Stuffy nose season

It's stuffy nose season.

Every kid in town with a stuffy nose commith to the ER, gets 2 breathing treatments to no effect, and then gets admitted and placed on Q4 breathing treatments for same runny nose.

And, ironically, the mom's say something along the lines of: "Golly, I should have just stayed home."

Gee, ya think.

Yet, if it weren't for the progressive surge on America for the "good of society," and their happy lawyers, we wouldn't be in this mess now would we. Or would we?

Instead of treating the patient, doctors are forced to treat patients in a way that prevents lawsuits and assures payment rather than doing what's really in the best interest of the patient.

It's unfortunate.

Of course we don't want patients staying home when they really need to be seen (like the guy we had come in the other day with a hemoglobin of 2.2 because he though he just had a cold). Yet we don't want to encourage moms to bring their kids to the ER with a common cold either.

Does healthcare reform really solve this problem, or make it worse? Would tort reform solve the problem of happy lawyers? Should we spend more time educating people so they know when to come to the ER? Do we need more government involvement or less?

One thing we must keep in mind is the U.S. has the best healthcare system in the world, so we don't want to do anything to mess this up. If someone says our healthcare system is not the best, I will ignore them.

I say this because some among us, including some in Washington, claim our healthcare system is bad just so people come crawling to them for the solution they have in the wait. We must not fall for this gag.

Or is doctor education the solution? Or how about patient education? Personally, I think the solution shouldn't fall on the patients, as they should be ignorant of medicine. Like national defence, healthcare should be taken for granted. People should be able to enjoy their lives without having to worry about these things.

I'm not encouraging stupidity either. I'm just saying I think the solution to the healthcare crisis should be in the hands of the physicians and the scientists and researchers. It should not be in the hands of the Fed, and -- likewise -- the people shouldn't have to worry about it either.

Healthcare should be in the hands of healthcare people. Yet more education all the way around never hurts.

So it's stuffy nose season. Doctors in hospitals are going to go overboard in treating these patients because they have no choice. If you go to the doctor's office, you won't be poked and prodded. If you go to the ER, you will be poked and prodded because doctors have to cover their asses. (It's the CYA protocol).

Personally, I think something needs to be done to encourage patients to see their family doctors for minor things like stuffy noses, and stay out of the ER. Yet hospitals want you in the ER, so getting to the bottom of this stuffy mess is going to remain a conundrum.

Sodutions adyone?

Okay, enough with the sick kids!

We had another sick kid tonight. He was a one-year-old boy and he was seizing. Perhaps it was due to a fever, but perhaps it was something else. I may never know, as he was shipped off to the big city hospital once we had him stabilized.

He was given Valium and stopped breathing, so we had to bag and ultimately intubate. We actually procrastinated on the intubation hoping he would wake up, but he never really did. He gasped about twice a minute, and had some un-purposeful movements, but that was it.

No previous medical history, the family insisted.

You always wonder if you really get the whole story. The mom and dad brought him in by car, and said he was not acting right for about a half hour before he was seen by a doctor in the ER. Who knows if he was hypoxic in that time and that was why he was still seizing two hours later when he was finally shipped. By this time he was even posturing.

Seriously, this kid never really stopped seizing. After we had him intubated he was stiff to bag. His whole body was stiff. His eyes were rolling in his head. He was seizing. There were three doctors in the room, so I'm sure he was getting the best care possible.

But still, when the Big City Helicopter crew arrived I was thanking them left and right. The little boy was still seizing as the flight crew carted him off.

Due to hippa, though, we might never know what happened. I hate Hippa.

This was my third bad kid in the last year. Three is a charm, and that's enough for a while.

She slipped and dropped her baby

Somewhere I read that one of the biggest fears of a parent is accidentally dropping a baby. Unfortunately, that fear sometimes becomes reality, as I learned tonight.

It was difficult to get all the details from the upset mother, but she said she fell and her 2-month-old baby was tossed into the air, landing on his head. CPR was started and the baby was rushed to the hospital.

By the time the baby was in the ER, it was breathing fine, but it had occasional episodes of apnea. And it was relatively limp, and occasionally it would let out a cry. It would also cry to painful stimuli, but it did not fight otherwise. It was pale and just didn't look good.

