Monday, December 31, 2007

Chips Anyone?

Well I found this kind of interesting, the first of this medical device that I've had a patient actually using. OK let me explain this one.

I was doing a ECG on a patient in the ER tonight and the ECG machine was picking up a lot of artifacts on the tracing so I readjusted all my leads and checked my wires and disconnected the lead to the ER monitor and still the same with the artifacts but the ECG machine was saying it was detecting muscle tremors. Now here is the part the that I though was quite interesting the patient said to me "Could it be the chip a doctor had implanted in her when she had heart surgery last year?" so now I'm curious and I ask her what chip is she talking about and she continues to tell me that it was told to her after the surgery that the doctor implanted a microchip in her with information of her surgery for future knowledge.

Now I start thinking maybe this is one of the RFID chips that I have heard about which can carry your medical information. I'm thinking yes, but is this becoming more common practice now for different surgeries? Now I have to go searching.

What I found out is that the company Verichip is manufacturing a chip called the VeriMed chip which links you to a database they maintain and can be accessed with a RFID reader that some ER's and Hospitals are starting to carry.

I read this little interesting story also:

In May 2006, William Koretsky made medical history when he became the first
emergency patient to be identified from an implanted radiofrequency
identification (RFID) chip. Koretsky, a 44-year-old sergeant with the Bergen
County Police Department (NJ, USA), had crashed his car into a tree during a
high-speed chase. When he was taken to hospital, an emergency-room scan revealed an RFID chip in his arm, which had been implanted in 2004 for identification
purposes at the suggestion of his police chief. Doctors retrieved the ID number,
identified Koretsky using an online database, reviewed his health history and
learned that he had type 1 diabetes. While treating his other injuries,
physicians quickly began monitoring Koretsky's blood sugar level. The RFID chip,
which was manufactured by VeriChip (Delray Beach, FL, USA), might have saved his life. “I was unable to communicate, but the chip talked for me,” Koretsky said.
“I couldn't lose the chip, like I could a MedicAlert® bracelet. The VeriChip
was a home run.”

That I found in a great article about the Verichips and the different uses, which can be found here in the full article.

Looks like they are targeting people with diabetes, cancer, coronary heart disease, stroke, chronic obstructive pulmonary disease, cognitive impairments, seizure disorders and Alzheimer's, and people with complex medical device implants, such as pacemakers, stents, joint replacements and organ transplants. These are some patients where it could save a life is the clinicians could have information of the patient faster. The future seems to be coming around faster and faster all the time now, I have noticed that our tablet PC's we use for charting now at the bedside do have a RFID reader, along with the barcode reader but we don't use either of those YET.

So is this a good thing or is it to much "1984" like with the possiblity of Big Brother watching. It's one thing to microchip your dog or some other belonging but are we ready to have human's microchiped? I think I can become quite helpful, like a guy I read about a couple years ago in Wired Magazine who was microchipped and when he would come home the house knew this, as he walked through the house lights would turn on and off as he would move from one room to the next. Ok that's a little extreme and lazy but interesting nun the least. So are we ready for this, time will tell.

Drive on RT's

Friday, December 28, 2007

It's Pouring!!!

Remember that "Wow it's been really slow for awhile now" thing I wrote a couple posts back? Well it's over now, tonight has become hell night, so I'm not able to blog about what I wanted to but I will at a later time.

Well I've been hit with a ton of COPD patients tonight along with multiple Chest Pain which cause use to do EKG's. It's just been crazy and we are assuming that it was the nicer weather that awoke all the bacterias up and now it's getting colder and we are expecting 3-9 inches of snow today, so yep weather and barometric pressure change can really effect those people with COPD and it's happening tonight at my little hospital. It's also happening at my wife's big hospital were she is a ER nurse, they have been just as busy.

Here in my little slice of heaven I am the only RT on a night so I'm running all over with the new patients we are getting and I'm only able to write a little due to forgetting to get the chance to do the controls on our ABG machines so I'm doing that now. Actually I walk into here one is stuck in the MS Windows start up screen and is spitting out paper as I speak slowly, now what the hell do I do? I'm not trained to mess with this type of problem, oh well we have 2 machines and I'm going to assume that the broke one will run out of paper soon.

