Attempt to stop teen teen smoking

We all know that smoking makes you look really cool these days and who doesn't want to look the coolest ... well Teens of course.

Japan have rolled out a cigarette machine that is supposed to verify if you are of age to smoke or not. How this worked is the machine has a face recognition camera that supposedly can detect your age. Interesting enough, and of course it's in Japan where they are quite good a finding ideas for things via technology.

So now these machines have been rolled out onto the street and they did seem to be working until someone figured out a way to hack it. How you ask? Well the kids are able to use a picture of a someone older and hold it up to the machine and look at there you are verified.

Here is the link to the article: Linky

Why did I post this, well it relates to smoking and the fight against it. And of course us RT's are anti-smokers right! Just thought it was interesting and fun. People are trying to cut down smoking.


Enjoy.

New Device helps a paralized person breathe.

Interesting respiratory related news, the FDA as approved a device called the NeuRx DPS RA/4 that can be implanted in the diaphragm which in turn stimulates the diaphragm and allows certain spinal cord injured patients to breathe for at least 4 hours a day off of the ventilator.

Here is a article to read more in this device. Diaphragm-Pacing Device.

This can definitely improve the quality of live for a person with paralysis. This device was approved by the FDA under the Humanitarian Device Exemption which is a approval process that in intended for devices that treat less than 4000 people per year.

I'm all for this, but really will be start seeing many people on this type of device? Is this something we might need to have a little training on? Who knows, I just thought it was interesting technology to know about.



Keep on driving on RT's.

What we see, not everyone does.

We are currently very low in our census of respiratory patients but we still have some interesting ones come in and out of my place here. Tonight I had a patient come into my ER who was very tachycardic to the tune of 170's and higher along with a respiratory rate of 40's and sweating very profusely.

What does that sound like? If you said a pulmonary embolism you would be correct. Now this really is nothing very new to most RT's but what really struck me about this one is the mortality of this person that was brought up to me. I had previously done a EKG on this patient when he first came into the ER and was called back to do another one about a half hour later. What I noticed was his rate had increased along with his heart rate and the patient just being very anxious, but he was very alert and awake.

When I finished I went out and talked with the doctor, I asked him if this patient had some sort of bad infection also because of a high fever according the the nurse. The doc said no, he has a bad PE and he was pretty sure this person was going to die.

Right there is was struck me, "pretty sure this person was going to die". Does this patient know that, are we looking at a dead man walking type of issue, somehow he can tell that this person who is alert and awake has a clock that is ready to stop. Well the doc was right, he got to the point that he needed intubated and not more than 2 minutes after the intubation his HR went from 170's to the 30's and a code was started.

After all was said and done this patient didn't make it, but between when I talked to the doctor until the code was stopped, I couldn't help but think that I was this alert person that we knew that his time was up and it was just a matter of time. I was talking to this person knowing that the doctor could be right and I could be the last person he talks to. We watched this person just fade away, did all we could to save him but in some sense we all knew there was not much hope at all.


This all started me thinking about what we see as RT's compared to other people in the world. If you think about it how many people actually get the chance to actually watch someone take their last breath? How many people get to see a person who is injured beyond recognition from a car accident? Really I don't think many people get the chance to experience the things we sometimes do and a daily basis. Yes most people will probably see a dead body after the fact at a funeral but really how many are able to see life just slip away from a person or see us as caregivers struggle to resuscitate a person and get their heart started again?

Honestly do people in our lives, friends and family really understand what we see and deal with at our job? Do you think they have a good idea of what our job involves? Unless you are around our job you can never really know what we see or do. In my 12 years as a RT I couldn't even guess how many people I have seen die, and really I feel I have been desensitized to the reality of death and dying. I often wonder that if, God forbide, one of my parents would pass away that I wouldn't be able to show much emotion but I do know I would be sad. It is possible that I am so used to seeing people die that I might not even be able to cry for my loved ones.

All in all as a RT I really think that we see more death that a lot of RN's in the hospital. Think about it, as the RT we are required to respond to all codes, not all RN's are. There is the possibility of a code happening in the floor that the RN works at, but we as RT's are responsible to respond to ALL codes in the hospital. So are we around it more, I think so. This fact I can see in the eyes of some RN's who I see in codes, it's in their eyes they just seem a little out of sorts. We on the other hand usually have been though many of codes and are a rock in the sea of turmoil called a code. Don't get me wrong there are a lot of RN's in the position to see a lot of this also, namely ER nurses, they probably see a bit more than us. They are also a special breed.

There are many jobs out there that see things that most people would not want to but that's what separates the people who are able to do these types of jobs. It's not for everyone, you have to have a certain toughness and mindset to do this type of work. We have that mindset, and it is needed to not only do you job but to be a calm face in a stressful situation.

Friends and family might know what a RT is, but will never understand really what we see and deal with as a RT. Sometimes it can get to you when you think about it.


Drive on RT's.

Small Town Patient Privileges

Patients in a small town hospital like the one I work happen to be a totally different animal than the ones in the bigger cities. This idea I'm pretty sure Freadom over a Respiratory Therapy Cave and agree with me about because it seems that he is in this same small town hospital category.

Some of the differences I have noticed are the types of reasons that people come in for are pretty simple compared to larger hospitals but there are exceptions also to this. There are the injuries that can be more local to the type of hospital you work in. For example where I work is a large farming community, we have had rolled over tractors, getting kicked by horses, falling off of barns, and my favorite the guy who him and a couple of buddies were drinking out in the cow barn and had a little to much and passed out and coded right in the middle of cows, down in the hay and manure. The EMT's said they were worried that the cows would kick them while they were working on the patient. This guy smelled awful and had cow manure and hay all over him, unfortunately he didn't make it and the ER room smelled and had hay all over the place. Then there was the Ethenol Toxicity patient who decided to drink some straight ethenol from the ethenol plant, yep not smart it's 200 proof!!!! He was quite red.

Tonight I had another one of my small town patient who received a privilege that I have not come across so far in my 12 years as a RT.

I was on my way to do a breathing treatment with a older patient at around 8 pm and when I got to her room there was no one there. Fine I thought she must be walking around the unit, we do encourage our patients to get up and walk. I see her nurse and ask if she is out walking and I'm told no she isn't, she is - get ready for this -

Ok here is the dialog:

Me: Hey Nurse Betty do you know where Mrs. Bing is at, she is due for her treatment?
Nurse Betty: No she isn't here right now, she's out.
Me: Out, not here, is she at a test?
Nurse Betty: Uhhh nope, she is at a Wedding.
Me: She is what??? (confused look on my face)
Nurse Betty: Yep you heard me right she is actually at a wedding, she left about 1 pm.
Me: Really, is she coming back?
Nurse Betty: Yea the doctor said she had to be back by 9:30 pm.
Me: So she is gone to a wedding and has a curfew. She is really sick isn't she. (dumbfounded)
Nurse Betty: (sarcasm) Oh yea she is so totally sick.
Me: Did she wear a dress? Get all dolled up?
Nurse Betty: No Idea I just go here at 7 pm.

Ok this I found interesting as she must not be very sick at all, send her home and have her follow up with a doc at the clinic. Your wasting our time.

So about Midnight I have to go assess her for respiratory status and she is there finally and I can give her the treatment also now.

