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


Iron Lung said...

This was a HUGE problem at our facility too. We were finally able to get the electronic ordering gizmo to automatically delay sending the order to radiology for 5-10 minutes, giving us time to get the meds and get in there. Of course, sometimes we run into the foley/EKG problem too, but I usually go ahead and assess if I need to barge in or not.

Freadom said...

How did you get this post out of my brain. You must have magic powers over on the other side of Lake Michigan.

This is exactly what I complain about here.

Djanvk said...

This must be a common thing in all RT circles. It just plain irritates me. I usually just hang out and Make a nice little "I guess breathing isn't as important as it used to be" comment.