Well enough typing for me right now the paper is yelping at me again so back out into the war against COPD and when this is over I have a couple days off to actually get to enjoy my Christmas presents.

I'm still driving on.

Wednesday, December 26, 2007

Need a Harmonica player for your band?

I found this interesting article from the Arizona Republic about a program at the John C. Lincoln hospital in Phoenix Arizona.

Basically it is a class put on by Mike Clark, a registered respiratory therapist at the hospital where patients with mainly COPD are learning to play the Harmonica. By using the harmonica these patients can hear exactly how they are breathing along with learning a instrument and getting some PEP therapy along with it I'm sure. They used to use therapies for strengthening their lungs by blowing out candles, walking treadmills or blowing up small balloons but it sounds like this one is a bit more fun.

I have to say therapy must be easier to do and stay with it is interesting and fun. Can't help but be a little impressed with this "alternative therapy". I have noticed over the years that the people who do get this highest amount on their Incentive Spirometry seem to have played some type on instrument in the past, mostly it seemed to be a trumpet like instrument where you purse your lips to play. Well I don't smoke but if I ever get COPD, I'm taking up the trumpet.

In another note I was asked for a update on a patient I had recently blogged about so here is a update:

This patient is currently still on the ventilator but we were able to finally get the inspiratory pressures down in the mid to upper 20's on pressure control. The ABG's had PH's in the 7.20 range for about 3 days in a row with no improvement. Overall what seems to be happening to this person is backing up with fluid. There was a 9 pound gain in weight over my last night's shift. Today dialysis was given and over 5 liters were taken off and guess what happened? We were able to drop the PC pressure to 22 and the PO2 from the first gas after the Dialysis on 70% was in the 100's finally, before the last 3-4 days we were lucky to get it in the 50's. Now this isn't first round of dialysis but it seemed to be a bit more effective after the fluid was removed this time around. Think maybe we might be on the upswing with this one.

I might blog a bit more tonight if I can remember the other topic I wanted to talk about, sounded good at the time now It's slipped my mind.

Drive on all and hope you had a great Holiday.

Sunday, December 23, 2007


Ok just did 2 posting but this is kind of interesting to any night shifters out there.

My wife and I have been watching this show called Paranormal State which is basically about ghost and paranormal hunters. Its a show where the video the actual hunts and the attempt to contact and remove the paranormal activity, this in not a Docudrama its real footage.

Anyways there is a time called Dead time which they say is when there is the most paranormal activity and this time is between 3:00am and 4:00am. OK if this is true and we work in hospital where people die and there are surely ghost around, maybe we should keep our eyes open during this time. Kind of eerie.

What do you think, seen any ghosts at your hospital? I have at another I worked at in Germany while I was in the military, but I will keep that story for a later post.

Keep calm.

Cardiorespiratory Therapist?

So why does it seem that the duties of EKG's always fall in the hands of us RT's? Where we trained in cardiology, or given the knowledge of ECG/EKG's or even doing these tests on patients? I know I was never given a class on this type of testing during my schooling, but it the powers that be seem to think that EKG's should fall onto us RT's. Now I'm sure this isn't the case for all RT's who work in Hospitals, but so far in the last 11 years doing this it seem to be the standard where I have worked.

Now being a male RT doing EKG's can become a little touchy at times, but we must know to remain professional at all times also. Ok now I'm not trying to sound perverted but really is it to hard to ask for a hottie patient to do a EKG on every now and then, I think not. Really think about it what is our EKG population like and the problems the come with it.

As a man we have to handle these women's breasts which are in general terms a taboo region just to bear in front of a stranger. With the older women you can't help but wonder is this offends them due to how they were brought up. Middle age women usually there is a husband in the room with them and they of course are watching another man handle their women and I have yet to meet someone like Suzanne Summers in this age group. Then comes the large overweight women where you need a crane to lift those monsters to get a little sticker under their, sure wish they came with a kickstand. You actually wonder if they feel bad putting you under all that stress of lifting those things.