Me: So I hear you went to a wedding today?
Mrs. Bing: Oh yes I sure did.
Me: Was it a good wedding?
Mrs. Bing: Yes very pretty and the reception was a lot of fun to.
Me: So what time did you get back?
Mrs. Bing: A little before 10pm, the doctor gave me a curfew. Can you believe it, I'm 86 years old and I was given a curfew. I really don't remember ever getting a curfew.
Me: Yea that is pretty funny, well glad you had fun and made it back before the doctor grounded you. Alright here's your neb.

I just really found this interesting that a inpatient is released to go to a wedding or really anything while they are sick. Granted we cannot hold someone against their will but why not just discharge this person, they seem to be okay. Oh well I thought it was funny.

Then tonight there is this younger 20 something in the ER who I had to do a EKG on. The police were here for this one because he was a bit unruly. Seem like he had a couple to many drinks or drugs of some sort. So anyways I'm in there and he threatens to spit on people so the conversation proceeds:

Big Dork: Get away or I will spit on you and give you the SARS I have!!!!
Me: I don't really think you have SARS.
Big Dork: Yes I do get away.
Me: How did you get SARS?
Big Dork: I don't know, how can you get SARS?
Me: It's not in the United States, have you traveled overseas recently?
Big Dork: Yes I've traveled overseas recently.
Me: Where to, because there are not to many places that have SARS?
Big Dork: What places have SARS?
Me: Japan, China, over in that area.
Big Dork: Well yeah exactly, that's were I went to Japan.
Me: Yea Okay, if you spit on me SARS or not I will let that cop beat on you.
Big Dork: I'm not really going to spit on you.
Me: Ok hold still so I can run this EKG, thanks all done and good luck with your SARS.
Big Dork: Thanks, can I have a glass of water.
Me: Let me ask you nurse, cya.

That was just plain funny, I like funny drunk/high people you can mess with then and they will never even really notice you messing with them.

Well hope this was as entertaining to you as it was to me tonight as it did make the night more interesting because I actually had no patient that were due anything overnight. Easy night

Drive on RT's

What do Cord Gas values mean?

In the different hospitals I have worked at over the years where the respiratory therapists either draw or run the umbilical cord gases I have often wondered about what the normal values of a cord gas was. Just from running a lot of cord gases I have came to my own conclusion of what a cord gas value should probably be but have never really looked into what the real normal values are and what a value out of the norm would mean.

I have done some research online to see what I could find out. Here are some fact about umbilical cord gases and the normal values:

• The umbilical cord blood is studied for the status of the fetal acid base. Cord gases are obtained to detect the presence or absence of acidosis and to decide whether the cause of the acidosis is respiratory or metabolic. Establishing the source and type of acidosis make it easier to a.) plan resuscitation b.) treat complications.
• Umbilical cord blood pH and acid-base balance is most useful in association with the delivery of an infant with a low APGAR score.
  
• Only newborns who have a persistent APGAR score of 0-3 for 5 minutes or longer and an umbilical artery blood pH of less than 7.00 are at risk of manifesting anoxic brain injuries.
• Premature infants are at higher risk for intracranial hemorrhage and subsequent neurological dysfunction, such as cerebral palsy. Without umbilical cord blood gas analysis, these neurological complications could be incorrectly attributed to intrapartum or birth asphyxia, especially if the latter is solely based on APGAR scores. Normal umbilical cord blood values in the premature infant virtually eliminate the diagnosis of significant intrapartum hypoxia or birth asphyxia.

The information I used above was found from different sources who are all basically saying the same thing. Now how about those normal values and the values the show a respiratory or metabolic acidosis.

As a reminder the umbilical cord is backwards as the Venous side carries the oxygenated blood and the Arterial side the unoxygenated blood. Doctors prefer to use the Venous cord blood but can assess PH with he arterial side also. Also these values are not set in stone, they are just a reference point, I have came across values the differ but very slightly.

After Birth­Normal Fetal cord blood pH and gas values:

	VEIN	ARTERY
pH	7.25 - ­7.35	7.28
p02	28­ - 32 mmHg.	16­ - 20 mmHg.
pC02	40­ - 50 mmHg.	40 - ­50 mmHg.
Base Excess	+/- 0 - ­5 mEq/Liter	+/- 0­ - 10 mEq/Liter

Abnormal Venous cord blood pH and gas values

	Respiratory Acidosis	Metabolic Acidosis
pH	<>	< 7.25
P02	Variable	< 20 mmHg
pC02	> 50 mmHg	45­ - 55 mmHg.
Base Deficit	< 10mEq/liter	> 10mEq/liter
	Respiratory Acidosis	Metabolic Acidosis
	Low pH	Low pH
	High pC02	Normal to high pC02
	Normal Base Excess	High base excess

As always I hope you have learned or been refreshed on this topic, I know just researching for this information I have learned a bit of information.

Thanks for reading.

Drive on RT's

Some are more sensitive than others.

Over the years of being a Respiratory Therapist I have learned a few different schools of though on the use of oxygen and how effective it is at different levels.

It has varied from:

• 100% Nonrebreather to in reality a 70-80% nonrebreather. A lot of nurses actually believe it is really 100% oxygen the NRB is giving.
• OWL protocol, or Oxygen With Love. This actually really seemed to work and what it was used for was to decrease the occurrences of retinal detachment in babies in the NICU. The protol was to keep the SPO2 level between 88-92%. We all know that high levels of oxygen can cause retinal detachment in infants, well this protocol actually worked, it decreased the amount of infant that needed eye surgery due retinal detachment from around 60% down to below 20% at the hospital I worked at. So did it work, I think so.
• You need a bubbler with oxygen. No you don't, not always. I do give them our for levels over 4 lpm on the nasal cannula IF they are at that level for awhile, or they are getting bloody or burning nares.
• All Post-Op patient need 2lpm of O2 for 12hrs after surgery. I think not.
• Anything under 2 lpm with a Nasal Cannula is a worthless on a adult.

That last one is a area that I'm dealing with right now. All of the other hospitals that I have worked for we were in the school of thought that under 2 lpm, you might as well just take them off because it doesn't do anything for that patient.

For some reason that has been true so far for me and my patients, until I started here at my current hospital. I recently had 3 different patient who I just couldn't wean off of oxygen. They were a 15 month old, a 60 year old and a 83 year old and they were all on the under 2 lpm levels of oxygen, which seemed to be the kicker.

Now that 15 month old I do understand that pediatric patients do respond to lower levels of oxygen flow, which is why they make a low flow oxygen flowmeter which goes from 0.1 to 1 lpm. This patient had a possible pneumonia but great sounding lung sounds after a day, but we could not get this child off of the 0.1-0.2 lpm of oxygen. She would drop to the mid to low 80's without it and as soon as I put it back on, poof back up to the high 90's.

Then the 60 year old I had. This person was a long term smoker, probably had COPD also so I would assume that this person lived in the low 90s to the high 80s. But what was interesting is that on RA this patient would drop down to 80% so we would put 0.5 lpm O2 on and the sats would jump back up to 97% right away. Seriously 1/2 lpm and the spo2 would jump that high. I was amazed. I had always learned that under 2 lpm was a waste of oxygen and equipment.

Now the last patient, my 83 year old was the same way. I was doing my oxygen rounds and I checked her spo2 on 1 lpm and she was 99% on the 1 liter. Great I though, I can take her off the oxygen, which I did. I then came back in a hour just to make sure that the sats were fine and wow was I shocked. 78% on RA!!!! I'm thinking, "Really no kidding, that 1 liter made that much difference with her!!!". Well it did, I put her back on the 1 liter of O2 and BoooYahhh, it shot right up to 97%. Amazing.

