Oxygenation and Ventilation, there is a difference.

I got a call from a nurse the other day at the beginning of my shift telling me about a patient who's oxygenation saturation had dropped to the 80's, she continues to tell me that this patient has a neb treatment coming up and if I can give it a bit early.  I ask her what oxygen device and flow the patient is on and she tells me and I respond with, "Increase the flow and give the patient more oxygen."  The nurse continues with chatter about the neb tx so I tell her, "You know that neb tx's are not to increase oxygenation they are to help with ventilation."  There is a pause and she says, "Nebs don't help the oxygen of a patient?"  She seems just plain stunned, and this is a seasoned nurse.

This is a topic that I've had to explain it multiple times to non RT's.  Neb's relax the smooth muscle tissue so it's easier to take a deeper breath if there is bronchoconstriction.  Neb's do not increase the oxygen in the blood, honestly you only running the neb and giving about 40% oxygen, if the patient is on a higher oxygen percentage their sat will most likely decrease if we go from a non-rebreather to a neb.  The particle size from a neb is 0.5 micron's where the size of alveoli is only 0.1 micron's,  how is Albuterol supposed to fit into the alveoli to help it oxygenate the blood?  Albuterol helps with ventilation not oxygenation, if you want to increase the oxygen level of a patient GIVE MORE OXYGEN, and then figure out why they need more oxygen.

Oxygenation and ventilation do not correlate with each other, increased ventilation does not necessarily increase oxygenation and visa-versa.  I have seen asthmatics struggling to get a breath and still have good sats and I have seen people with sat's in the 70's and still be breathing comfortably.   Treat the problem, if oxygen is low give oxygen, if the patient can not get a breath in and is tight treat the problem causing ventilation issues, just as if CO2 is elevated increase ventilation to remove this CO2.

This is another reason why there are RT's to educate on about one the most important systems in the body, we need to breath.  Oxygenation vs Ventilation, if we teach the difference we may start to get calls for the correct treatments.

Frustrations of Advancing up the chain in Respiratory.

Respiratory Therapy is a great and rewarding career, you get to help people daily, see them improve and unfortunately see their health deteriorate also, but that's the nature of the game in a health care field.  RT's get to move around the hospital getting to know many areas of the hospital and you're not stuck in a cubicle anywhere.  Unfortunately I do see a downside to this career, and that's room for advancement.

I've been a RT for 20 years now and have been looking for opportunities to advance and move up the so called "Chain of Command" and get into the management side of healthcare, and the problem is there is not a lot of room for RT's to move up, really the only spot is the head of the RT department or maybe if you're in a bigger hospital a shift leader position.  Nursing on the other hand can move into management in many different area's of a hospital, for instance my department just went through 2 years of having our Operations Leader who is a RN, not a RT which is was for decades.  Fortunately recently we went back to having a RT as a Operations Leader.

RT's who are looking to move up in management have to look around outside of the hospital unless a opening comes up in your department because it seems people who get into RT management like to stay there because of the lack of opportunities for positions in management in the RT field.  I've known RT's who have moved a few states over just to take a management position over a RT department, or just moving to another hospital when they noticed something opened up.

So if you're looking for move up in the chain, a lot of times it's not easy and you either get lucky and something opens up in your department, otherwise you basically have to look outside of where you work, or get a degree and something else.

Drive On RT's.

The good old days for helping asthmatics.

I present to you:

Dr. R. Shiffman's Asthmador Cigarettes.

     Apparently when doing some research Stramonium and Belladonna both have bronchodialation and anti-inflammatory properties.  Belladonna is also a type of Nightshade plant which was used as a poison in the middle ages.

Women who quit smoking before 30 cut risk of tobacco-related death by 97%

Women who quit smoking before 30 cut risk of tobacco-related death by 97% according the a new study from the Lancet of more than 1 million women.  This is good news for those female teenagers who started in High School and then decide to quit early.

"Women who smoke into middle-age have three times the death rate of non-smokers and risk dying at least 10 years early, according to adefinitive study of the effects of tobacco in more than a million women in the UK.