I already had a #3.5 ETT ready to go, but the baby WAS breathing with an SpO2 of 100% on room air, so I just stood by. I humbly watched as the nurses and the DR. struggled to put in an IV, and then I watched as the doctor screwed in the inner-osseous port. I had learned about this in ACLS last fall, but had never seen it done.

The baby needed an airway, so we intubated. It was a very smooth operation, considering none of us work with baby's as often as we work with adults. But thankfully we have our bi-annual check offs and reviews of such a situation JUST IN CASE.

Today, the JUST IN CASE became real. It was really sad when the mom came in. She was a wreck, and understandably so. I have no idea how I would react if I would have dropped my baby. I might just be a wreck too.

But, as a member of the medical team, we couldn't let emotion effect us. It's neat how cool and calm we can be while we work on someone's limp baby. It was sad. But we had a job to do, and we did a great job.

We stabilized the baby, and within 45 minutes he was on his way to Big City hospital. That's what we do here. We stabilize and ship. We do whatever we can to give a sick baby a chance.

We never had time to do a cat scan. Perhaps a head bleed?

Because of Hippa, though, we may never get an update.

I'm not in the business of criticizing a young mother, especially because this very easily could happen to anyone.

Still, this is a reminder that we should never take these fears of dropping a baby for granted.

Help out a girl with a rare disease called chILD

We have a greater mission today, and that is to help out the cute little girl in the picture to the left.

Bob Sherman, my fellow RT blogger over at Respiratory Report, has written a couple posts about Julia Roberson, who has been stricken with a rare disease called Children's Interstitial Lung Disease (chILD).

She is involved in a fundraiser in an effort to raise money. Click here to learn more.

I've taken care of patients with interstitial lung diseases (ILD) before, but all of them were adult with idiopathic pulmonary fibrosis. This would be a disease that causes scarring in the distal air passages that causes the lungs to stiffen and decreases the lung's ability to exchange gases. Interstitial pneumonia is also considered a type of ILD.

One of my favorite all time patients was a 40-year-old lady with pulmonary fibrosis. Her and I used to have some really cool discussions, but only while she had her BiPAP on. She told me she hated that BiPAP, but that's what was needed to maintain an SpO2 level even in the mid 80s. That and lots of supplemental oxygen. And even with it on she remained dyspneic.

She told me one night, shortly before she died, that she so much wished that she would get better so she could help other people who had a disease that made it difficult to breath. She was thinking of other people even while she knew she was dying, and for that I respected and admired her greatly.

But there was nothing she could do to stop the disease process, as so little was known about it. Likewise, very little is known about chILD.

So what exactly is chILD? The cause is idiopathic, or of unknown origin. But there are some theories.

child Foundation reports that adult ILD is different than child ILD. It involves a series of diseases "that vary in their severity and in their long term outcomes. In simplest terms, all types of chILD decrease a child’s ability to supply oxygen to their body. If you suspect your child has chILD a pediatric pulmonologist with expertise in chILD should be consulted."

According to emedicine, and per the most recent research, the process is believed to be the result of "tissue injury with aberrant wound healing resulting in collagenous fibrosis." This ultimately leads to "structural remodeling (scarring) of the distal airspaces, leading to impaired gas exchange."

While the exact cause is questioned, it is theorized that the disease process is the result of "some type of lung injury to the distal air spaces caused by the adenovirus (RSV), or exposure to organic dust. This results in damage to the epithelial or endothelial layers and the associated basement membrane."

It is very rare for such a disease to inflict a child, but when it does the mean life expectancy has been just 47 months.

According to the chILD Foundation, after ruling out other diseases, a child would be considered to have this disease if he or she has three of the following:

• Fast breathing
• Use of accessory muscles
• Abnormal chest x-ray
• Need for supplemental oxygen
• Failure to gain weight
• Persistent crackles, wheezing or other abnormal sounds heard during auscultation
• Recurrent pneumonia
• Recurrent bronchiolitis
• Recurrent cough

A more definitive diagnosis would come from a lung biopsy.

So, very little is known about this disease, and there is no cure. Which is why more money is needed to research it.