This was in the same night, all three of them had their oxygen issues. This night right here disapproved the idea to me that anything under 2 liters per minute of oxygen is worthless in adults, I was a skeptic but now I think I might be a believer. Even most of the books say a nasal cannula is set between 2-6 lpm and 24-36%. Now 1/2 lpm is 23% according to the formula:

21% + (oxygen liters per minute *3) = fio2.

That there is under the book definition of the nasal cannula, but it seems to do some good. Oh well as long as they are not dying on me and it's that 1 lpm that is keeping them from doing so, I will keep using the lower levels now as needed.

if anyone has any information or web sites about the lower levels of oxygen on adults I would be very interesting in that information, because like I said I have always heard it worthless under 2 lpm, but apparently some patients are more sensitive than others.

Drive on RT's and thanks for reading.

Diagnosing my Grandfather

My Grandfather was in the hospital again this last week for a couple of days because of shortness of breath and he has a doctor that seems to just beat around the bush by not giving my grandparents a definite diagnosis. He was told that he did have a blood clot behind that knee that is taking Lovenox for at home, yep my Grandmother is giving his shots in the stomach. I saw her do it today, she does a good job.

The problem my grandparents are having is that this doctor has never given a good distinct diagnosis of what is causing his breathing issues that he has been into the hospital for two times this year and has also been in before, so as a good RT I am going to lay out the facts and give my diagnosis. Maybe a good case study here.

• He is 86 years old
• Has had 2 heart attacks both with CABG surgery
• He smoked for over 50 years, quit about 15-20 years ago
• He does a lot of woodwork with lots of sawdust
• He gets very SOB when it is hot and humid
• Has a productive cough
• When SOB he sleeps better sitting up
• Breathing treatments do help him
• He gets bronchitis fairly often
• He is diabetic
• He is very active, does woodworking, walks to mow lawn, plays with grand kids
  

Ok from what I have here I really think that he has a good case for COPD. I understand that there could be some heart issues here, but I would rule out COPD and would like for him to have a PFT test done. There is a good possibility that a corticosteroid would do some good for him and a rescue inhaler.

This particular doctor will not say what this could be. He has said there could be a touch of emphysema, and that the cough is "chronic in nature", but he will not send him for the proper tests to check to see if the lungs have problems. This is driving me nuts. How hard is it to order a PFT testing to be done? Why not send him home with some MDI's. He did send him home with a antibiotic called Avelox that after reading is supposed to be good for upper respiratory infections. This med only takes 4 pills to kick bacterias butt, pretty cool and powerful.

This is added as a late entry, but this doctor also stated to my grandparents that the Sawdust from his hobby has no effect on his lungs as the particle size is to large to get into his lung. Huhh. Yep he said it's gets stuck in the upper airway and that's why there is sawdust in his sputum when he coughs because it is filtered out by the nose and upper airway. Yea ok quack.

Well that's the deal, I really hate this cannot make up my mind mentality of this particular doctor and I'm glad he is not from my hospital.

Let me know what you think.

Cover your workers, don't set them up for failure.

My wife as I have said before is a ER nurse at another hospital and she came home the other night just a little bit distraught about something that happened at work where a couple good points or we can say lessons came out that can come into play for all medical professions.

I was night shift and she had a patient who was a child and a very overbearing mother to go along with the child. An I.V. was placed in the patient and it took about 6 nurses and tech's to hold this 8 year old child down who was biting and kicking to get the I.V. done. I.V was finished and blood was drawn.

My wife grabbed the labels off the chart the tech had put on there and labeled the blood tubes and send then to lab. 1o minutes later the lab calls and said they were the wrong labels they were for another patient.

Not good but can be fixed, the patient has a I.V. so we can just draw more. Now lab comes down to draw more blood from the patient and is told to wait a moment so we can get the labels together. Lab does not hold on and goes ahead and throws her fellow workers in front of a truck. This young lab tech goes into the patients room and proceeds to tell the patients mother that the Nurse screwed up the blood and didn't put the correct labels on the tubes.

Good job young lab tech, not mom is irate and comes out of the room into another patients room and starts yelling and dropping the F bomb all over the place to my wife right in front of another patient. Calling her the worst nurse ever, this hospital sucks, I'm taking my child outta here (go ahead), among other colorful things.

Now how could this of been avoided? Of course double checking the labels, yes that is a lesson learned. Also though this lab tech could of easily told the mother that they needed more blood for another test, or that the blood in a tube clotted, anything but YOUR NURSE SCREWED UP, and this could of all be avoided. The patient had a I.V. so there would not be another needle stick at all. Easy fix.

The security was called for a irate parent, the nurse supervisor called the young lab tech and chewed her out and the doctor said nothing was wrong with the patient anyways, plus my wife was upset and said some things to the parent.

What did we learn from this besides checking your labels:

1. Cover the integrity of your fellow employers and the reputation of the hospital if it is possible.
2. Do not set people up for failure, help each other out and things run smoother for everyone.


It's easy, just use you brain and common sense.

Thanks for reading, Drive on RT's.

The PediaRTritian is born

Pediatrics are an interesting bunch, sometimes they receive treatments like adults and others times they are treated totally differently. Either way we all know pediatric patients do cause some nervousness with certain people.

I like to think that I have quite a bit of experience with pediatric patients. Lets see I worked in a level 3 NICU which I was also on the neonatal transport team where a RN and RT would fly or drive babies born with problems, normally respiratory problems. I have also worked in a Pediatric ICU along with different peds units. On top of all of that I also have 4, yes I said 4 kids at home. I've been around the peds population a bit.

So you ask where am I going with this? Well it has to do with the small town hospital I work at currently. Now this is a small town hospital that really doesn't get a lot of pediatric patients at all.

It is that time of the year for evaluations and I was called into the supervisor's office to do a little evaluating of me for the past year which I had just started working at this hospital. So I'm going through the Blah Blah Blah, your doing fine, Blah Blah Blah, what can you improve on, etc etc and this comes out.

Supervisor - "A RN wrote you up some months ago about not feeling comfortable with you as the RT of a peds patient, but was comfortable with your other night shift cohort."

Look on my face: WTF? I do remember this patient.

Me - "How so, I took great care of this patient."

Super - "Well this was a new nurse and she said that you didn't help her very much."

Me - "Help her with what, I did my RT stuff and the patient was in no distress."

Super - "She was just new and nervous and wished that your were more around to help her be comfortable with a respiratory peds patient."

Me - "Really? But isn't she a nurse who went through school? I'm not sure I understand what she was getting at, but I guess where I come from there are nurses who are pediatric nurses."


OK so after chatting a little while it basically came down to the supervisor, who is also the floor's supervisor, letting me know she want's us more involved in the care of peds patients with respiratory problems. Just help our more because the RN's don't get a lot of peds patients and get a little nervous around them.

Correct me if I'm wrong but do we not get the same amount of respiratory peds patients as the RN's do as inpatients? Granted I probably have more experience that most of the nurses on that floor with peds but still, what more can I do besides educate those RN's who are not comfortable with respiratory issues, I will not sit there and hold their hand. I guess I just don't quite get it.

Once again another added responsibility of what the RT can do is added to the list, the PediaRTritian is born. Tonight it also just so happens that there is a peds patient on the floor for us to see and besides just doing my nebs and RT stuff, I am stopping down about every 2 hours to check with the RN to see how she thinks the baby is doing, what else can I do. This just frustrated me a bit that I was told that a nurse wasn't comfortable with me and now we are wanted to be MORE involved with peds patients, but I am not going out of my scope of practice.

