Friday, April 17, 2009

Allergy Season is on it's way.

It's becoming that time of year for another bout of respiratory problems, the allergy season. This time of year brings on the great problem called Hay Fever and there are more than 35,000,000 Americans who suffer from this type of problem.

Hay Fever is a type of allergen rhinitis triggered by pollens from different plants this time of year because they are all beginning to grow. Some major players in the problem of pollen are the Birch tree which can cause problems for 15-20% of suffers and then the largest player for people who suffer from the type of problem is grass pollen, it is estimated that 90% of hay fever sufferers are affected by grass pollen. Hay Fever is not caused by a virus its caused from a allergen. Hay fever can begin at any age, you're most likely to develop it during childhood to early adulthood. It's common for the severity of reactions to change over the years and for most people the symptoms tend to diminish slowly, often over decades.

Some common trigger of Hay Fever can include:
  • Tree pollen, common in the spring
  • Grass pollen, common in the late spring and summer
  • Weed pollen, common in the fall
  • Spores from fungi and molds, which can be worse during warm-weather months
  • Dust mites or cockroaches
  • Dander (dried skin flakes and saliva) from pets such as cats, dogs or birds
  • Cockroaches
  • Spores from indoor and outdoor fungi and molds

Some of the signs to look for in a allergen problem are:
  • Sneezing more than usual
  • Eyes that continually water
  • Cold symptoms that last more than 10 days without fever
  • Repeated ear and sinus infections
  • Prolonged loss of smell or taste
  • Frequent throat clearing or hoarseness
  • Persistent coughing
  • Sinus pressure and facial pain
  • Swollen, blue-colored skin under the eyes (allergic shiners)
  • Decreased sense of smell or taste
Where this comes in for Respiratory Therapy is the coughing, doctors really like to give nebs for coughing to help it stop so there goes our case load in the E.R. more neb treatments for coughing. Asthma though is one problems which often occur along with Hay Fever, along with Sinusitus, Eczema, and Ear infections.

The best way for these patients to limit problems to these allergens is to keep from being exposed to much to these allergens:
  • Close doors and windows during pollen season.
  • Don't hang laundry outside — pollen can stick to sheets and towels.
  • Use air conditioning in your house and car.
  • Use an allergy-grade filter in the ventilation system.
  • Avoid outdoor activity in the early morning when pollen counts are highest.
  • Stay indoors on dry, windy days.
  • Use a dehumidifier to reduce indoor humidity.
  • Use a high-efficiency particulate air (HEPA) filter in your bedroom.
  • Avoid mowing the lawn or raking leaves, which stirs up pollen and molds.
  • Wear a dust mask when doing outdoor activities such as gardening.
These are just some ideas I found reading about this online and if you suffer from hay fever you might want to take some of these precautions.

There are quite a few types of medications which help with Hay Fever:

  • Nasal corticosteroids. These nasal sprays help prevent and treat the inflammation caused by hay fever. Examples include fluticasone (Flonase), fluticasone (Veramyst), mometasone (Nasonex) and beclomethasone (Beconase).
  • Oral corticosteroids. Corticosteroid medications in pill form, such as prednisone, are sometimes used to relieve severe allergy symptoms.
  • Antihistamines. These oral medications and nasal sprays can help with itching, sneezing and runny nose, but have less effect on congestion. Older over-the-counter antihistamines such as diphenhydramine (Benadryl) and clemastine (Tavist) work as well as newer ones, but can make you drowsy. Newer oral antihistamines are less likely to make you drowsy, but are more costly than the older antihistamines. Over-the-counter examples include loratadine (Claritin, Alavert) and cetirizine (Zyrtec). Fexofenadine (Allegra) is available by prescription. The prescription antihistamine nasal spray azelastine (Astelin) starts to relieve symptoms within minutes of use. It can be used up to eight times a day, but can cause drowsiness. Side effects include a bad taste in the mouth right after use.
  • Decongestants. These medications are available in over-the-counter and prescription liquids, tablets and nasal sprays. Over-the-counter oral decongestants include Sudafed, Actifed and Drixoral. Nasal sprays include phenylephrine (Neo-Synephrine) and oxymetazoline (Afrin). Because oral decongestants can raise blood pressure, avoid them if you have high blood pressure (hypertension). Oral decongestants can also worsen the symptoms of prostate enlargement, making urination more difficult. Don't use a decongestant nasal spray for more than two or three days at a time because it can cause rebound congestion when used longer.
  • Cromolyn sodium. This medication (NasalCrom) is available as an over-the-counter nasal spray that must be used several times a day. It helps relieve hay fever symptoms by preventing the release of histamine.
  • Leukotriene modifiers. Montelukast (Singulair) is a prescription tablet taken to block the action of leukotrienes — immune system chemicals that cause allergy symptoms such as excess mucus production. It has proved effective in treating allergic asthma, and it's also effective in treating hay fever. Like antihistamines, this medication is not as effective as inhaled corticosteroids.
  • Nasal atropine. Available in a prescription nasal spray, ipratropium bromide (Atrovent) helps relieve a severe runny nose by preventing the glands in your nose from producing excess fluid. It's not effective for treating congestion, sneezing or postnasal drip. The drug is not recommended for people with glaucoma or men with an enlarged prostate.
This turned out longer than I expected it to but as a Therapist I figured it something we will deal with in the coming months and one little more tidbit of information about Hay Fever:

Hay fever doesn't mean you're allergic to hay. Despite its name, hay fever is almost never triggered by hay, and it doesn't cause a fever.

Keep driving on RT's.

Thursday, April 16, 2009

Need a Prayer for a young boy.

I'm posting this to reach out for a family I know who is having hard times right now with medical problems. The mother of this family is having to deal with her 9 year old son in a pediatric ICU and needs some extra prayers to get this boy to turn around. This 9 year old child has been having small strokes and is in and out of a coma. He was starting to turn around a little bit and was off he ventilator for a couple days then had another stroke which put him back in a coma state and again on the ventilator.

This child was born with hydroencephalitis and had an operation to place a shunt in his brain and the parents were told he would not live to be more than 2 years old. Well he is 9 and was doing everything a normal child would do, did good in school, loved the Iowa Hawkeyes, and played with his friends and brother. These current events started when he went in for a checkup on his shunt and things went bad, this was about 2 weeks ago. The medical staff at the medical center he is at are still trying to track down what is going on and the cause of the strokes but nothing is promising yet at this time, but we are still hopefull.

What makes this so hard for the mother of this child is that just over a year ago her husband, this boys father, lost out on his battle with brain cancer and he was only 39 years old. This woman now has to deal with her youngest son possible not pulling through which would be devastating to her as this would be 2 major losses to her family in under 2 years. Something like this would be hard to fathom by most people, and she has another son to stay strong for with all this going on.

I'm just asking for a little prayer, thought or anything just to help this family get through this time of need and sadness. I do believe there is the possibility of the power of prayer and thought to help people in need. Thank you for any thoughts and prayers, and if you where wondering, this boys name is Jack, and her is a HUGE Iowa Hawkeye's Fan like his father was.

Monday, April 6, 2009

Shortage of Health Carre Workers in 6 years predicted.

I was recently reading through the April 2009 AARC journal magazine and there were predictions on different health care topic which would affect RT's. One I saw that interested me was:

"There will be a national shortage of all health care providers in all sectors, Even those who frequently interact directly with patients."

This struck me as interesting because you would thinks with the unemployment rate as high as it is this would be a job sector which people would maybe flock to because of the job security of there always being sick people to take care of, but I guess this isn't so.

I starting thinking about this and realized there are large portions of society who are hardly even tapped to work as health care workers. These people would be the men of the United States. If you work in the health care sector think about it, who so you see mainly working directly with patients as a majority? Women right. There you can even break it down even more, these would mostly be white women also as a majority. Now I'm not trying to bring in the race card it's just a observation and I tried looking up some facts which I could find on this topic.

As for men in the health care workforce I wasn't able to find a overall men in health care number but I found a number for male nurses. According to the American Nursing Association only 6% of all RN's are male. Here in this article: "Is there a male nurse in the house?" about 7.5% of male nurse graduates leave the profession within 4 years of graduating. These are not good numbers.

Now when we look at the minority sector of the health care work force I found out that 1/4 of our population is made up of African American, Hispanic and American Indians but only 10% of them are in the health care field, this is according this this article: Diversity in Health care. This leaves a lot of possibilities for more health care workers.

Why don't more men work in the health care field? I believe it's the stigma and stereotype of women always being the nurses. When I say nurse I do picture a female and it's because of stereotype. Men also are not normally brought up to be caregivers like mothers. More men should really look into health care because were going to need to fill the gaps if this prediction is correct. Honestly there are a lot of perks, good pay, stability, job security, air conditioning and heat, hot looking nurses, friendly atmosphere, and the list goes one. If we are to fill these gaps in health care jobs were going to need to disperse of the stigma of men being in health care other than being doctors. Like we all know, Respiratory Therapy is a good field, and the women dig us.

