Thursday, May 29, 2008

Pixie Dust...What can it do for us?

There is a article at about some stuff coined "Pixie Dust" which is being experimented with on soldiers who have a amputated body part like fingers, arms, legs or toes but not heads. This is being trialed at Brooke Army Medical Center (BAMC) in San Antonio Texas where I took my Respiratory Training.

You can read the article here: Pixie Dust

This pixie dust is supposed to give the body a salamander effect and trick the body into regenerating the missing body part. The powder forms a microscopic "scaffold" that attracts stem cells and convinces them to grow into the tissue that used to be there.
"If it is next to the skin, it will start making skin. If it's next to a tendon, it will start making a tendon, and so that's the hope, at least in this particular project, that we can grow a finger," Wolf said.
This is pretty interesting, how could this help our profession? Could this "pixie dust" help regenerate lungs destroyed by smoking, improving quality of life for COPD patients? Could it help people exposed to substances cause them to get fibrosis?

Interesting to say the least and I will keep a look out in for how it turns our for humans and for the soldier in the article. Hope it works.

Protocols Do Work.

Today I had to come into work early due to the requirement of the monthly Staff Meeting. Ohh what fun, but I did actually gain some information this time that I thought was pretty interesting.

If you have read one of my earliest posts I talked about a Therapist Driven protocol that we had implemented at my little hospital about 7 months ago. This protocol had to do with us the RT's assessing patient and then being able to adjust nebulizer, MDI and Oxygen therapy's as we deemed needed. Well we are now done with the testing phase of the implementation of our therapist driven protocol and a letter from our director is out to the doctors with surveys to see if we continue with this type of therapy.

There are some statistics that we pretty interesting that were compared from this 6 months of the protocols being in use and the 6 months prior to the protocols being in use. These stats were pretty interesting and pointed in favor of using these protocols and making them law. The only areas of care that were talked about were patients with Pneumonia and COPD issues.

Hospital staylLengths for Pneumonia and COPD decreased by 1 day in both areas. So we were able to adjust treatments for the patients and decrease their length of time in the hospital.

Now here is what I though was pretty amazing in the financial aspect.

In patients with a Pneumonia the cost of Respiratory Therapy given to the patient was DECREASED by 23% with the protocol in use. We saved the hospital 23% per patient on average if they had pneumonia.


Patients in with a COPD issue the cost of Respiratory Therapy given to the patient was DECREASED a whopping 36% with the protocol in use. Here we saved the hospital 36% per patient on average if they were in for COPD.

These facts speak strongly for the use of Therapist driven protocols and that we might actually know what we are doing.

During this meeting I did get into a disagreement with the director and supervisor about how we should for the first 24 hours do the treatment exactly how the doctor ordered it due out of respect to the doctor so they don't think we are just saying they don't know what they are doing.

Whats the point of doing the protocol assessments in the first 24 hours if we are not going to change anything? The doctors signed off on the protocols, so we have a right to use them as needed, otherwise you need to change what the protocol says.

I think I stunned the director when I said "So basically you two want us to suck up to the doctor's so they don't feel bad?" They said no it's a teamwork thing.

I don't know I feel as though if we don't use the protocol as written the doctor's might get the impression that we are skeptical on our abilities as therapist to assess our patients and choose the right treatments.

Fortunately I have a couple of other therapist who agreed with me and backed me up in my thoughts. Good to know I wasn't alone in my thoughts. So this was to be a unwritten rule that I'm not so sure people will follow. I for one will keep doing it as I have been and that's by the book on how the protocol was written up. Can't get into trouble for that.

Statistics show that we must be doing something right, and there are no complaint's about how we have done our assessments so far. Hopefully the doctors do really see it that way and the surveys come back in good shape, then we can make this law and continue on.

Drive on RT's

Sunday, May 25, 2008

Stop and put you hand on that person.

I'm coming up on my re certification of my CPR card very soon and I was looking around on the guidelines at the American Heart Association to see if there are any new changes, and wow did I see something different:

Hands Only CPR.

There are only 2 Steps to save a person's life:

1) Call 911
2) Push hard and fast in the center of the chest.

So I started looking around a little bit and from what I understand is that this simplifies the process for the standard layperson. Just make a phone call and press that chest.

This is just for a adult who was witnessed collapsing not someone who possibly has been down for awhile or a drowning victim. So basically if you see someone collapse just start pressing that chest. Easy right.