Now that RN who wrote me up, well she quit soon after that because that peds patient stressed her out to much and took a job at a clinic where she doesn't deal with peds patient. Now was it me or just a new RN freaking out a little to much and not being comfortable with her own training. I've also been informed that there are RN's here who flat our refuse to take peds patients even to the point of calling off work if there is that possiblity. Amazing.


Pretty soon RT's will run the hospitals.

Keep it up RT's and drive on.

Kids Site about the Human Body

The picture on my last post came from this site:

http://www.thehumanbody.ecsd.net/

It's a site made from a 2nd grade class and here's is what it says it's about:

The Human Body

A Telecollaborative Project for St. Mary's Grade 2 Class with Mrs. Vaage and Mrs. Nugent

I though it was a pretty neat site, there is a gallery of pictures of the human body drawn by the kids and in there are little articles about the different body parts written by the kids.

Fun little site I thought I would share.

Nebulizers or MDI's inline with a Ventilator?

Here at my hospital we seem to go through streaks of how we give medication to patients on ventilators. For a couple of months we might use MDI's and then we might just switch over to Nebulizers inline for a couple of months, and it is normally the same doctor who will oversee these patients on vents, it would be our pulmonologist who does it.

Tonight I just came back from being off for 2 days and we now have 3 ventilators running and all three of them are getting nebulized medications. One of the vent patients used to be getting MDI treatments but has now been switched over to nebulizer treatments. So I got to thinking which is better? Could this just be because he has Xopenex ordered as one of the medications along with Atrovent? Shouldn't be the reason we carry these by MDI also I have heard, even though I have yet to see a Xopenex MDI here at this hospital.

Doing some reading online and my own personal experience I have found different pro's and con's of using either a nebulizer or MDI with a ventilated patient, this is what I'm going to try and share with everyone, and I am looking forward to any opinions you might have for either side.


Metered Dose Inhalers Inline with a Ventilator

• MDI's have to be perfectly timed with a vent cycle
• MDI's give better deposition
• You need more puffs from the MDI to get a regular dose to a patient due to the moisture in the ETT that will cause the medication to stick to the ETT or inspiratory limb of the vent circuit. I have seen anywhere from 4 to 24 puffs given at any one time.
• MDI's treatments are faster than nebs.
  
• Need to give a pause after the breath otherwise the majority of the medication could possible go out the exhalation limb.
• You have to push the MDI right after the inhalation cycle starts or if your to early a lot of the medication goes out the exhalation side, you can actually watch this.
  

Nebulized medications Inline with a Ventilator

• Becomes a vapor like the humidification
• Do Not have to time with the ventilation cycle
• Same dose as you would use with a non ventilated patient
• Does take longer
• Does increase measured exhaled tidal volume and minute volume
• decreases the trigger sensitivity of the pressure supported breaths due to higher flow making a bigger negative pressure necessary, increasing he work of breathing in the patient
• may cause problems with the internal ventilator components due to the medication sticking to the components
• should possibly use a extra expiratory filter and maybe a inspiratory filter to protect the ventilator

Those are just some quick little notes of interest I have come across in my researching information for this article along with information I have learned as my time of being a RT.

Some more information I have learned about the placement of the nebulizer and MDI's when you give the treatments I have found and some I have known or used in the past.

When giving a MDI through a ventilator you should put the MDI inline as close to the wye as possible and up to 6 inches behind the wye. Always give the puff timed with a inhalation cycle or it will go down the exhalation side and not to the patient.

With the nebulizer inline I was really curious about the best way to place the nebulizer inline as to get the best treatment and from what I found which was the consensus was to put the nebulizer as far back from the wye on the inspiratory side as possible. Some even will put it behind the humidifier as they found that the aerosol of the nebulizer will mix with the humidified water aerosol, which are basically both the same. The reason it is said to place it farther back is so the inspiratory limb on exhalation will fill up with the nebulized medication aerosol and on inhalation there is a larger concentration of medication given to the patient. There is also the old law that says a gas will go towards the area with the least resistance, so if its closer to the wye the exhalation flow will be the area of least resistance due to the flow and there is a entrainment aspect to that side of the tubing also. Which makes sense to me.

I now after reading am more partial towards the use of nebulizers inline with a vent than MDI's at this time. I also will be moving my nebulizers farther back from the wye, which I will do here in about a hour's time. I lot of my questions were answered by doing some research and I hope I might of given you some more information that you never really knew.

One more thing, DON'T Forget to remove the HME before you give a treatment!!!

Drive on RT's

Pixie Dust...What can it do for us?

There is a article at CNN.com about some stuff coined "Pixie Dust" which is being experimented with on soldiers who have a amputated body part like fingers, arms, legs or toes but not heads. This is being trialed at Brooke Army Medical Center (BAMC) in San Antonio Texas where I took my Respiratory Training.

You can read the article here: Pixie Dust

This pixie dust is supposed to give the body a salamander effect and trick the body into regenerating the missing body part. The powder forms a microscopic "scaffold" that attracts stem cells and convinces them to grow into the tissue that used to be there.

"If it is next to the skin, it will start making skin. If it's next to a tendon, it will start making a tendon, and so that's the hope, at least in this particular project, that we can grow a finger," Wolf said.

This is pretty interesting, how could this help our profession? Could this "pixie dust" help regenerate lungs destroyed by smoking, improving quality of life for COPD patients? Could it help people exposed to substances cause them to get fibrosis?

Interesting to say the least and I will keep a look out in for how it turns our for humans and for the soldier in the article. Hope it works.

Protocols Do Work.

Today I had to come into work early due to the requirement of the monthly Staff Meeting. Ohh what fun, but I did actually gain some information this time that I thought was pretty interesting.

If you have read one of my earliest posts I talked about a Therapist Driven protocol that we had implemented at my little hospital about 7 months ago. This protocol had to do with us the RT's assessing patient and then being able to adjust nebulizer, MDI and Oxygen therapy's as we deemed needed. Well we are now done with the testing phase of the implementation of our therapist driven protocol and a letter from our director is out to the doctors with surveys to see if we continue with this type of therapy.

There are some statistics that we pretty interesting that were compared from this 6 months of the protocols being in use and the 6 months prior to the protocols being in use. These stats were pretty interesting and pointed in favor of using these protocols and making them law. The only areas of care that were talked about were patients with Pneumonia and COPD issues.

Hospital staylLengths for Pneumonia and COPD decreased by 1 day in both areas. So we were able to adjust treatments for the patients and decrease their length of time in the hospital.

Now here is what I though was pretty amazing in the financial aspect.

In patients with a Pneumonia the cost of Respiratory Therapy given to the patient was DECREASED by 23% with the protocol in use. We saved the hospital 23% per patient on average if they had pneumonia.

And

Patients in with a COPD issue the cost of Respiratory Therapy given to the patient was DECREASED a whopping 36% with the protocol in use. Here we saved the hospital 36% per patient on average if they were in for COPD.

These facts speak strongly for the use of Therapist driven protocols and that we might actually know what we are doing.


During this meeting I did get into a disagreement with the director and supervisor about how we should for the first 24 hours do the treatment exactly how the doctor ordered it due out of respect to the doctor so they don't think we are just saying they don't know what they are doing.

