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.

10 comments:

Tej Chahal said...

I guess many people do over look the simplest things when they are in a situation that makes them nervous. I agree with your view on how you do not require extreme treatments for minor things. Also you do not need medicine for every problem the patient has.

Your experience throughout the 16 years you have been working as an RT really does make a difference on how you see things and make better decisions. Respiratory Therapist's like yourself will help RT's like us who are just beginning our careers make better and more educated decisions.

I believe it comes down to how you educate yourself and how you handle situations. The better educated you are the better you can do your job.

Jolynn McCormick said...

Hello- I am writing to see if I could get some pointers on how to get a job right out of school-I graduated in June and I have been applying everywhere and I have been turned down or not contacted at all-How do I get experience if no one will hire me? Right now I have my CRT and will be taking my RRT tests later this week and next week-thanks!

Douglas Kohn said...

I think the Job market is a little slow right now for RT jobs there doesn't seem to be much around. I guess you might want to be willing to move cities if needed. Just keep applying, look into all hospitals, home health, long term vent facilities.

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One of the most overlooked part of cleaning homes is the jetted bathtub

Jetted bathtubs have about 15 to 20 feet of plumbing lines underneath the tub. These lines are full of warm stagnant water. This contaminated water forms what is called biofilm. Biofilm is full of bacteria and mold. Biofilm is resistant to chemicals not designed specifically to remove biofilm. The University of Bozeman Montana's Center for Biofilm Engineering has proven that bleach (sodium hypochlorite) can't penetrate biofilm, along with vinegar, dishwasher detergent etc. You must use a chemical specifically designed to remover biofilm to clean the tub.

What are the hazards of bathing in untreated water?
1) When the jets are turned on, you are breathing in high levels of mold and bacteria.
2) Large facilities like hotels run the risk of developing Legionnaires Disease.
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4) In hotels and resorts, patrons are literally sharing bath water from previous users.

Properly treated tubs should be as safe to bath in as the source/tap water. Bacteria levels in untreated tubs may have a plate count of 1,000,000 or so, and down to 100 if treated properly.

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Colleen Matheson said...

Right on the money with these scenarios. Good post!

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