Wednesday, September 26, 2012

Common Sense in Respiratory

Why is that when someone is coughing outside of the hospital they will go get cough medicine or a decongestant?  But when there is a patient coughing in the hospital the first treatment of choice is the great a powerful nebulizer.  This always amazes me because I see quite a few patients where just a nice cough medicine would probably do the trick to get rid to the dry throat or the tickle in their upper airway.  Now I do know that some cough's are caused by a bronchospasm, but ER's are notorious for calling for a nebulizer treatment on any patient with a cough even though they have not actual respiratory history.  I'm pretty sure that cough medicine is much cheaper than calling us RT's for a nebulizer tx.

In another aspect of common sense I see quite a bit in my 16 years as a therapist is the classic, "The patient got up to use the bathroom and now is back in bed and winded."  Yes a COPD patient or a morbidly obese patient will get winded by walking to the bathroom and back when they are sick.  Lets compare this walk with a 5 mile run in a healthy person.  When I go for a run and I stop yes I am winded but I do not have bronchospasms going on.  Now lets think what works for relieving my windedness (not sure if thats a word), well I just rest and can re-cooperate back to my normal breathing.  Back to the sick COPD or morbidly obese patient, or even a pneumonia patient, moving that short distance in their present condition can cause them to be winded or short of breathe, not really due to a bronchospasm but because their body is out of shape due to their current condition, so it is my thought that if your allow these people to sit and re-cooperate they will recover.  Again as I said previously there are situations where one of these patients could definitely be having a legitimate bronchospasm, but I've seen it multiple times where I'm called for a breathing treatment on these patients when I'm with another patient and by the time I get to this patient they have recovered.  The recovery can also be sped up by increasing their oxygen flow if they are on for a little while.

These are all just observations I have noticed, but they seem to fall under the use of common sense and just thinking things through, even though most of the time the nurse and patient really don't want to hear this they just want immediate solutions and in their mind medicine is the best treatment.