Whats the point of doing the protocol assessments in the first 24 hours if we are not going to change anything? The doctors signed off on the protocols, so we have a right to use them as needed, otherwise you need to change what the protocol says.

I think I stunned the director when I said "So basically you two want us to suck up to the doctor's so they don't feel bad?" They said no it's a teamwork thing.

I don't know I feel as though if we don't use the protocol as written the doctor's might get the impression that we are skeptical on our abilities as therapist to assess our patients and choose the right treatments.

Fortunately I have a couple of other therapist who agreed with me and backed me up in my thoughts. Good to know I wasn't alone in my thoughts. So this was to be a unwritten rule that I'm not so sure people will follow. I for one will keep doing it as I have been and that's by the book on how the protocol was written up. Can't get into trouble for that.

Statistics show that we must be doing something right, and there are no complaint's about how we have done our assessments so far. Hopefully the doctors do really see it that way and the surveys come back in good shape, then we can make this law and continue on.

Drive on RT's

Stop and put you hand on that person.

I'm coming up on my re certification of my CPR card very soon and I was looking around on the guidelines at the American Heart Association to see if there are any new changes, and wow did I see something different:

Hands Only CPR.





There are only 2 Steps to save a person's life:

1) Call 911
2) Push hard and fast in the center of the chest.

So I started looking around a little bit and from what I understand is that this simplifies the process for the standard layperson. Just make a phone call and press that chest.

This is just for a adult who was witnessed collapsing not someone who possibly has been down for awhile or a drowning victim. So basically if you see someone collapse just start pressing that chest. Easy right.

One of the big things I see this helping is the though of most people that they don't want to put their mouth on a strangers mouth for fear of disease, this is understandable and this technique removes that problem. Also this is a very simple process so the person who is going to do CPR doesn't have to worry about not remembering the proper steps to do CPR. These 2 factors could possibly help a person faster than before because now maybe people will be quicker to react and not hesitate because fear of doing this wrong or getting their mouth on a strangers mouth, unless of course it is some Hot person you would want to put your mouth on.

Back to the topic at hand. Of course is this is the full standard now there would really be no need for a CPR class because it would take like 2 minutes to teach, so no this isn't all there is anymore you still need to learn the regular way for if you find someone down and not sure how long they were down. This also isn't for the pediatric population only for Adults witnessed collapsing.

Hopefully this isn't old news to everyone but I found it interesting, now to sign up for my CPR class and get this over with.

Drive on RT's.

Here's you card....Duhh

Ring Ring (RT Department Phone ringing)

Me: Respiratory Therapy, can I help you?

Nurse: I have a patient who wants to take his MDI, he has 2 in his med cabinet but only had orders for one of them but he wants the other, can I give it to him?

Me: What is the order for?

Nurse: Albuterol 2 puff, may take on own.

Me: What is the name of the other mdi medication he has?

Nurse: Ventolin.

Me: (Laughing to self) Ok Ventolin is albuterol, it's the a commercial name of albuterol.

Nurse: Really, I've never heard of it.

Me: Yea it's like how acetaminophen is the same a Tylenol, or ibuprofen is the same as Motrin only cheaper.

Nurse: Ok I got it, so which one can I give him?

Me: (Duh look no face) Which ever one he wants.


Someday people will understand.

Miracle, sure it is, but something is missing.

I ran across this new article here from Newsnet 5 talking about a woman who was clinically dead but miraculously came back to life and all was well.

Here is the article, for you RT's out there you might find something out of the ordinary, or which I have given a hint by making the area's bold. This will also all into line a bit with my previous article about respiratory mishaps in movies and TV shows.

Woman Wakes Up After Family Says Goodbye, Tubes Pulled

CLEVELAND, Ohio -- A West Virginia woman was being transferred to the Cleveland Clinic after walking the line between life and death. Doctors are calling Val Thomas a medical miracle. They said they can't explain how she is alive. They said Thomas suffered two heart attacks and had no brain waves for more than 17 hours. At about 1:30 a.m. Saturday, her heart stopped and she had no pulse. A respiratory machine kept her breathing and rigor mortis had set in, doctors said. "Her skin had already started to harden and her fingers curled. Death had set in," said son Jim Thomas. They rushed her to a West Virginia hospital. Doctors put Thomas on a special machine which induces hypothermia. The treatment involves lowering the body temperature for up to 24 hours before warming a patient up.After that procedure, her heart stopped again.

"She had no neurological function," said Dr. Kevin Eggleston. Her family said goodbye and doctors removed all the tubes.

However, Thomas was kept on a ventilator a little while longer as an organ donor issue was discussed.

Ten minutes later the woman woke up and started talking.
"She (nurse) said, 'I'm so sorry Mrs. Thomas.'
And mom said, 'That's OK honey. That's OK," Jim Thomas said.
Val Thomas and her family strongly believe that the Lord granted them their miracle and they want everyone to know."I know God has something in store for me, another purpose. I don't know what it is but I'm sure he'll tell me," she said. She was taken to the Cleveland Clinic for specialist to check her out. Doctors said amazingly she has no blockage and will be fine.

I just find this funny as we all know what you cannot talk while on a ventilator especially with a endotracheal tube in. I'm sure she wasn't trached with a Passey Muir valve on or a capped trach with fenestration since this seemed to only happen in about 24 hours. As bad off as she was I'm thinking a trach was the last thing they were thinking about. I just found that interesting how the media can get things wrong.

So what to do, well I'm going to drop a email off to this news channel just to see if I get a response. I'm thinking this was maybe make to be a little over dramatic as most of the public has not clue with some of this medical stuff. But us RT's will catch the little respiratory inconsistencies that people will make when it comes to our profession right.

If I get a response, it will be posted here for all to see at a later time, but I'm not really expecting anything to much, you never know though.

Drive on RT's.

Google Health.

Just a quick post here about the recently released:

Google Health

I've been playing around with it a bit and it does seem like it could some in pretty handy and informative for someone who uses medications and has multiple medical problems.

You can put in your medications here and it will show indications, contraindications and possible problems if you have incompatible medications, which is good so you don't become like Heath Ledger.

One thing I'm not to sure of on this site is the ability to upload your medical records to the site. I'm thinking some kind of privacy issues here, but on the other hand it's Google and if they do share your information you can definitely win a large sum of money from a lawsuit.

Overall it looks very promising as all Google products seem to be, I do like the idea of all my information, calendar's, email and other information in one place. Google is a well respected name and is probably trustworthy. It's probably something that could help people keep their medical information organized, plus there is a nice print function that will print all your information out so you can go to the doctor with your medication listing and prior procedures and hospitalizations. That is good because I see a lot of people come in with written lists of their own information and with the computer age and Internet being so big now this can be a easy way to pull up your information from anywhere really.

I'm liking Google's response to Microsoft ’s HealthVault (which launched last October), Revolution Health, and Aetna’s SmartSource, because is uses Google clean interface with nothing really distracting on the screen.

I'm not Pro Google or Microsoft or anything but I just really enjoy technology and of course the way it can interact with health care.

Keep it real RT's.

High off Inhalers?

I ran across a article in Science Daily that is talking about teens misusing inhalers (MDI's) to get a buzz or get high off of them.

"Asthma inhaler misuse is prevalent in the adolescent population, particularly among antisocial teens, US study findings indicate."

I find this interesting because I'm wondering how many puffs off of a MDI do they have to do before the feel any effects of being high?

