Showing posts with label rt creed. Show all posts
Showing posts with label rt creed. Show all posts

Monday, April 7, 2025

How To Order Acapella (a.k.a. Crapapella)

What They Teach in RT School

Description & Indication:
The Acapella device is a medical tool designed to help loosen and remove thick, stubborn mucus from the airways. When a patient exhales into the mouthpiece, it generates vibrations that travel through the airways, helping to dislodge mucus. This device is commonly used for people with lung conditions such as cystic fibrosis, bronchiectasis, or COPD. It is particularly helpful for patients who struggle with coughing up phlegm or have difficulty clearing their airways.

How to order them? An RT will recommend one and give it to the patient if it's needed. 

What They Teach in Medical School

Description & Indication:
The Acapella device is a magical contraption that helps patients bring up secretions—whether they have secretions or not. Clear lung sounds? No problem! This device can apparently summon mucus from thin air. Need to "treat" someone who has absolutely no issue coughing? Perfect! The Acapella is your go-to device for solving problems that don’t exist.

How to order them? If you think of it order it. It can't hurt. Who cares about RTs complaining that they are overworked. 

Sunday, December 29, 2024

Decoding the Nebulizer: How Hospitalists Choose the Magic Mix

The "REAL Physician's Creed" is a highly classified and esoteric document, designed exclusively for hospitalists. Through our covert and undisclosed sources, we have obtained access to this "document" and its latest update.

Please keep this information strictly to yourself—should your hospitalists discover that you’ve gained access, they may take steps to shut down this blog. Use this insight wisely, not just for your amusement, but to better understand the absurdity behind some of the orders we all encounter.

--------------------------------------------------------------------------

To Whom It May Concern:

In the spirit of evidence-based medicine (or, at least, medicine that feels evidence-based), we at the Real Doctor’s Creed Administration have made some updates to our guiding principles. These are, of course, grounded in the timeless medical philosophy: "If it sounds reasonable, why waste time proving it?"

For instance, research suggests that water is good for the lungs. Rather than waste valuable time with studies, let’s simply agree this makes sense and get on with it. After all, we often ignore inconvenient findings from studies anyway. Consider nebulizers and inhalers. The research clearly states that inhalers with proper technique work just as well as nebulizers. Yet, in our infinite wisdom, we prefer to order QID nebulizers (or Q4ever, meaning "until discharge"). And if respiratory therapy dares to discontinue treatments using their so-called "protocols," we simply re-order them. Because why follow protocol when you can wield authority?

Now, in 2024, we’re embracing the same spirit of untested brilliance with a groundbreaking update to the Creed. We propose that the effectiveness of a treatment be directly correlated with the amount of solution poured into the nebulizer. A simple, elegant idea, isn’t it?

Here’s how it works:

  1. If a patient with COPD, pneumonia, pneumovirus, influenza, parainfluenza, COVID, or heart failure hasn’t improved after two days of Albuterol, Levalbuterol, or Duoneb treatments, don’t bother considering other explanations. Instead, refer to the Creed.

  2. Add more solution to the nebulizer. Not because there’s evidence to support it, but because it feels like we’re doing something. For best results, try:

    • 4cc of hypertonic saline (especially if mucus plugging shows up on x-ray)
    • Pulmicort, because why not?
    • Performist/ Formotorol (and don't bother d/cing the duoneb or albuterol as duplicate orders are okay with us
    • Mucomyst (especially if mucus plugging shows up on x-ray)
    • If the patient has been using Albuterol alone, switch to Duoneb. The irony of giving a muscarinic to dry out lungs and hypertonic saline and mucomyst to thin and increase secretions can be just ignored. 
  3. Ensure treatments are ordered Q4 or Q6. The goal is to maximize the length of treatments, ideally to the point of inconveniencing respiratory therapists. If they’re annoyed, it must be working.

By adhering to this new protocol, we uphold our longstanding commitment to decisions driven not by science, but by intuition, tradition, and the thrill of making things up as we go.

Yours in medicine,
The Real Doctor’s Creed Administration

P.S. If this update creates any confusion among staff, refer them to the nebulizer for clarity. It’s bound to fix something.

