Monday's class: My response to your queries

Before I went on vacation I wrote a post responding to ten Google and Yahoo searches that linked someone to my site.

The reason I did this is because I know that 62 percent of those who click on my site stay here for less than five seconds and, in many cases, if they'd have just hung around a bit in the RT Cave they would have found the answer they were looking for.

So, with that in mind, here are my honest and not politically correct responses to all your queries. While some queries are so goofy they may lead to a facetious response by me, I will be completely serious when the question is a respectable one. I promise.

1. Respiratory therapy inserting catheters: God, I hope it never comes to that.
   
2. I hate respiratory: Why is it that this keeps coming up? I wonder how much time this person spent on my blog.
   
3. Signs a person might need to use an inhaler: You can do so by using a peek flow meter or by knowing the signs of an impending asthma attack. Another great place to find information about asthma is asthma mom, and National Jewish Medical and Research Center. The later hospital and a research center that specializes in pulmonary diseases. I know three people who spent time their for their asthma. It's an excellent place.
   
4. How to know when an asthma attack is occurring: See question #3.
   
5. What is it like being a respiratory therapist?: The best way to find the answer to this question is to check out what the RT bloggers have to say. It's a great job where you get to meet many wonderful people in need of help with their breathing. Some will need a simple breathing treatment, and others more intense therapy. The greatest parts of being an RT, in my opinion, is being part of a great team. We work together with Drs and RNs to the benefit of the patient. As with any job where you work with people, it can be very challenging at times -- yet rewarding too. This could be an idea for a future post. Stay tuned.
   
6. I'm sick with a cold in my chest bronchospasms: Sounds like you should go see your physician, or get one if you don't have one.
   
7. When to intubate: Here is a good link to check out. Cardiopulmonary arrest is an obvious indication for intubation. And during surgery patients are often intubated to keep them alive during the operation. Other times it's mostly a judgemental call made by the doctor and the care team, which includes us RTs. Here are some other indications: Ventilatory and Oxygen failure that might occur with asthma, COPD or pneumonia; to protect the airway of a comatose patient or patient who has lost his gag reflex; signs of impending failure where the airway will need to be secure, such as a trauma or burn patient.
   
8. Holter wheeze: You lost me.
   
9. What kinds of potassium does nursing homes give patients: I have no clue why this query was linked to my sight. I would have to refer you to one of my fellow RN medblogs for this. Check out the links to the right.
   
10. Can a peak flow meter be used for anything else: They are typically beneficial and helpful for helping asthma patients. Other than that, I suppose you could experiment. You could use it as a cool children's toy. You could have a competition during the last day of school to see who can blow the highest number. The winner gets a lolly pop.

That concluses this session.

Your Respiratory Therapy Search Engine Queries: Here are the responses from the RT Cave

I don't really spend a lot of time checking my stat counter, but about once a week I check it out for fun just to see who's been clicking on my blog. One of my favorite things to do while I'm there is click on "Recent Keyword Activity."

This is where my stat counter records what was typed into a search engine, such as Google or Yahoo, that led someone to clicking on my website. A few of the searches have nothing to do with respiratory, such as "Scratchy Neck," but the majority are respiratory related.

As I glance through the list, I wonder if that person had his question or concern answered. And, I think, they should just email me and I'd give them a legitimate reply, or at least I could tell them I don't know.

The reason I think this way is that some of these questions could only possibly be answered by an RT. So, with that in mind, I have listed some of the "recent keyword activity," and my humble responses.

1. "blowing into computer for respiratory": Um, I have no clue.


2. "Itchy neck pain": Um, how did that cause Google to link you to me.


3. "Duoneb pediatrics": Some studies show it works well in ER. Other than that I'd recommend just Albuteral. Personally, though, I don't see what it would hurt.


4. "Doctor doesn't believe in Peek flow meters: The doctor is a fool to disregard the benefits of a peek flow meter. It's a great tool to use in asthmatics to measure the effect of a breathing treatment, and to be an adequate tool to determine when to use a rescue inhaler, go to the doctor, or come here to the ER.


5. "Persistent croup": You can try the shower. You can taking the child outside in the cool air because many times it goes away on the way to the hospital. But don't be afraid to come in and get checked out. That's why we are here.


6. "Will Ventolin harm you if taken unprescribed": NO. However, I would not recommend it. If you have a need for Ventolin, you should go see your doctor.


7. "Does Albuterol Help Crackles?": No. The medicine particle size is too large to even get down in to the colapsed alveoli, and even if it did it wouldn't be able to re inflate it. But this is a great question, because often doctors prescribe Albuterol for this.


8. "Needle shot stings": Yes.


9. "How to write BiPap orders": With a pen in the doctors order section. It works best if you write the doctor's name followed by your signature. Plus I'd write "RT to set up BiPap to patient tolerance." Seriously, every patient is different, and every patient tolerates BiPap differently. That's how we write the order where I work.


10. "House filled with smoke from fireplace fever coughing": I would recommend not having the fire in the fireplace if it causes you to have trouble breathing due to it. It may cause you to cough, but it will not cause the fever. However, if you do have a respiratory illness, it may exacerbate your problem. Also note that it is not uncommon for smoke to bother people with respiratory illnesses.