Now we get to the younger population of women, which is usually not the case for EKG's but it does happen. As a guy you might think great a woman I really don't mind touching but then professionalism takes over and you attempt to put these stickers on with averting your eyes as to not make her think you are staring at her in a way other then medically. Then there is the possibility of teenagers getting a EKG also and as a Dad with 2 girls, I do my best to keep them covered up because I don't want a parent thinking anything or being uncomfortable with a man touching their daughter.

As for the guys, who cares they don't. Just get it done and move on, these are the easy ones and the easiest to find their landmarks.

Over the multitude of EKG's I have done at this current hospital I work at my initial worries I had doing these has since gone out the door but those were real concerns at one time. Professionalism has taken over and I just get it done, try to make the patient feel comfortable and work on getting them covered back up as soon as possible. Yes I still get a little grossed out from the underboob sweat along with other funky things that are under there with the bigger women but we drive on and get the job done.

Yes some of use are CRT's .... CardioRespiratory Therapists, but please don't ask me what I see in that EKG because I cannot tell you because I'm only trained to put stickers on you.

Next Episode: What to look for on a EKG/ECG.

Moments of Busy.

As you might of noticed from my last post that we are really not all that busy here in my RT Cave, but we do have our moments of busy and last night was one of them.

I get here at my normal time of 1830 figuring on a pretty decent night. I do the normal thing, put my coat and my food in my locker and fridge and then page the RT on shift to see if they need any help, usually it's a "Nope, I'll be right up.". Well not this tonight it was more of a "Could you get started on the treatments and meet me in the ICU, or I'll find you when I'm done." Ok still nothing to really get me thinking busy, I mean our treatment load is 2 QID's and one Q4, sure I can knock that out.

After I get those 3 really tough nebs (sarcasm) done I head off down to the ICU to see if my partner needs any help, well yep she does with a patient who is vented. Now I notice that she is bagging this patient and the vent is next to her and running, so I ask whats going on? She had been bagging this patient for over a hour now because the vent will not ventilate the patient. I go ahead and check out the vent to make sure it's working properly and passes all the self tests ... Yep works just fine, this patient is crap.

I go ahead and take over the bagging and get some report, this patient is septic in falling deeper into ARDS (Adult Respiratory Distress Syndrome) and is so tight that on Assist Control the most tidal volume we can get in is 30-50 ml's, not good. Alright next try is Pressure Control, great we have a Inspiratory Pressure up to 40 with no peep and can only get about 100-150 ml's VT, still not good.

My Partners pager goes off ... now what. Of course it's nothing good, we have another patient that I had done a neb on just about 20 mins ago now crashing so off she goes and there I am bagging a patient who cannot ventilate and is stiff as a board.

So it's now a Hour and a Half later, my hands are cramping and I'm still bagging and trying to figure out what to do, well dialysis is called in to get some fluid, almost 5 kilo's are wanted to be taken off, and hey here comes my partner with the other patient behind her while she is pushing a bipap machine, great what the hell is going on there. Turns out he has a reaction to a antibiotic that was just given to him that looked just like orange juice, now I'd think that would be rough going in on the veins. With further questioning I find out that the med he was give required you to premedicate the patient with Tylenol and Benedryl before it's administered, wow hardcore stuff there.

Finally 2 hours later my partner is able to give me some relief in the bagging area and the dialysis is started finally and a half hour later we are able to ventilate with PC on the ventilator, phew finally we can step back and relax a bit.

Now This patient pretty much stayed the same during the night. I ran three ABG's on the patient and from number 1 to number 3 the biggest change was a PO2 from 45-49 to good in the oxygenation department and spo2 was showing in the low 80's, but Doc said he was good with that and really didn't know what else to do because nothing was working.

Now getting a chance to think of everything that happened you start to notice the limitations of a smaller hospital. Heli-Ox would of been nice but we have none of that. PRVC mode might of worked but we don't have that on the PB 840 vent, there is VC+ which is supposed to be like PRVC but didn't really work to well as I tried it. Would of been perfect patient to transfer out but the weather was crap. So what do you do? Improvise and do the best with what you have, what else can you do, in a way it does make you use you knowledge a bit more versus using technology so much.

I must say I do like interesting patients and this one is interesting. Tonight I get the honor to having this patient again and so far nothing is improving, just a little increase in the saturation of oxygen area, but that could be due to the peep going from 12-16 cmh2o today. So tonight my last day before Christmas working I am still slow, with a Ventilator and a Q4 neb but as we all know anything can change at anytime.