The respiratory report writes that "Julia is going to participate in the Respiratory Health Association of Metropolitan Chicago’s 2008 Hike for Lung Health. She has set a fundraising goal and I want to help her reach that goal. If each person who reads this article would donate $10.00 to Julia’s effort along with $10.00 to chILD Foundation, you would be doing so much more than that for her and her family’s spirit. Continue reading →"

So, we here at the RT Cave urge you to open up your hearts and your wallets, and click on this link for more information about Julia Roberson and her rare illness. Or, click on one of the links above to help her out.

Stop smoking in front of your kids. Period.

Here's another issue that could be discussed in ethics class at some lengths. Or, better yet, a great topic for Stupid People 101. What do stupid people do? Stupid people smoke in front of their kids, that's what they do.

I'm so sick and tired of taking care of kids because their parents are too stupid to know better. Kids do not know any better, and therefore it is the responsibility of parents to create a safe, clean and healthy environment for their kids.

Smoking in front of your kids is not safe, clean nor healthy. In fact, it is just plane stupid and irresponsible. It may have been acceptable 50 years ago because people didn't know any better, but there is so much information out there, there are no more excuses for this kind of stupidity and ignorance.

The fact is, smoking in front of little boys and girls is hazardous to their health if they have healthy little lungs, let alone bad lungs already.

I'm not a fan of making a laws just because, but I'd be willing to make an exception for a law to make it illegal to smoke in front of kids. Then I could take half the mom's who bring kids to the hospital and put them away for 30-90 days for causing their kids to get sick. Maybe that's what's needed to knock some sense into them.

Tonight I took care of yet another little boy who was having an asthma attack. And I didn't even need to ask my usual 101 questions to know the mom smoked in front of her child, as they both smelled of smoke. Yet I asked anyway, and the answer was a nonchalant, "Yes."

Pathetic, I say. Just pathetic. Pure stupid.

Is there any way possible that any parent in existence in the United States today can possibly not know how stupid it is to smoke in front of their kids, let alone a kid with asthma.

You sit there and watch your kid have an asthma attack. You love your child so much that you take him to the ER when he is having an attack, yet you don't know enough to not smoke in front of him. How stupid. How stupid you are.

Let this peon of an RT tell you something: If you want to ruin your own lungs and your own life by smoking, you have that choice. Your son doesn't have the same choices you have. He has to live in the atmosphere you create.

It's your job to protect him. Do not destroy his life too. Don't smoke in front of him.

That is the thought of the day. Thoughts anyone.

Not working hard and appreciating it

I woke up early today, and the first thing that popped into my mind was the image of a little boy we had taken care of a while back. I decided as soon as I got to work I was going to check on him via his mother's blog.

Now here I sit. It is freezing cold here in the RT cave. Even with the thermometer turned up to 85 I can still feel a draft coming from the window. And, considering we only have seven patients on our RT list, I have plenty of time to sit here at this computer, which sits on a table right in front of that window with the draft.

Seven patients seems like a lot these days, considering when I came in Thursday night we only had 2 patients. By the end of that night we were up to a whopping three patients, the third of whom actually took up some of my time during that night, but it was still a major task staying awake by morning.

Last night our patient load escalated all the way up to four, but two were QID and one Q4 W/A, so I ended up not giving any of them treatments all night because I'm certainly not going to wake a patient up whose sleeping comfortably. So, what I ended up with was a hell of a lot of time on my hands.

By six in the morning, after spending the majority of the night right here completing some projects and, of course, just a little blogging, I was feeling very sleepy. This wouldn't bother me so much if I were actually doing something, but since I was sitting around so much I needed tooth picks to keep my eyes open, and what I looked forward to more than anything was going home for no better reason than to give my butt cheeks a rest.

I really haven't had an interesting case worth writing about lately, which is unfortunate because I have the time to write. The ironic thing is, if I worked at a larger hospital like some of you other RT and RN bloggers out there, I'd probably have many interesting cases to write about, but no time to write. So, I suppose, that's life.

Last night around six, eyes burning, I slouched back in a chair behind the critical care desk and had a real philosophical discussion about God. It seems when you are most tired, like say after 2 a.m., is when these discussions occur. The discussion seemed really enlightening at the time, and I thought I might write about it later, but, for the life of me, I can't remember the details.

Oh, I suppose this might have something to do with the fact that at around 6:30 it seemed the discussion rested mostly between my two RN co-workers, and I decided to rest my eyes a minute. I will do this just a few minutes, I thought, and then I'll go out and do my QID treatments."