One of the big things I see this helping is the though of most people that they don't want to put their mouth on a strangers mouth for fear of disease, this is understandable and this technique removes that problem. Also this is a very simple process so the person who is going to do CPR doesn't have to worry about not remembering the proper steps to do CPR. These 2 factors could possibly help a person faster than before because now maybe people will be quicker to react and not hesitate because fear of doing this wrong or getting their mouth on a strangers mouth, unless of course it is some Hot person you would want to put your mouth on.

Back to the topic at hand. Of course is this is the full standard now there would really be no need for a CPR class because it would take like 2 minutes to teach, so no this isn't all there is anymore you still need to learn the regular way for if you find someone down and not sure how long they were down. This also isn't for the pediatric population only for Adults witnessed collapsing.

Hopefully this isn't old news to everyone but I found it interesting, now to sign up for my CPR class and get this over with.

Drive on RT's.

Saturday, May 24, 2008

Here's you card....Duhh

Ring Ring (RT Department Phone ringing)

Me: Respiratory Therapy, can I help you?

Nurse: I have a patient who wants to take his MDI, he has 2 in his med cabinet but only had orders for one of them but he wants the other, can I give it to him?

Me: What is the order for?

Nurse: Albuterol 2 puff, may take on own.

Me: What is the name of the other mdi medication he has?

Nurse: Ventolin.

Me: (Laughing to self) Ok Ventolin is albuterol, it's the a commercial name of albuterol.

Nurse: Really, I've never heard of it.

Me: Yea it's like how acetaminophen is the same a Tylenol, or ibuprofen is the same as Motrin only cheaper.

Nurse: Ok I got it, so which one can I give him?

Me: (Duh look no face) Which ever one he wants.

Someday people will understand.

Miracle, sure it is, but something is missing.

I ran across this new article here from Newsnet 5 talking about a woman who was clinically dead but miraculously came back to life and all was well.

Here is the article, for you RT's out there you might find something out of the ordinary, or which I have given a hint by making the area's bold. This will also all into line a bit with my previous article about respiratory mishaps in movies and TV shows.

Woman Wakes Up After Family Says Goodbye, Tubes Pulled

A West Virginia woman was being transferred to the Cleveland Clinic after walking the line between life and death. Doctors are calling Val Thomas a medical miracle. They said they can't explain how she is alive. They said Thomas suffered two heart attacks and had no brain waves for more than 17 hours. At about 1:30 a.m. Saturday, her heart stopped and she had no pulse. A respiratory machine kept her breathing and rigor mortis had set in, doctors said. "Her skin had already started to harden and her fingers curled. Death had set in," said son Jim Thomas. They rushed her to a West Virginia hospital. Doctors put Thomas on a special machine which induces hypothermia. The treatment involves lowering the body temperature for up to 24 hours before warming a patient up.After that procedure, her heart stopped again.

"She had no neurological function," said Dr. Kevin Eggleston. Her family said goodbye and doctors removed all the tubes.

However, Thomas was kept on a ventilator a little while longer as an organ donor issue was discussed.

Ten minutes later the woman woke up and started talking.
"She (nurse) said, 'I'm so sorry Mrs. Thomas.'
And mom said, 'That's OK honey. That's OK," Jim Thomas said.
Val Thomas and her family strongly believe that the Lord granted them their miracle and they want everyone to know."I know God has something in store for me, another purpose. I don't know what it is but I'm sure he'll tell me," she said. She was taken to the Cleveland Clinic for specialist to check her out. Doctors said amazingly she has no blockage and will be fine.

I just find this funny as we all know what you cannot talk while on a ventilator especially with a endotracheal tube in. I'm sure she wasn't trached with a Passey Muir valve on or a capped trach with fenestration since this seemed to only happen in about 24 hours. As bad off as she was I'm thinking a trach was the last thing they were thinking about. I just found that interesting how the media can get things wrong.

So what to do, well I'm going to drop a email off to this news channel just to see if I get a response. I'm thinking this was maybe make to be a little over dramatic as most of the public has not clue with some of this medical stuff. But us RT's will catch the little respiratory inconsistencies that people will make when it comes to our profession right.

If I get a response, it will be posted here for all to see at a later time, but I'm not really expecting anything to much, you never know though.

Drive on RT's.

Wednesday, May 21, 2008

Google Health.

Just a quick post here about the recently released:

Google Health

I've been playing around with it a bit and it does seem like it could some in pretty handy and informative for someone who uses medications and has multiple medical problems.