Friday, November 4, 2022

Instant Pneumonia: An Illness Doctors Just Made Up

The following is an update to the Real Doctor's Creed. We have come upon this top secret (shared only with the medical community) information. We will continue to share these as we gain access to them. At the present time we have several spies in the medical community, making it possible to publish the Creed right here on the RT Cave. 

Doctor's Creed: Update 10/1/2022

Add the following to the pneumonia section of your booklets. Please do not publish online, as we do not want respiratory therapists to have an opportunity to hack into our esoteric wisdom. 

So, we know what pneumonia is. It is a condition caused by a virus or (usually) a bacteria. Walls of alveoli become inflamed. And this causes puss and fluid to fill alveoli. This renders the affected air exchange units less effective. And a may result here is soreness (especially with a deep breath), shortness of breath, and lowered oxygen levels. And, if severe and untreated, potential death. 

Now there is a new type of pneumonia. And it results from aspirating large doses of stomach contents. It is generally not caused by aspirating small amounts of stomach contents over time, as that would be diagnosed as GERD. But, if you aspirate large amounts of stomach contents (such as due to a drug overdose), then this is referred to as aspiration. 

A new study, one never performed by the fake left leaning scientific community, has now determined that aspiration INSTANTLY results in pneumonia. And this would help explain why we doctors are now able to diagnose patients with "Aspiration Pneumonia" instantly following aspiration. 

Respiratory therapists have often said things like: "Now, how the hell can someone develop instant pneumnonia? It usually takes time for alveolar walls to become inflamed." Or they say things like, "It should be called 'aspiration' not 'aspiration pneumonia'"

We in the medical community know better! We understand that unwanted fluid in the lungs from aspiration is "automatic" and "instant" pneumonia. Sure, there may be no inflammation right away. But, still, the aspirated contents fill alveoli meeting our definition of pneumonia. 

Besides, a consensus of doctors agrees with this author. And therefore it must be true. 

Also, insurance people love pneumonia and are willing to fully reimburse hospitals for pneumonia. So, adding the term "pneumonia" to the term "aspiration" shall guarantee the highest reimbursement potential for your patients admission. 

Monday, February 29, 2016

Dr. Creed: Rules for PEEP

Warning: What follows is top secret information surreptitiously leaked to me via one of the nations elite pulmonologists from an elite teaching hospital. Read at your own risk. This is not edited.



Appendix 7
Rules for PEEP/ CPAP/ EPAPt:

So, when do you increase PEEP. To answer this we have to understand what PEEP is. 

PEEP is an abbreviation for Positive End Expiratory Pressure. When used on a ventilator it is called PEEP. When referring to noninvasive ventilation it is called EPAP, which is an abbreviation for End Positive Airway Pressure.  When used alone, it is referred to as CPAP (Continuous Positive Airway Pressure). 

Essentially, PEEP, EPAP, and CPAP are the same thing, only the terms vary depending on what type of machine is applying the pressure (ventilator, BiPAP, or CPAP machine). The unique terms help caregivers tell know what device is being referred to: Ventilator, CPAP, or BiPAP. 

Whether called PEEP, EPAP or CPAP, it is a constant flow during expiration to keep the pressure inside the airways above atmospheric pressure. It increases FRC, or Forced Residual Capacity. This is the amount of air left in the lungs at end expiration. By keeping some air inside the airways, it prevents them from collapsing. Essentially, it:
  • Prevents muscles of the upper airway from collapsing. Some individuals develop flaccid muscles around the upper airway that may collapse during end expiration, resulting in upper airway obstruction. This causes obstructive sleep apnea. It may result in apnea and hypoxemia. CPAP alone may keep upper airways from collapsing to keep these airways open. Studies have confirmed this, so RTs will usually agree with this theory
  • Alveoli may collapse at end expiration, resulting in V/Q mismatching and hypoxemia. CPAP, EPAP, and PEEP prevent these alveoli from collapsing, thus improving oxygenation. Studies have confirmed this, so RTs will usually support this theory too. 
  • By keeping atmospheric pressure in the lungs above room air atmospheric pressure, this helps to push fluid out of the lungs. It also prevents the buldup of fluid in the lungs. So, if you have a patient who you suspect might eventually get fluid in the lungs, PEEP will prevent it. So, even if the ABGs are normal, PEEP, CPAP and BIPAP might be indicated. No study has ever confirmed this, so RTs will usually argue with you, and contest that all PEEP does is reduce cardiac output (blood pressure) which reduces blood flow to the lungs. We doctors go by what sounds good, not by what's proven. It sounds good, so it must be true. 
Conventional uses for positive expiratory pressure.
  1. To keep airways open
  2. To improve oxygenation
Unconventional uses of positive expiratory pressure include. 