Happy Holidays.

Monday, December 17, 2007

Where's the patients?

Now I'm not complaining but it can get a little boring around here without patients to work with. Yes I'm talking about having no patients through the night and this is my 4Th shift in a row where it's been like this. Actually we have only 7 total patients that require our RT expertise, which is 5 more than there was 3 days ago.

It is damn cold here lately with a lot of snow and ice around so maybe the cold is killing all the Bactria's off so nothing to get anyone sick. That's not true the Flu is running through my house. My 9 year old had a Asthma flareup with vomiting from the Flu which then went to my 9 month old who has been vomiting for 4 days now, but better today. Now did anyone know that doc's don't give medication to babies anymore to help stop the vomiting? I didn't!!! Nor did my wife the ER nurse, but the pediatrician said there was a study of some sort and they don't recommend anti-vomiting meds anymore for babies, so we just had to keep washing his sheets and 6 changes of clothes a day. Anyways this also got passed onto my 3 year old, yep more vomiting and laundry washing along with diarrhea also....what fun. Now he was able to get Zofran (spelling) to help but not his brother, but with a ER nurse mom what do you think she did? Yep cut it in half to help the little one and it worked...well he had to eat something and keep it down he was losing weight plus he made me late one night. Just as I was getting ready to leave I was holding my son and of course...BLAAAHhhhhh...all over my scrubs. So of course I have to iron a new pair but what are you gonna do.

Is anyone else's census down? I'm curious how long this will continue because winter is usually the busy season. As of now I'm catching up with some DVDs I've been meaning to watch, cleaning the department a bit and just wandering around to stay awake.

Take care and Happy Holiday all.

Monday, December 3, 2007

Does smoking drive our profession?

Is it possible that smoking drives out profession? Is it also possible that the patient load of our profession could be decreasing significantly in the future?

This is just maybe a theory I have thought about but let me explain myself. If you look at the patients who we give nebulizer tx's to on a regular basis the majority of them are COPDer's and Asthmatics in trouble. Now say we cut out the COPDers and notice how much our census will drop because to me it seems that I see more COPDers than I do asthmatics so if we see less of them our census goes down right, also with more education and better use of medications there can be less of the admitted in the hospital. Here is a article showing this.

Self-Management Education for COPD Patients Cuts Hospital Admissions

There are a couple of sites that have shown that study that I have found, but I'm only going to post one for now.

Another way to look at my thoughts on how our census will decrease in the future goes like this: The majority of COPDers in the world are of a older age. Now here is where my thinking comes in so stay with me, but it shouldn't be that hard. Due to the fact that the COPDers are older and there wasn't a whole lot of education on the harmful effects of cigarette smoking at that time versus the education there is now (seriously the military packages cigarettes with the soldiers meals in WW2) and the perception of smoking has in the United States in today's day and age. It's getting banned everywhere, the price is increasing, there are warnings everywhere, you have to be a certain age, and it's almost getting to the point where it is illegal to smoke anywhere anymore. All of this in my opinion equals less COPDers in the future which will in turn should decrease the census for nebulizer treatments with COPD patients.

Lets look a little deeper now also. In the past there was asbestosis which caused respiratory problems and this is now outlawed. Different jobs that have fumes that can be inhaled are not required by OSHA for the personnel that do these jobs to wear a mask that filters out these fumes which can cause respiratory issues for example automobile painters which have the paint that can be inhaled. These precautions can cause a decrease of people with lung problem due to inhaled fumes, particles or whatever is able to be inhaled at certain jobs.

Well there you have it my ideas on how our job census will decrease in the future, basically when the current population over 65 passes on there is a possibility of a decrease in patients due to education and studies of smoking and harmful inhalants. According to this study Half of elderly patients discharged from hospital following a first admission for COPD are dead within 3 to 7 years. So that right there could show that it really might not take to long.

Remember this is in no way a scientific study but just a thought I have had, but I would love to hear anybody else's opinion on these ideas. Of course there are also the studies about air pollutants causing COPD like symptoms in people also, so maybe if we don't get green enough as a country it will stay the same but the cause will be different.

Drive on RT's