You can put in your medications here and it will show indications, contraindications and possible problems if you have incompatible medications, which is good so you don't become like Heath Ledger.

One thing I'm not to sure of on this site is the ability to upload your medical records to the site. I'm thinking some kind of privacy issues here, but on the other hand it's Google and if they do share your information you can definitely win a large sum of money from a lawsuit.

Overall it looks very promising as all Google products seem to be, I do like the idea of all my information, calendar's, email and other information in one place. Google is a well respected name and is probably trustworthy. It's probably something that could help people keep their medical information organized, plus there is a nice print function that will print all your information out so you can go to the doctor with your medication listing and prior procedures and hospitalizations. That is good because I see a lot of people come in with written lists of their own information and with the computer age and Internet being so big now this can be a easy way to pull up your information from anywhere really.

I'm liking Google's response to Microsoft ’s HealthVault (which launched last October), Revolution Health, and Aetna’s SmartSource, because is uses Google clean interface with nothing really distracting on the screen.

I'm not Pro Google or Microsoft or anything but I just really enjoy technology and of course the way it can interact with health care.

Keep it real RT's.

Monday, May 19, 2008

High off Inhalers?

I ran across a article in Science Daily that is talking about teens misusing inhalers (MDI's) to get a buzz or get high off of them.

"Asthma inhaler misuse is prevalent in the adolescent population, particularly among antisocial teens, US study findings indicate."

I find this interesting because I'm wondering how many puffs off of a MDI do they have to do before the feel any effects of being high?

There was a study conducted to get an idea of how prevalent this actually is and the results were kind of surprising:

"Brian Perron (University of Michigan, Ann Arbor) and Matthew Howard (University of North Carolina at Chapel Hill) conducted a cross-sectional survey with face-to-face interviews assessing substance use, psychiatric symptoms, and antisocial behaviors among 723 adolescents in residential care. Over 26% (193) of adolescents were diagnosed with asthma, 91.2% of whom had received a prescription for an inhaler. Almost a quarter of the 373 adolescents who had used a prescribed or nonprescribed inhaler reported using an inhaler to get high."

Is this like any other inhalant that kids use to get high, is it like huffing gasoline, inhaling paint thinner? You would think that there would be a cheaper way to get this type of high, but I guess if insurances is paying for it or you are from a lesser well off family and you have a medical card, it probably is pretty low cost for the kids who do this.

Reading later in the article is shows what effects misuse of the inhaler can cause:

"Inhaler misusers were significantly more likely than asthma inhaler users to report euphoria, memory problems, slurred speech, blurred vision, confusion, dizziness, and a variety of other acute reactions to asthma inhaler use."

Pretty interesting to see how people will look to anywhere to find a way to get high, and with inhalers I'm sure these kids are thinking that this is a lot safer to use like this instead of other inhalants like gas and paint thinner. Wow what is this world coming to, are we now going to start have MDI seekers coming into the ER as well as the regular drug seekers? I'm doubt that would happen as this I couldn't see becoming very popular, but on the other hand you can never fully tell what is going to happen.

As you giving that MDI and spacer instruct to a person who you didn't think really needed that neb you just did on them, they might just be a one of those MDI get High people.

Bronchospasm or something else?

Over at the Respiratory Cave, Freadom has a group of "Olin's" which are a listing of all the magical properties that Ventolin is supposed to have, but we all know better now don't we as RT's, and hopefully most RN's who look at our RT blogs have learned from us on what breathing treatments can REALLY cure. Actually our breathing treatments can really cure .. (drumroll please) .. is NUTTIN!!! No really it cannot cure anything, it can only help ease the discomfort of a symptom which would be a bronchospasm. Thats right Ventolin or Albuterol only really relieves bronchospasms.

So what am I getting at here, well I'm going to show different problems that we are called for that this wonder medication cannot really do anything for because it's not a bronchospasm issue. Please feel free to comment and criticize to your heart's content if you disagree with me on this topic. But really some things we cannot help a whole lot with Albuterol.