There was a study conducted to get an idea of how prevalent this actually is and the results were kind of surprising:

"Brian Perron (University of Michigan, Ann Arbor) and Matthew Howard (University of North Carolina at Chapel Hill) conducted a cross-sectional survey with face-to-face interviews assessing substance use, psychiatric symptoms, and antisocial behaviors among 723 adolescents in residential care. Over 26% (193) of adolescents were diagnosed with asthma, 91.2% of whom had received a prescription for an inhaler. Almost a quarter of the 373 adolescents who had used a prescribed or nonprescribed inhaler reported using an inhaler to get high."

Is this like any other inhalant that kids use to get high, is it like huffing gasoline, inhaling paint thinner? You would think that there would be a cheaper way to get this type of high, but I guess if insurances is paying for it or you are from a lesser well off family and you have a medical card, it probably is pretty low cost for the kids who do this.

Reading later in the article is shows what effects misuse of the inhaler can cause:

"Inhaler misusers were significantly more likely than asthma inhaler users to report euphoria, memory problems, slurred speech, blurred vision, confusion, dizziness, and a variety of other acute reactions to asthma inhaler use."

Pretty interesting to see how people will look to anywhere to find a way to get high, and with inhalers I'm sure these kids are thinking that this is a lot safer to use like this instead of other inhalants like gas and paint thinner. Wow what is this world coming to, are we now going to start have MDI seekers coming into the ER as well as the regular drug seekers? I'm doubt that would happen as this I couldn't see becoming very popular, but on the other hand you can never fully tell what is going to happen.

As you giving that MDI and spacer instruct to a person who you didn't think really needed that neb you just did on them, they might just be a one of those MDI get High people.

Bronchospasm or something else?

Over at the Respiratory Cave, Freadom has a group of "Olin's" which are a listing of all the magical properties that Ventolin is supposed to have, but we all know better now don't we as RT's, and hopefully most RN's who look at our RT blogs have learned from us on what breathing treatments can REALLY cure. Actually our breathing treatments can really cure .. (drumroll please) .. is NUTTIN!!! No really it cannot cure anything, it can only help ease the discomfort of a symptom which would be a bronchospasm. Thats right Ventolin or Albuterol only really relieves bronchospasms.

So what am I getting at here, well I'm going to show different problems that we are called for that this wonder medication cannot really do anything for because it's not a bronchospasm issue. Please feel free to comment and criticize to your heart's content if you disagree with me on this topic. But really some things we cannot help a whole lot with Albuterol.

1. Congestive Heart Failure - the fluid needs to come off, make them pee or if it's bad enough get em on a bipap.
2. Fluid Overload - not our fault, again Lasix would help here, and stop all the damn fluids.
3. Rib fractures - these hurt to breath deep, Albuterol will not make you breathe deeper.
4. Pneumonia - will not cure this problem, might help them breathe a little easier but it will not get rid of the pneumonia.
5. Gas - let it out, its pushing up on your diaphragm making it hard the flatten and take a deep breath.
6. Over Eating - they ate to much and it stopping the diaphragm from flattening, so unable to take a deep breath.
7. A Cold - of course its harder to breathe, they have a stuffy nose, no lets not try Albuterol and see if it helps at all.
   
8. Croup - doesn't help at all, period. Try Racemic.
9. On a Ventilator - just because you are on a ventilator doesn't mean they need Albuterol. If their lungs are tight then yes, but not just because they are ventilated.
10. High Fever - did you ever think the patient has a high respiratory rate because the body is trying to blow off heat. No really it's true.
11. Chest Pain - yes it hurts, and it's probably hard to take a deep breathe because it hurts, and not do not switch to Xopenex because it won't have as much of a effect on the cardiac areas.
12. Because you don't know what else to do for the patient - if you don't know Doc, how are we supposed to know.
13. Anxiety - almost forgot this one, Give this person some Ativan or Xanax, these do wonders for anxiety. Calm them down. Take the caffeine away, turn off the light and go to sleep.
    

Yes it's one of those things we RT's deal with, and of course it will not change anytime soon because no one really treats it like a controlled medication, it's more like a "let's try to see if it does anything" drug. There is a lot of common sense involved in using nebulized medications and MDI's, for instance: if the lungs are full of secretions or the patient if fluid overloaded how is the medication going to get through the fluid? It would be like trying to salt a burger in the bottom of a pond. It just won't get to where it is supposed to.

Off my soapbox I go, Drive on RT's.

I always thought is was A.B.C.

One basic principle that was driven home to me as a medical professional in either of my schools, be it my Combat Medic course, EMT course or Respiratory Therapist course has been the concept of the ABC's, also known as Airway, Breathing, Circulation. This has always been understood my be to be there order of importance when it comes to a person in medical need. Yes this is supposedly for mainly first responders and emergency situations.

Now in the Emergency Room I would think that this would come into play, because well its a emergency room. Unfortunately I have noticed at many places, and a lot where I work that I will get a call the the ER for a patient that needs a breathing treatment. This usually tells me that there is a person in the ER that is having some type of difficulty breathing, and if you look at the ABC though process it would be number 2 on the list, because if they can breath in a nebulizer tx the airway must be somewhat patent.

Here is my issue that I see more and more, I'm called to do a neb in the ER and when I get there I will get from the nurse and sometimes the doctor, "Oh I'm sorry Xray got here before you so they took the patient to get their Xray done." Or there will be Xray there and they just do the "Haha I beat you here" thing. Sometimes I even get the, "Can you give us a minute, we need to put in this foley catheter first." Then comes the "Hey come do this EKG first before you do the neb treatment."

Does anyone else see anything wrong with these scenarios? As far as I know I would think that breathing would take precedence over Xrays, plus you would get a better view of the chest with a more open chest I would think, but then I'm not a Xray person. I would also think that breathing would be a little more important than a foley catheter, but a foley catheter could help with the breathing if they are fluid overload, so lets both do our thing at the same time. And that EKG before giving this neb to a asthmatic, look at your ABC's, circulation comes after breathing.

There are many times a patient doesn't really need a neb very badly and it's not a emergency situation, but even then it's irritation to be called away from what you were doing to show up and the patient was gone to Xray. Maybe this is more of myself complaining about something, but it irritates me to think that when it comes to patients feeling better, an xray will make them feel better than the nebulizer that will ease their breathing. Personally I would rather be breathing better than getting a picture taken.

Thanks for reading

Drive on RT's

Healthcare Workers Week? HUH.....

Is it just here at my hospital or is everyone celebrating Health care Workers Week 2008? Tonight there was cake and other food items being brought around to the different departments for this particular week. This happens to be Health care workers week 2008, now I don't remember a version of this for 2007 or any year prior to this year. Is it a new thing we get to add on to our calendar as a hospital worker.

Really this isn't a bad thing, we got cake, pens, sticky notepads, and from what the hospital grapevine is saying we are getting a rolling cooler that can hold 36 cans of your favorite beverage. You can't get much better than that. Maybe this can make up for nothing being done for us up here in my small hospital for Respiratory Care week 2007.

Has anyone ever stopped and looked at all the so and so special weeks, months and days there happens to be in a hospital? Seriously there are a lot and just for an example here are some of them I see posted on walls and flyer's:

• Nurses Week
• Respiratory Week
• Radiology Week
• Doctors Appreciation Week
• Bosses day
• Breast cancer awareness month
• Spinal Health week
• ect. ect. ect.....

