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.