1.  You have a patient in renal failure. His ABGs come back pH 7.37, CO2 48, PO2 90.  The patient has a history of pulmonary edema due to renal failure. In order to prevent pulmonary edema, order BiPAP.

2.  You have a patient on a ventilator with the following settings. PEEP 5, Vt 500, rr 12, hr 89, SpO2 94, PO2 87, pH 7.39, CO2 39.  The patient has had trouble with pulonary edema. So, what do you do? You increase PEEP to 10. RTs will cringe, but you know it works because it feels good. 

Sunday, September 13, 2015

H.R. 3862: Obamacare Amendment

H.R.3862 - Respiratory Care Amendment to Obamacare 115th Congress (2015-2016)

Sponsor: Rep. Ding, Bill  [R-NY-11] (Introduced 03/06/2015)
Committees: House - Ways and Means
Latest Action: 04/23/2015 Referred to the Subcommittee on How to Screw Up Healthcare Even More

Shown Here:
Introduced in House (03/06/2015)

Amendment to Obamacare  - Amends the Patient Protection and Affordable Care Act of 2010 to:
  • Creates many senseless policies to ensure a high procedure count for respiratory therapists; to assure that they can keep their jobs; to keep the U3 unemployment number as high as we can get it so we can assure the president looks good.
  • Authorize the newly created state police to better prepare patients for emergency services in the hospital setting.  
  • Mandate that all patients with lung diseases be clean shaven so it's easier to fit a BiPAP mask over their faces.  
  • Based on studies that show the COPD patients who wear BiPAP at home are less likely to make repeated and costly visits to the emergency room, it is requires that all COPD patients be fitted with, at a minimum, the cheapest BiPAP equipment and be required to wear it between the hours of 10 p.m. and 6 a.m.  Settings will be made up by physician rather than wasting government monies on sleep studies or relying on a respiratory therapist who knows how to actually manage the BiPAP.
  • Requires all physicians to talk to their patients about end of life planning so physicians no longer have to waste their time asking, and respiratory therapists and nurses no longer have to waste valuable time that could be spent watching reruns of Columbo wondering.  
  • Requires that all respiratory therapists prioritize emergency room patients over all other patients, even if the patient in ER was using it as a medical clinic.  
  • Further enforces that all patients who are to be admitted to the hospital must be sick enough to have received three bronchodilator breathing treatments in the emergency room.  
  • Once admitted to the hospital, all respiratory patients or patients who produce or might eventually produce annoying lung sounds (i.e. asthma, pneumonia, heart failure, pulmonary fibrosis, kidney failure, faux pneumonia, phthisis, lung cancer, ETOH, dehydration, Sepsis, DIC, altered mental, over the age of 85, on a ventilator, will be on a ventilator, might need a ventilator, requires BiPAP, smells nasty, is annoying to nurses and doctors, sun downers, etc.) must require at least a minimum of four breathing treatments a day to meet criteria for admission and criteria for 
  • On the other hand, if a patient really does require 3-4 breathing treatments in the emergency room, this certainly does qualify them for admission.  It is, however, essential that these patients be ordered to receive Q4ever breathing treatments. 
  • Initial orders for breathing treatments for children under the age of 10 must include Q2 times 4, Q3, times 4, then Q4-6.  It is also highly recommended that mucomyst and pulmicort be thrown in.
  • No two respiratory medicines can be mixed in the same nebulizer.
  • All nebulizers must be cleaned with normal saline after each use by a respiratory therapist.  Surely there is no evidence this will do any good, but it makes us feel like we are doing something useful
  • Requires that all patients show evidence that they are trying to obtain their ideal body weight, with a three year time frame to obtain it.  Punishment for violators is: 1st offense -- 3 days forced BiPAP with a rate set 6 higher than spontaneous rate; 2nd offense -- one practice intubation and extubation (to be performed after office hours as to not interfere with profitable hours); 3rd offense -- a practice intubation by a first year respiratory therapy student followed by one day on a mechanical ventilator without any sedation and run by a physician who barely passed med school and was trained at the same school that teaches physicians not to oxygenate ALL COPD patients.  
  • The 15 year phase-in of a respiratory therapy bachelor's requirement for all respiratory therapists, because just having an associate's degree does not qualify someone to know more than a physician. Of course a bachelor's degree won't either, but, hey, we like to create laws that don't make sense. Violators will be subject to an increasing workload of stupid doctor orders until retirement (which may be forced, because dogmatic, seasoned therapists know too much and must be stopped from educating the young ones that we are tying to indoctrinate.  
  • Nurses and respiratory therapist must scan a patient's band and the medicine prior to administering a medicine, regardless of how urgent it is needed.  Patient suffering and risk of not administering a medicine is no reason to skip steps and cut corners.  Punishment for violators is spend a week doing nothing but making wrist bands for patients. 
  • Punishment for taking the time to check and see what someone else charted and just copying it is branding with the word "Dipshit!" or "Dingdong!" on forehead.  
  • Respiratory therapists are no longer allowed to write "no change" or "no difference" in the post treatment assessment phase.  The reason for this is because we know (we, as in people who sit in suit coats in Washington) that no doctor would order a breathing treatment unless it had some potential benefit.  "No Effect" is likewise unacceptable in the post treatment charting area.  Punishment for violation will be to read the entire 3,000 pages of the Patient Protection and Affordable Care Act