11. "Respiratory therapy one treatment at a time": I would recommend it, but sometimes you will have no choice. If your patient takes nebs at home, or if the nebs are not indicated, then you should be okay doing more than one treatment at a time, just make sure you are only one or two rooms away. This is where it really comes in handy to know your patient. However, if you are new at this, or not sure, then you should definitely do one at a time.


12. "I hate respiratory therapists": What's your point.


13. "Breathing treaments for pneumonia": Same as for the question on atelectasis above: Albuterol does not get down to the alveoli. Besides, Albuterol relaxes bronchiolar muscles, and there are no bronchiolar muscles in the alveoli anyway. However, if the pneumonia causes bronchospasm, the treatment might work. Usually the first treatment in ER does the trick. If I were a doctor, I'd order Albuterol Q4 prn for these patients so we can give a treatment if indicated.


14. "Coughing spasms albuterol": If it's caused by bronchospasm then Albuterol is a good idea, othersise what's the point. Albuterol will not cause someone to stop coughing if it is not caused by bronchospasm. Personally, I'd try one and see what happens. It's a safe medicine.


15. "COPD on BiPAP": It works. And if it keeps them off the vent, you'll be happy and so will the patient. I've kept many patients off the vent by using a BiPaP. The big problem here is patient compliance. You will have to do a good job of explaining and be very patient with the patient.
    
16. "How long are patients intubated for": Depends on how long it takes them to recover. Depends on how sick they are. Many times, with the new microprocessor ventilators, it takes only one or two days. But every patient is different. If you are the family of someone currently on a vent, you should talk to the RT for an explanation.


17. "Do you give breathing treatment for cough congestion?": Yes, many doctors do. But Albuterol is technically speaking indicated for bronchospasm only.


18. "Where should one live with asthma": While there was once an advantage to living in dry areas like Arizona, research shows that this is no longer a benefit due to air polution.


19. "Why do people need to be intubated": I like to tell people that they, or family member, need to be intubated to get over the hump when they are really having trouble breathing. It allows their lungs to rest. Unlike in the movies, it is also indicated when someone goes into cardiac arrest. It is also done during certain surgeries, if someone is comatose to prevent aspiration, bronchoscopy, or you can check Wikipedia for more information.


20. "Tips for being a great respiratory therapist: Be patient. Don't be afraid to let other people take credit for your ideas. Do your homework. Most important, have fun with your patients and enjoy your job.

Well, I could go on, but I figure I had best stop at 20. There were many that I chose not to list here just because I saw via the stat counter that the person was linked to one of my articles where I know they would have found the answer if they read it.

Perhaps I'll make this a regular feature on this blog.

Peak flow meter compliance in question

I always forget to do peak flows when I 'm working in the emergency room. In fact, I've been cornered by my boss more times regarding this than anything else. I admit I should remember to do them, but I still continue to forget.

We used to have to do peak flows on all patients, but one of my co-workers complained that we were wasting our money doing peak flows on patients other than asthmatics. And this might be part of my problem, as if I did them on everyone I'd never forget.

Still, occasionally, we have a new doctor order a peak flow on a COPD patient, but it is my experience that the peak flow number on about 90% of them goes down after the treatment as opposed to up. And then the doctor thinks he has to admit the patient based on the peak flow alone.

In fact, while the American Lung Association states they may be used for COPD, some lung organizations, like the National Lung Health Education Program, note point blank, "This device SHOULD NOT be used to diagnose or monitor COPD."

I don't know how credible that second website there is, but I agree with it.

The idea of using the peak flow meter is something that has been taught to child asthmatics for about 30 years now. From all my hospital visits when I was a kid, I have probably 30 of them crammed into a bag in my basement. Some might even be antiques by now.

The general idea behind peak flows is that the child will use it as a guide or "tool", according to NationalJewish.com, which has a great tutorial on using peak flows.

"Your peak flow meter is only an aide," the site states, "to you. Do not rely on your peak flow numbers alone when deciding whether to take your rescue medicine or call your doctor. Your symptoms also need to be considered."

The general idea is that they go home, blow in the meter morning and night for two weeks to obtain a normal value or "personal best". After that, they are taught to blow in the meter once a day, or if they are feeling asthma symptoms.

If the peak flow number is 80% of the patient's "personal best," the child is expected to use his rescue inhaler. And, after 20 minutes, if the peak flow is not back to normal then the patient is expected to call his or her doctor.

If the inhaler doesn't work, the patient is supposed to go see his or her doctor. If the number is 60% of normal, the patient is supposed to consider this an emergency, take the rescue medicine, and go the the doctor or emergency room.

The problem I see as an RT is this: very few asthmatics are compliant with their peak flow meters. In the past year, I remember one patient who used her meter on a regular basis, and knew what her normal value was. But she was an adult, and didn't need the peak flow to know she needed to be in the emergency room.

As far as I an remember, that was the only compliant patient I've ever had here.

When I was a kid I never used my meter. When I was breathing good I had better things to think about than blowing into that darn thing, and I suspect most kids are the same way. However, it probably would have been a good idea had I done so, may have even saved me some stress.

I did find one study about compliance, and it showed that about 80% of asthmatics were indeed noncompliance, however the study must have been inconclusive, as it called for more studies on the matter. I think that would be a good study.

So, while the peak flow meter is an effective tool for asthmatics, especially asthmatic children, I will continue to question patient compliance with the device.