You get the picture, if you really look around at the hospital you work at I'm sure there is some appreciative day, month or week going on, because of course there is a special week for any profession that seems to work in a hospital. So really maybe this Health care workers week is just a way to consolidate everything into one Christmas like holiday thing for the hospital.

"Jingle Stethoscope, Jingle Stethoscope, jingle on your chest..."
"Here comes Dr. Claus, Here comes Dr. Claus right down the hallway..."
"We wish you a merry health care workers week, we wish you a ......"

In actuality these different profession do deserve a bit of appreciation every now and then and I have nothing against these different appreciation weeks and all but I just thought it was interesting how many there actually are, and now there is another one here for use to be happy for because we get cake and things with the hospital logo on it. WooHoo free stuff.


So until next time:

HAPPY HEALTH CARE WORKERS WEEK 2008!!!

Whoa It's been awhile, people are still nuts.

OK so I have to apologize for not posting for like 2 months now, I became a little busy with life and this was put on the back burner. My hospital started blocking personal (BLOGS) sites from viewing on the internet so I wasn't able to log onto Blogger here and post anything because I usually did it from work. Home has been a bit busy and there just wasn't enough hours in the day to do much posting.

So here I am posting again, my hospital set up a WIFI network for patient and others to use so I bring my laptop into work now and can have some time to post again. So stick with my I'm able to do this again.


Now on to more pressing matters, OK so it's only what I think is a funny little story about a patient at work who really either had no clue, or she just wanted to be difficult and not have to the my therapy.

We RT's here at my little hospital have to start and do Incentive Spirometers with every surgical patient for 4 times to make sure they are doing it correctly and acheiving 50% of there predicted volume, which I personally think should be 50% of their PRE-surgical volume they were able to acheive and not the predicted. Some people have trouble getting 50% of predicted without the surgery. So anyways if the patient cannot get 50% of predicted we start EZPAP until they can acheive this goal. OK now off to my story.

I walk into Mrs. White's room to do round 2 of her I.S. and it goes like this:

"Hello Mrs. White I'm with Respiratory Therapy and I'm here to work with your I.S."
"OK, hand it here and I will do it."

I hand her the I.S. and she of course blows as hard as she can into the mouthpiece and of course nothing moves.

"Umm your doing this wrong, you need to suck in on the mouthpiece to make it move"
"Oh OK I remember."

Now mind you she has been previously instructed on this, I'm there for round 2. She goes ahead and blows on it.

"No remember suck in on it like you would when drinking from a straw."
"I can't, I hate using straws, I don't use them."
"Ok well have you ever used them, while drinking some pop or soda?"
"Nope I have always hated them and have NEVER used one."
"Well how do you know you hate them then."
"I just know I do."
"Well lets try breathing on this again, OK"

So off she goes blowing in and out on the I.S. and it's doing nothing.

"Mrs. White, try to take a deep breath through the tube like you would if you were going to go swimming under the water."
"I don't know how to swim, I don't swim."
"Umm, you have never gone swimming or wading in a pool?"
"No, I'm from the Southwest there are no pools there."
"I used to live in the Southwest for a couple years there were pools there, it's hot and people have to cool off."
"Well not in my time there were no pools in the Southwest."
"OK, I see, lets try sucking in on this tube again."

So now she is like panting on the tube, quick short breaths.

"Now take the tube out of your mouth and put your hand in front of your mouth and blow out."

She does

"Did you feel the air on your hand?"
"Yes."
"OK do the opposite of that, ya got it"
"OK I see."

Back with the I.S. she if breathing deeper in and out of it.

"Did you see it move up there?"
"Yes I did."
"OK now do what you did to make it move up only do it bigger!"

FINALLY SUCCESS, she hit 1500 ml's on the I.S. and her predicted is only 2000 ml's so she is over the 50%, NO EZPAP, whoo hoo.


The next day I come to work and find out the day shift was having the same issues that I did with this patient, so like I said she either has:

A) No Clue
or
B) She is jacking with us.

Either way I didn't have to see her again. You can always find humor in this job. Actually I think you have to have a sense of humor to work this job.


Thanks for reading.

Compassion, Real or Fake?

I've came across a observation that I have finally seemed to put my finger on and it deals with compassion towards our patients and with all health care workers that I have dealt with.

First off how about a definition which I took off of Wikipedia:

Compassion is an understanding of the emotional state of another or oneself. Not to be confused with empathy, compassion is often combined with a desire to alleviate or reduce the suffering of another or to show special kindness to those who suffer. However, compassion may lead an individual to feel empathy with another person.

Now that that is out of the way I will continue.

As health care workers we need to be able to show compassion and empathy towards people who are not feeling well or even dying. This is something we are told in school that we need to use is compassion towards our patients.

Understand that not everyone in health care is able to show compassion and those are the one try entirely to hard to fake showing compassion. This is what my observation is about. I have noticed that it is really easy to spot a person who really doesn't have a whole lot of compassion and is just doing this as a good paying job, but they are not necessarily suited for this type of job.

Some jobs take more than just understanding and knowing the position and knowing how to do that particular job. Need more than just schooling and getting a good GPA in their degree.

Let me try some examples:
A photographer can know all the settings, but they also have to know how to see the world, how to work with their subjects.

A bartender can know how to make every drink in the book but still needs to be able to listen and talk with people, who wants to sit a bar and have a unsociable bartender.

A teacher could of graduated with perfect grades from college, but still has to be able to communicate to the class, and be able to be a mentor.

A Psychologist can know everything there is to know about Freud but they also need to know how to listen and get a person to trust them.

A waitress/waiter needs to know what is on the menu but also needs to be able to be personable with the customers, who wants a unfriendly waitress...sorry no tip.

OK by now I'm sure you get the idea. We, RT's, nurses, doctors, xray techs, lab techs, hell anyone who works with sick or injured people has to be able to show compassion to these people, let them know we do care that they are ill and wish for them to get better and that we will do what we can to help them.

I've come to notice that there are some people out there who do not possess this skill, but do know their job. These people try to disguise this by being overly compassionate, looking to eager to do their job, almost forcefully doing their job. Just plain faking it. It's it totally obvious if you look, you can see it in their faces, hear it in the tone of voice and especially notice it as they walk out of the room.

The people who are compassionate do not try to force their way through the job, they just do their job. Just watch the nurses you can tell, the ones who are good are the ones who don't get overly rattled, the ones who look more relaxed and not rushed. When they talk to the patient their words and expressions don't look like they are acting, they look comfortable and not trying to hard to be overly nice.

Oh yes just look around and watch, you can definitely tell.

I feel like I'm compassionate with my patients and I don't force it, I just be myself and I usually get along with my patients. I don't fake anything, I just am who I am.

Don't fake it, people can always tell ... Yes ladies even your boyfriends and husbands can to.
;)

Do you have any Coupons?

First off I want to say thank you for the kinds words about our accident, everyone is recovered now and things are finally back to normal, again thank you.



Have you ever wondered what the patient is going to be charged for those great therapy's we provide for them?

Well I have wondered that, and were I currently work the night shift RT does all respiratory charges for the day on the patients. I did a little digging and found a area in our computer system that allows me to see exactly what it costs the patient for their different therapys they have received, pretty interesting and a little fun to see how much people are up to on their bills for the stay they are currently in.

So anyways here is what I have found for prices with respiratory therapy services here at my little hospital. Also keep in mind that some of these items I am told are package deals where more than one piece of equipment is included in the cost, what a bargain right...but I will try and distinguish which ones they are. Each of the prices I am showing are only a single charge unless I state otherwise. So like a room will be per night.