The good news, according to the study by a team of Oxford University researchers led by Sir Richard Peto, is that giving up cigarettes before the age of 40 reduces a woman's risk of smoking-related death by 90%. Quitting by 30 reduces it by 97%."  - from the Guardian Article.

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.

Grave risk of silica.

Study Exposes Grave Health Risks of Silica

A study conducted in China has recently unearthed some new findings that could be very important to the prevention of future respiratory problems. The study, which was conducted by Chinese scientists over many years, followed and examined a large group of Chinese mine workers that were exposed to a compound called silica. Silica is a substance that is present in both sand and rock, and can be extremely harmful if inhaled. It is perfectly harmless if contained within the rock or the sand, but when rocks and sand are drilled or broken, fine silica dust particles then escape. These are easily inhaled and then lodge themselves deep within the lungs. This leads to all kinds of problems, such as scarring and respiratory issues and even death.

The problems experienced by the Chinese workers - who were working in places such as mines, pottery factories and gem stone factories - had a sinister outlook. The study found that the workers were not only experiencing problems with breathing, but as a result were also at a greater risk of contracting very serious heart problems, infectious diseases and even cancer.

Significant findings

The study is of particular significance due to its sheer size. The scientists monitored the health of 74,040 mine and pottery workers in China, and over a period of 33 years. They then compared the health of these workers to that of people who were not exposed to silica.

One of the leading researchers on the study, Professor Weihong Chen at the School of Public Health, Huazhong University of Science and Technology in Wuhan, Hubei province, acknowledged the new significance of the findings: "In addition to a higher risk of respiratory disease, we see a heightened risk of cardiovascular disease in exposed workers," she said. "This is a new discovery."

The findings of the study are likely to change the focus of health concerns for those conducting jobs with a high exposure to silica and other harmful dust particles; not only for those in mining jobs but also those conducting regular activities such as joinery, glass engraving or sanding. "Before we were mostly concerned about respiratory diseases," Professor Weihong Chen explained. "As to whether it raises the risk of cancer, we can give a definite answer: We see a heightened risk of lung cancer in workers exposed to silica."

Large scale

The results of the Chinese study are not only significant in terms of focus and direction of health care issues for these workers, but also in terms of the scale of the risk being posed. The study found that workers exposed to silica were a massive seven times more likely to develop harmful infectious diseases, five times more likely to develop serious respiratory tuberculosis, and around twice as likely to develop some form of cardiovascular illness than those people that worked in clean environments with little exposure to silica. Also among the findings of the study was that those working in environments such as pottery factories or mining wells were almost twice as likely to develop nose or throat cancers.

This study should set off warning bells for industries such as mining, pottery and stone farming, not just in China, but throughout the rest of the world. China is one of the many countries that has a strong industrial dependency, with around 23 million workers exposed to silica through their jobs. Although the United States has nowhere near this number (we currently have around 1.7 million people in these trades), we still have a huge number of people to think about.

Silicosis

One form of harmful respiratory disease is a condition called silicosis that, as its name suggests, is caused by silica. In China, around 24,000 workers die from this disease every year as a result of silica getting into their lungs and staying there. The silica causes so much inflammation, scarring and pain that people with the disease die young - commonly in their forties. This is a huge proportion and a grave cause for concern.

It is hoped that the publication of this study and its findings will lead to increased awareness of the dangers of exposure to silica and will prompt companies to do all they can to decrease the risk of harm to their workers. Professor Chen has made the following recommendations for organisations.

"We recommend that worksites control levels of such pollutants; it's a public health problem. Through changes in the work environment, we can reduce the risk of disease and (early) death. Factories can use stronger ventilators, and more effective masks for workers will reduce silica exposure."

Members of the general public should also take this study as a warning of the dangers of dust compounds such as silica. It is always dangerous to expose your lungs to overly dusty environments. Wearing masks in these circumstances will go some way to protecting your lungs against harmful long term damage.

The ground-breaking study was published this week in the Public Library of Science journal PLoS Medicine.

Obese children with asthma need more Steroids

Obese children need more corticosteroids then these children do according to this study.
Obese children with asthma require more steroids.

This goes well with I do you said to people lost more weight would spend less time because our country is at an all time high score obesity.