I opened my eyes and looked up at the clock: it read 6:55. My co-workers were still rapt in their discussion. I don't think they even had a clue I had fallen asleep.

Here I sit; the cool draft causing me to shake slightly as I click away these words. I'll eat my lunch soon, finish off my two treatments, and then I'll end up right back here for a few hours unless the emergency room finds other things for me to do.

And I feel fortunate nonetheless. When I have nights like this, at work, I think of how many 18 hour days my dad put in, and his dad before him. And I think how many people have sacrificed their lives over the years so I can have this. I thank them.

Thinking of this makes me appreciate all the more how wonderful a life I have, especially to have a great job like I do.

This reminds me of the little boy again, so I clicked on his mother's blog.

He was transferred from out services to the Big City hospital and placed on an ECMO machine within a few days. If you're not familiar with ECMO, that's a machine that removes the blood from your body and oxygenates it, giving your lungs and heart a rest and time to heal.

She wrote how she was informed by the doctors that there was a chance the boy would survive, but it would be a long and difficult road.

Going on an ECMO machine is nothing like the ECMO machine used in an episode of ER that I watched two nights ago, where the patient was put on an ECMO machine right in the emergency room and taken off five hours later. This boy's doctor said it would be a minimum of three weeks.

I know very little about ECMO other than what I was taught in a brief two hour lesson when I was in RT school. I did see one once when I was an RT student at a large University pediatric hospital in our state, and what I remember is a roomful of machines, IV's and other machines and, right in the middle, this tiny patient.

In doing my research, I learned that there were other children who had swallowed kerosene and survived. Two I read about were placed on ventilators, and another was on an ECMO, and all three of them survived.

This mother was well aware of this, and this gave her hope.

I read today the child passed away.

Now I didn't know this child, as I don't know probably 99% of the people who walk through these doors, but it's very nice when a family keeps us updated on people we cared for, even patients we stabilize in a few short hours and ship out.

While I feel for the child, and especially the mother, this situation acts as a reminder to us all how fragile life is. It provides me a greater appreciation of how wonderful a life I have, and how great a job we have, even while I sit here freezing.

The saddest part of the job

There are a lot of tough parts about working in the medical field, but by far the worst is when you have to face the death of a boy or girl.

So the story goes, his mom thought he was watching TV with his brother. But, what he was really up to was riding his quad. It was snowing out, so he probably thought it would be fun to ride in the snow. But the fun turned on him, as the quad landed over his little 9-year-old body.

He was rushed to the hospital by ambulance, but he was probably already gone. Nonetheless, our staff worked on him for over 45 minutes hoping to defy the odds. Our general surgeon rushed in to help at the code, and we are thankful for his efforts, but in the end there was really nothing any of us could do.

I was told he didn't have any cuts or scrapes on his body, so whatever got to him must have been internal. Perhaps the pressure of the quad on his chest didn't allow him to breath and he suffocated. Perhaps he broke his neck. We're praying he broke his neck, because that would be the quick way to go.

While most of us are bagging, or inserting IV lines, or deciding what recommendations we could give to the doctor, the Doctor has the job of telling the child's mom that her son is not going to make it, and the rest have the job of consoling her. That, I think, would be the saddest job in the world. I'm glad I don't have to do it.

I've been in too many situations like this, and I can tell you the worst part is when you are still bagging and the family comes in to say their final good-byes. A rare person will walk from that room without a tear in his eye as the doctor says, "Okay, time of death 12:05."

The silence as everyone slowly sets down what they were doing and stares at the lifeless child, all saying their silent prayers. They stare at the child, sweet and innocent up to the end, even in his last daredevel act.

He was in the prime of his childhood. He will never to go on a date. He will never explore the world on his own. He will never again sit on his mom's back porch and feel the cool, fresh breeze upon his face. He will never hug his mom again. He will never play with his brother again. He will never play catch with his dad again.

But that's not the worse of it. The worst part is thinking how his mom is going to cope. Because I can't imagine anything that would be more difficult in this life than losing a child.

In an older person's death we find some solace in knowing they had a full life. In a middle-aged person we have solace knowing they died in their prime. There is no solace when a boy dies, only anger and regret.

Knowing the child is now with Jesus does little to make a mom feel solace, I'd imagine. Yet, that's where solace will come from in time.

I can't imagine anything worse than losing a child.