Friday, April 3, 2009

Discoid Atelectasis, what might that be?

Tonight I had a patient I was assessing for out therapy driven protocols and was reading this person's xray and I noticed a word I have never came across before in my medical travels and it was describing a type of atelectasis:

Discoid Atelectasis
which is also known as Plate Atelectasis.

Now being the good RT that I am, I had to do and look it up so I could do a proper assessment of this patient and what I found was interesting to me and I thought I would share it with anyone who might read this blog of mine.

Discoid or platelike atelectasis is a form of atelectasis which has s disc or platelike appearance on a xray which is linear or horizontal position. They often look like a CD or a dinner plate and thought to occur from shallow breathing or hypoventilation which can occur after a abdominal or thoracic surgery. It can be also seen in other conditions such as painful breathing, general anaesthesia, pulmonary embolism, ascites and diaphragmatic paralysis.

There is really no different type of treatment for this versus any other type of atelectasis because it is just a term to describe what is seen on the xray but overall it's still just atelectasis.

Really there is not to much alarming about this it's just something I came across and have never seen so I thought I would share it with everyone and hopefully if you come across this in a report you will now know that those radiologist are talking about because it seems they like to try and stump us, but because of the Internet things can be looked up quickly now.

If you didn't know, now you know ... Drive on RT's.

Thursday, April 2, 2009

The Secret Book of Doctor Knowledge!!!

Doctors are a interesting bunch, there are good ones, interesting ones, bad ones, ones we are not sure how they got through medical school but overall they are a interesting bunch.

Something that sparked my interested is how a doctor will get on a certain type of treatment kick for awhile which will make us RT's look at each other and go hmm, where did this come from and why are we doing it?  This just doesn't make any sense to do this to every patient we see.

For instance we have 2 doctors in particular who get on these treatment kicks, right now one is on this Duoneb with Ezpap QID & Q4prn for anyone who has anything to do with Respiratory, seriously do we need to add Ezpap to a patients home regimine if there are not even in for Respiratory problems and does EzPap really help treat a patient with a history of COPD?  Then we have another Doctor who is on a Mucomyst kick for EVERYONE with nebulizer treatments, yes we get that D/C'd a lot curtosy of our protocols but they also have learned they can write NO RT Protocols and then we are stuck.  

There are cases of other doctors getting on certain treatment kicks like the Xopenex for everyone kick along with not following the company's drug reps recommendations on how to order Xopenex (not created to be used Q2 or continous, still makes heartrate go up), and I'm sure there are kicks that RN's see the doctors get on, but I don't deal with that side of the house.

So this makes me wonder if there is a Secret Book of Doctor Knowledge which has all the information why these treatement are the current "Cat's Meow" in the respiratory world of care because I've look everywhere for some definitive knowledge on how Mucomyst will help all patients or what good does EzPap do for a patient with COPD and this information has eluded me because I'm assuming it's in the Secret Book which of course if probably locked in the doctors lounge.  I just wish they would give us a quick in service on this instead of looking at us like we are stupid when we question these treatments.   

I'm sure these kicks will die down after awhile of use and go away until some other little bit of knowledge gets updated in this book like a Doctors version of Wikipedia, but it would be nice to just share a little bit of information to us troops in the trenches.

Drive on!!!

Wednesday, April 1, 2009

Oxygen Dependant COPD man to run marathon.

I ran across this article and thought is was interesting:


Its about a man who is oxygen dependent, diagnosed with COPD and is the first person with COPD allowed to run the Boston Marathon. This person is on some serious O2, when asked what is prescription is he responded:

"I have been on supplement oxygen for 4 years. My current prescription is 4-6 liters at rest and 7-18 liters when I’m active or exercise."

Now that's some serious O2 he is on for exercise, just think how many tanks he might go through in a 26 mile race.

This guy has already completed 2 full marathons, 14 half marathons, 1 ten mile, a 5 mile, 4 times did the 10k the Bolder Boulder, a bunch of 5k's and climbed 2 14,000 plus foot mountains. Quite amazing. He says that he went through 5 tanks a marathon and was lucky to have friends to help with the changing of tanks when needed.

This is pretty amazing for a COPD oxygen dependent person to do and it just shows their is life after a COPD diagnosis, you just have to take care of yourself and work to acheive some added health to help cope with the problem.

To add to his accomplishments on March 10 of this year he finished the Climb Chicago event for the American Lung Association. 4 buildings; 180 floors; 360 flights; and 2340 stairs, for a time of 1:06:13. Really amazing, that would hurt me.