  1. Congestive Heart Failure - the fluid needs to come off, make them pee or if it's bad enough get em on a bipap.
  2. Fluid Overload - not our fault, again Lasix would help here, and stop all the damn fluids.
  3. Rib fractures - these hurt to breath deep, Albuterol will not make you breathe deeper.
  4. Pneumonia - will not cure this problem, might help them breathe a little easier but it will not get rid of the pneumonia.
  5. Gas - let it out, its pushing up on your diaphragm making it hard the flatten and take a deep breath.
  6. Over Eating - they ate to much and it stopping the diaphragm from flattening, so unable to take a deep breath.
  7. A Cold - of course its harder to breathe, they have a stuffy nose, no lets not try Albuterol and see if it helps at all.
  8. Croup - doesn't help at all, period. Try Racemic.
  9. On a Ventilator - just because you are on a ventilator doesn't mean they need Albuterol. If their lungs are tight then yes, but not just because they are ventilated.
  10. High Fever - did you ever think the patient has a high respiratory rate because the body is trying to blow off heat. No really it's true.
  11. Chest Pain - yes it hurts, and it's probably hard to take a deep breathe because it hurts, and not do not switch to Xopenex because it won't have as much of a effect on the cardiac areas.
  12. Because you don't know what else to do for the patient - if you don't know Doc, how are we supposed to know.
  13. Anxiety - almost forgot this one, Give this person some Ativan or Xanax, these do wonders for anxiety. Calm them down. Take the caffeine away, turn off the light and go to sleep.

Yes it's one of those things we RT's deal with, and of course it will not change anytime soon because no one really treats it like a controlled medication, it's more like a "let's try to see if it does anything" drug. There is a lot of common sense involved in using nebulized medications and MDI's, for instance: if the lungs are full of secretions or the patient if fluid overloaded how is the medication going to get through the fluid? It would be like trying to salt a burger in the bottom of a pond. It just won't get to where it is supposed to.

Off my soapbox I go, Drive on RT's.

Friday, May 16, 2008

I always thought is was A.B.C.

One basic principle that was driven home to me as a medical professional in either of my schools, be it my Combat Medic course, EMT course or Respiratory Therapist course has been the concept of the ABC's, also known as Airway, Breathing, Circulation. This has always been understood my be to be there order of importance when it comes to a person in medical need. Yes this is supposedly for mainly first responders and emergency situations.

Now in the Emergency Room I would think that this would come into play, because well its a emergency room. Unfortunately I have noticed at many places, and a lot where I work that I will get a call the the ER for a patient that needs a breathing treatment. This usually tells me that there is a person in the ER that is having some type of difficulty breathing, and if you look at the ABC though process it would be number 2 on the list, because if they can breath in a nebulizer tx the airway must be somewhat patent.

Here is my issue that I see more and more, I'm called to do a neb in the ER and when I get there I will get from the nurse and sometimes the doctor, "Oh I'm sorry Xray got here before you so they took the patient to get their Xray done." Or there will be Xray there and they just do the "Haha I beat you here" thing. Sometimes I even get the, "Can you give us a minute, we need to put in this foley catheter first." Then comes the "Hey come do this EKG first before you do the neb treatment."

Does anyone else see anything wrong with these scenarios? As far as I know I would think that breathing would take precedence over Xrays, plus you would get a better view of the chest with a more open chest I would think, but then I'm not a Xray person. I would also think that breathing would be a little more important than a foley catheter, but a foley catheter could help with the breathing if they are fluid overload, so lets both do our thing at the same time. And that EKG before giving this neb to a asthmatic, look at your ABC's, circulation comes after breathing.

There are many times a patient doesn't really need a neb very badly and it's not a emergency situation, but even then it's irritation to be called away from what you were doing to show up and the patient was gone to Xray. Maybe this is more of myself complaining about something, but it irritates me to think that when it comes to patients feeling better, an xray will make them feel better than the nebulizer that will ease their breathing. Personally I would rather be breathing better than getting a picture taken.

Thanks for reading

Drive on RT's

Thursday, May 15, 2008

Healthcare Workers Week? HUH.....

Is it just here at my hospital or is everyone celebrating Health care Workers Week 2008? Tonight there was cake and other food items being brought around to the different departments for this particular week. This happens to be Health care workers week 2008, now I don't remember a version of this for 2007 or any year prior to this year. Is it a new thing we get to add on to our calendar as a hospital worker.

Really this isn't a bad thing, we got cake, pens, sticky notepads, and from what the hospital grapevine is saying we are getting a rolling cooler that can hold 36 cans of your favorite beverage. You can't get much better than that. Maybe this can make up for nothing being done for us up here in my small hospital for Respiratory Care week 2007.