Sunday, August 30, 2015

'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

Saturday, August 22, 2015

Study: Secondhand albuterol linked with side effects

A new report published in the Journal of the Respiratory Creed suggests that second hand albuterol has side effects that may include grumpiness, apathy, burnout, a dry sense of humor, increased wisdom, and the ability to differentiate pneumonia and heart failure from bronchospasm without even seeing the patient.

Researchers followed 1,600 newly graduated respiratory therapists over a period of ten years between July 7, 2002 and July 14, 2012.  Six hundred sixty of the therapists gave an average of 10 albuterol breathing treatments in a given day.  A control group of 720 therapists was given a placebo to give to their patients.  But they were told to just sit in the RT Cave and watch movies on Netflix or play on their iPhones.  Six hundred twenty therapists were disqualified for already having been diagnosed with respiratory therapy apathy syndrome (RATS).

The results showed that 100% of the therapists who gave albuterol breathing treatments developed the symptoms, with 75% experiencing increased incite within the first year doling out treatments (a minimum of 36 hour work week was required of all participants), and 82.5% developing a dry sense of humor within the first eight months.

Level of IQ was tested using a typical IQ scale, although adjusted for respiratory therapy wisdom.  A typical question might entail, "Is heart failure treated with Ventolin?"  Members of the control group were too bound to their fantasy world's to have time to answer the question.  Members of the non-control group all answered the question correctly, with one scratching a comment in the margins of the test (taken on paper because because), "Are you kidding me!  Of course not."

The study was the first ever study to study the study abilities of respiratory therapists and the possible impact that ventolin may have on their demeanor.

"It was just amazing the results that we discovered by doing this simple scientific study," said Dr. Carl Olin of Westbrook University where the study was conducted.  "Who ever would have thought that people with only an associate's degree could actually know more about respiratory therapy than physicians?"

Cal Tripper, Medical Director of Respiratory Therapy at Buterol University, said, "It has been observed for years that respiratory therapists display a unique wisdom, particularly regarding respiratory therapy, although it was tough to put a finger on the reason before this study.  I highly recommend to other physicians to talk to a respiratory therapist, ask them if they have an opinion or a recommendation, the next time a patient has respiratory complications.  The truth to the matter is, even though they only have associate's degrees, they may actually know more than we do about how to manage respiratory therapy.  And it's all because of second hand albuterol."