If you see one who doesn't you ought to report him or her and wonder if you are receiving good care.
7. what happens to fio2 when using a simple mask and the patient breathes deep: The simple mask is a low flow oxygen device, meaning that the FiO2 is dependent on the patients respiratory rate and tidal volume (minute ventilation).
8. i hate my job, respiratory therapy: It's a free country. Nobody is stopping you from getting a different job. Go for it.
9. does wheezing mean you have copd: Not always. If the muscles of the bronchioles are spasming, this will cause a wheeze. This is called brnchospasm and occurs with COPD or asthma. Albuterol can relax these muscles almost instantly, making it much easier to breathe. Pulmonary edema occurs as a result of the heart pooping out, and fluid backs up and fills the lungs. This can be caused by Chronic Heart Failure (CHF). If the pressure in the lungs gets high enough with CHF, this fluid in the lungs will actually squeeze the bronchioles, causing a wheeze. Because this is caused because of a weekend heart, it is called a cardiac wheeze. Sometimes, however, it is hard to tell the difference.
10. Bipap asthma: I've actually seen it work well for some asthmatics, however when an asthmatic is really short of breath he may actually feel claustrophobic enough without the BiPAP. Thus, if the patient can tolerate it, go for it. BiPaP should always be ordered to tolerance.
11. continuous aerosol with atrovent: I questioned it too, but some doctors where I work have done it with no consequences. Atrovent is similar to Albuterol in that the side effects are minimal. If Albuterol is safe, Atrovent is even safer. Some recent studies show some added benefits to COPD and Asthma patient with giving continuous Atrovent along with continuous Albuterol. As with everything in the medical field, every doctor or RT will have a different opinion on this. With that in mind, I do not see any point in giving a continuous treatment with just Atrovent. If a patient is so short of breath he or she needs a continuous treatment, then you better throw in some Albuterol. (Note: a continuous treatment is when you give a treatment back to back to back until the patient starts to open up.)

Keep in mind I receive hundreds of queries a week, and I am limited in space on this weekly column.

If you have a question I have not addressed here, or if you want an answer right now, feel free to contact us anytime and we'll get you an answer ASAP. You can contact us at Freadom1776@yahoo.com, or RTcave@yahoo.com.

That concludes today's class.

I violated RT Cave Rule #3 and now I must pay

RT Cave Rule #3: If you are trying to get a protocol passed, you have to keep your mouth shut about treatments not being indicated. You must be diplomatic.

I think I got Dr. Krane our ER doctor mad at me tonight. And I suppose that's not good news considering she's the main obstacle to us getting an ER protocol

Dr. Krane was back in her cubby behind the ER desk, and one of the ER nurses said, "So, other than us nobody is bothering you tonight, hey."

"Pretty much you're it," I said, "Except for this one professional COPD patient who calls me every 3 or 4 hours for a treatment."

"Oh, that's pretty good then."

"Yep, He's a pro. I don't even really need to check in on him, he just calls me when he's ready for one."

"That's cool."

"Yep," I said, "And those are the kind of patients that I really like to give treatments to. You know, patients that are really having bronchospasms and need them, as opposed to... just because."

Dr. Krane walked out of her cubby and past me without as much as a look my way. She went to ER Room 1 where I was currently giving the 10th treatment to a patient who came in with a cough and was never short-of-breath.

I followed her into the room, "So, you think you got her cured yet."

Dr. Krane gave me a smile. I'm not sure if that smile was her acknowledging my humor, or her annoyance at my comments. Or if I was just imagining things, because maybe she never heard me in the first place.

However frivolous I think some of the therapies we do are, like this current series of treatments, I rarely say anything to the nurses or doctors about it. I save comment for this blog and make humor of it. I think that'a far better therapy than complaining.

When I'm tired, or have too much time on my hands like tonight, my tounge sometimes slips,
and they give me this look like, "Um, you're trying to get out of work. You're just saying that because you're lazy."

I'm serious. It happens every time I mention something like one of my 'olins, or if I tell them my true opinion of a treatment I'm doing.

---

The first treatment on this patient was Duoneb X2 and then again in an hour.

"Are you short of breath?"

"No."

"Do you have asthma?"

"No."

"Have you ever gotten short of breath?"

"Only when I go into a coughing jag, of which I've had many tonight."

"But you're not short of breath now."

"No."

The patient appears to be in no respiratory distress, and before and after every treatment she has denied short of breath, even after several Duoneb treatments and one Xoponex the wonder drug.

I think DR. Krane is privy to knowledge esoteric to even the other doctors here, because she not only orders Atrovent with every treatment, she will know that someone will be short of breath an hour later.

To me, it would make more sense to have me come back and assess for the need. Then again, if that were the case, I probably would have done maybe one, and the nurses would complain that I was just being lazy.

Okay, so there goes our ER protocol.

I need to be more political. I need to be more diplomatic. I need to keep my mouth shut.

---

I know there is new research on Atrovent. I'm going to try and tackle this in the next few days. I might even talk to Dr. Krane about it; that is, if she still likes me.

If she follows RT Cave Rule #2 we'll be just fine, although, as we RTs so well learn, Drs don't always follow the rules.

RT Cave Rule #4: Hospital workers, especially one's that work nights, do not hold grudges.You can't hold coworkers accountable for what they say under stress, pressure or lack of sleep -- especially lack of sleep.