Has anyone ever stopped and looked at all the so and so special weeks, months and days there happens to be in a hospital? Seriously there are a lot and just for an example here are some of them I see posted on walls and flyer's:

  • Nurses Week
  • Respiratory Week
  • Radiology Week
  • Doctors Appreciation Week
  • Bosses day
  • Breast cancer awareness month
  • Spinal Health week
  • ect. ect. ect.....
You get the picture, if you really look around at the hospital you work at I'm sure there is some appreciative day, month or week going on, because of course there is a special week for any profession that seems to work in a hospital. So really maybe this Health care workers week is just a way to consolidate everything into one Christmas like holiday thing for the hospital.

"Jingle Stethoscope, Jingle Stethoscope, jingle on your chest..."
"Here comes Dr. Claus, Here comes Dr. Claus right down the hallway..."
"We wish you a merry health care workers week, we wish you a ......"

In actuality these different profession do deserve a bit of appreciation every now and then and I have nothing against these different appreciation weeks and all but I just thought it was interesting how many there actually are, and now there is another one here for use to be happy for because we get cake and things with the hospital logo on it. WooHoo free stuff.

So until next time:


Saturday, May 10, 2008

Whoa It's been awhile, people are still nuts.

OK so I have to apologize for not posting for like 2 months now, I became a little busy with life and this was put on the back burner. My hospital started blocking personal (BLOGS) sites from viewing on the internet so I wasn't able to log onto Blogger here and post anything because I usually did it from work. Home has been a bit busy and there just wasn't enough hours in the day to do much posting.

So here I am posting again, my hospital set up a WIFI network for patient and others to use so I bring my laptop into work now and can have some time to post again. So stick with my I'm able to do this again.

Now on to more pressing matters, OK so it's only what I think is a funny little story about a patient at work who really either had no clue, or she just wanted to be difficult and not have to the my therapy.

We RT's here at my little hospital have to start and do Incentive Spirometers with every surgical patient for 4 times to make sure they are doing it correctly and acheiving 50% of there predicted volume, which I personally think should be 50% of their PRE-surgical volume they were able to acheive and not the predicted. Some people have trouble getting 50% of predicted without the surgery. So anyways if the patient cannot get 50% of predicted we start EZPAP until they can acheive this goal. OK now off to my story.

I walk into Mrs. White's room to do round 2 of her I.S. and it goes like this:

"Hello Mrs. White I'm with Respiratory Therapy and I'm here to work with your I.S."
"OK, hand it here and I will do it."

I hand her the I.S. and she of course blows as hard as she can into the mouthpiece and of course nothing moves.

"Umm your doing this wrong, you need to suck in on the mouthpiece to make it move"
"Oh OK I remember."

Now mind you she has been previously instructed on this, I'm there for round 2. She goes ahead and blows on it.

"No remember suck in on it like you would when drinking from a straw."
"I can't, I hate using straws, I don't use them."
"Ok well have you ever used them, while drinking some pop or soda?"
"Nope I have always hated them and have NEVER used one."
"Well how do you know you hate them then."
"I just know I do."
"Well lets try breathing on this again, OK"

So off she goes blowing in and out on the I.S. and it's doing nothing.

"Mrs. White, try to take a deep breath through the tube like you would if you were going to go swimming under the water."
"I don't know how to swim, I don't swim."
"Umm, you have never gone swimming or wading in a pool?"
"No, I'm from the Southwest there are no pools there."
"I used to live in the Southwest for a couple years there were pools there, it's hot and people have to cool off."
"Well not in my time there were no pools in the Southwest."
"OK, I see, lets try sucking in on this tube again."

So now she is like panting on the tube, quick short breaths.

"Now take the tube out of your mouth and put your hand in front of your mouth and blow out."

She does

"Did you feel the air on your hand?"
"OK do the opposite of that, ya got it"
"OK I see."

Back with the I.S. she if breathing deeper in and out of it.

"Did you see it move up there?"
"Yes I did."
"OK now do what you did to make it move up only do it bigger!"

FINALLY SUCCESS, she hit 1500 ml's on the I.S. and her predicted is only 2000 ml's so she is over the 50%, NO EZPAP, whoo hoo.

The next day I come to work and find out the day shift was having the same issues that I did with this patient, so like I said she either has:

A) No Clue
B) She is jacking with us.

Either way I didn't have to see her again. You can always find humor in this job. Actually I think you have to have a sense of humor to work this job.

Thanks for reading.