Well hope that article was inspiring and hopefully this guy can inspire other COPD patients in the future.

Drive on RT's.

Saturday, March 28, 2009

Peds Pneumonia VS. Adult Pneumonia

We are not in a time of year where there seems to be a larger than usual amount of Pneumonia cases coming into my hospital. There are many different types of pneumonia out there but we mainly deal with only a couple of them.

Some Different types are:

  • Viral

  • Bacterial

  • Fungal

  • Parasitic

  • Comunity Aquired

  • Hospital Aquired

  • Severe Acute Respiratory Syndrome(SARS)

If you want more information on the different types of pneumonia just go look it up, many sites are out there with this information.

Now if you noticed in my title of this post I'm talking about Peds VS. Adult pneumonia's. The reason I am talking about this is because my hospital will isolate all pediatric patients for Droplet Precautions if they have any lung problems, including pneumonia. Now my question is why do we just isolate the kids with pneumonia and not the adults with pneumonia? This I am confused about, but I do understand the the underlying virus or bacteria which cause pneumonia could be contagious but why more so in kids than adults?

With our kids we need to gown and mask but with adults nothing extra as of precautions is taken which is perplexing to me as I cannot find a decent answer to this question and unfortunately I don't see the Peds doc very ofter as I work nights.

So if anyone can shed some light on this for me I would be much obliged, but until then I will keep searching and wearing my gown and mask for the kids, but I'm sure we would look less scary to them without that garb on.

Thanks for reading

Keep driving on RT's.

Thursday, March 19, 2009

We need a law for resusitation age limits!!!

Just a quick note of something that I think needs to be implemented for the humane treatment of older adults who would happen to have their heart stop beating:

"Anyone over the age of 90 years should automatically deemed DNR."

I would even go as low as 85 years old if allowed. It's almost inhumane to code an patient who is over 90 years old and put them through that.

Maybe I will get into this more in depth later.

Just a thought.

Wednesday, March 18, 2009

Video of Lung Recruitment

I ran across this video of a rabbits lungs being ventilated outside of the body, yes not rabbit just the lungs, and it show the expansion of the lungs after different levels of peep are applied. Quite interesting.

Hope you enjoyed this.

Really there is a proper way to wean a vent.

One of the problems with small town hospitals is that there are usually only one specialist in a certain field. In our field as Respiratory Therapist we use the the pulmonologist specialist for our profession because they are the specialty doctor who deals with the lungs.

Here is a good page on what a pulmonologist does if your interested: Pulmonology

So anyways because I work at a small hospital we only have one pulmonologist on staff which creates the problem of not having the chance to consult another pulmonologist on a case. With only one of these doctors on staff also lets them be the know all do all doctor in this field, saying we do it they way he/she likes it done.

On with my problem of weaning ventilator patients. When I was in school and also when I was at other hospitals vent patients were weaned much more smoother, the rate was slowly decreased as needed, the oxygen level was decreased, they were given time to just breathe on only pressure support ventilation, and then if they survived that we would run weaning parameters and extubate. This to me is a humane way to wean and extubate a patient, much more friendly. Now back to my one pulmonologist and the way he does it. First off we use Assist Control mode like it's going out of style (which is actually is) and SIMV is almost unheard of as if this pulmonologist forgot to renew his subscription to Pulmonology Today. These poor patients are always put on Assist Control with a rate of 12 or greater but now here is the part that drives me nuts we wean directly off of this, for weaning parameters or a Tube Compensation trial we got straight from Assist Control with a Rate of 16 to NOTHING and hope there are good weaning parameters!!! How can you expect a patient to do well if you go from full support to nothing, this is not weaning. Weaning is a gradual process to remove something from something, like a bottle from a baby, you slowly give the child less and less bottles and more sippy cups or whatever. We do a sink or swim type of wean. Full support to nothing, this is not how I was taught nor how I've ever seen it done at a hospital where I have worked.

Amazingly though this doctor is well liked and respected with how he treats patients and their illnesses but when it comes to vents, my department cringes but does our best to deal with it.

Any comments would be much appreciated, I would like to hear if anyone else weans like this.

Keep driving on RT's.

Friday, March 13, 2009

It's been awhile.

I've been gone for awhile, I started taking classes again and just got myself busy trying to get back into this school thing and realized I missed having a outlet to post things on my mind when it comes to Respiratory Therapy. So, I'm back and hopefully I can get some good posts out here in the RT blogosphere which can spark some thoughts and conversation.

There that's my 2 cents worth and I will be posting something more substantial later.

Thanks for reading.