First I will start with the room charges, yea I know this isn't really a RT charge but hell compare this to a hotel room and WOW, more bang for the buck in a hotel room in my opinion. No package deal here, just the room cost.

Standard Floor Room: $826.00
Intensive Care Room: $1960.00

Next I will do some standard medication prices, not to back actually but can add up.

Albuterol for Neb: $7.40
Atrovent for Neb: $7.80
Xopenex for Neb: $10.25
Mucomyst for Neb: $7.75
Advair 500/50: $348.40 This would be a full Diskus
Flovent MDI: $256.30 Full MDI

Now I will do the Respiratory Therapy service prices, somehow I think we should get a bigger cut from this, but don't we always want more pay.

Initial nebulizer treatment, includes equipment and our service: $77.25
Subsequent nebulizer treatment: $57.25
Initial nebulizer with Ezpap treatment: $295.50
Subsequent nebulizer with Ezpap treatment x 10 mins: $85.75

At my hospital we change nebs out everyday, so a QID neb orders each day would be charged for the Initial and 3 Subsequent prices. I think we change out to often but that infection control's thing.

Initial MDI treatment: $49.50
Subsequent MDI treatments: $34.25

I think that is just for services, seems pretty steep for me.

Here are our Oxygen prices, now I couldn't find prices for different O2 Equipment like cannula's and masks so I don't know about them, I'm guessing they are included in something.

Oxygen per hour: $17.25
24hr of Oxygen: $414.00
Bubble Humidifier: $11.75
Pulse oximeter check: $35.50 This is just us going in an recording a Sat!

Now lets get to some ventilator and bipap charges, this can definitly add up.

Initial Ventilator day: $1576.50
Subsequent Ventilator day: Exact Same as above

Suposedly this included all equipment, checks, oxygen, nice package deal.

Bipap per day: $167.50
Mask: $131.75
Tubing: $37.75
Headgear: $75.50
24 Hours of Bipap: $945.50

Some reason we charge for that headgear, but it comes in the same package with the mask. Someone is getting over I think.

Now just some other miscelleanous stuff:

ABG: $190.75
EKG: $195.00
Ambu Bag: $140.50
CO2 Detector: $116.25


Now just for fun lets see what a QID Albuterol and Atrovent neb would be:

Inital Neb Tx: $77.25
3 Subsequent Tx's: $57.25 x 4 = $229.00
4 Albuterols: $7.40 x 4 = $29.60
4 Atrovents: $7.80 x 4 = $31.20

Grand total of: $367.05

Yep thats our daily price for QID Albuterol and Atrovent nebs. Not even sure if we charge a sales tax or anything, I don't think so but you never know.

Well there you have it, our pricing scheme, I'm sure it' probably pretty close to most hospitals, I though it was just interesting to see.

Any of you know some of your prices it would but fun to compare prices with types and sizes of hospitals, could be interesting. I'm damn glad I have decent insurance because hospital costs can really add up. There is probably a good possibility that prices become inflated from patients with no insurance and us taxpayers cover the cost.

Just my opinion but I think if you don't have insurance and you come to the ER with something that could be taken care of at a clinic, you should have to pay something, even just $10, might make people think twice. There are too many people who take advantage of the ER and if you charge them these people might have to make a decision beween their cigarettes and beer or how bad there stuffy nose really is. You know these types and I know I'm not the only one who thinks like this.

Anyway take care everyone and thanks for reading.

Drive on RT's.

Gotta Love the Grand Caravan's

Just a quick posting here tonight.

I haven't been able to get around to posting lately due to an automobile accident my family and I had last Saturday.

We were on the way home from my girls swim meet and traveling on a country road when our vehicle became caught in some slush and ice on the side of the road and started pulling our van off the road, my wife tried to keep up on the road but over corrected a bit and we flew across the road head first into a telephone pole breaking it in half. The back end of our vehicle flipped over and we were on the roof and then started rolling finally ending up on the passenger side of the vehicle.

When we finally stopped I figured out that I really wasn't hurt but then became the scariest part of it, getting ready to look around and see if my wife and 4 kids were ok or horribly hurt, possibly even worse. First I looked up to see my wife hanging from her seat and she had blood running down her face and was very swollen but she was alert and talking to me. I then tried to get her to stop moving but as a mother she yelled at me to get her unhooked from the seatbelts so she could go see how the kids are, so I did and pushed her up and out of her window which had broken out. She went around back to get the girls out and they were fine, just a little big banged up and scared because of the crash and how their mother looked. I unbuckled and crawled through the van to get my boys out of the middle from their car seats, these two were perfectly fine but crying, hell who can blame them. So I was able to get them out of the back of the van also. When I finally was able to get out there was a couple from the house we landed in front of there with blankets and were taking the kids and my wife into their house and started dressing wounds along with calling 911 for us which I also had done on my cellphone while crawling out of the vehicle.

EMS and police responded fast and before we knew it we were off in the ambulances. Overall we only spent 3 hours in the ER with my oldest and wife getting CT Scans and xrays and the rest of us were fine, my left hand was pretty cut up plus I had glass all over my face but none of it cut me. My oldest (11) has a headache and a swollen knee, my 10 year old was just a bit shook up, my 3 year old was fine as was my 11 month old, the car seats worked well.

Now my wife had multiple cuts on her head and the right side was very swollen. Her left hand needed stiches and she had a concussion. The next day she ended having 2 black eyes and a bruised face. We also noticed that a area in the front of her head her hair was sliced off to about 1/2 inches instead of her normal 6 inch long bangs. Something sharp flew over her head.

In the end we did $15,000 in damage to our van, some of us here banged up, we were all sore the next day and a little leary to drive anywhere so we ordered in pizza. My wife of course made a hair appointment for the next day to fix the area where she lost some hair, funny I did find the hair when I went to get what I could out of the vehicle.

Amazingly we were very lucky and I put a lot of that luck on how our vehicle was made and how safe it was, also the importance of seatbelts and carseats was totally proven to me and my family, yep we all had them on. My kids are now especially good now about putting on their seatbelts and making sure everyone else has them on.

Probably wondering what this vehicle was, well it was a 2001 Dodge Grand Caravan and it held up wonderfully, so much so that we went out and bought another, only this time it's the new 2008 model.

I will be back with more posting this week, thanks for reading.

Friends Vs. Military Friends

Ok so this doesn't have much to do with Respiratory or medical in general except it was sent to me from one of my Respiratory friends from the Military so I guess it's kind of Respiratory related.

I thought this was interesting and actually very true as I'm closer with my Military friends than I am with my say High school Buds. Which is OK because really my military buds and I have been through much more together in my 10 years of service, hell we lived together in many different situations and places. So anyways here goes:


Friends Vs. Military Friends

1. FRIENDS: Tell you not to do something stupid when drunk

MILITARY FRIENDS: Will post 360 degree security so you don't get caught

2. FRIENDS: Call your parents Mr. and Mrs

MILITARY FRIENDS: Call your parents drunk as hell and tell them about
The fat chick you tried to pick up

3. FRIENDS: Hope the night out drinking goes smoothly, and hope that no
one Is late for the ride home.

MILITARY FRIENDS: Know some wild shit will happen, and set up rally
Points and an E & E route.

4. FRIENDS: Bail you out of jail and tell you what you did was wrong.

MILITARY FRIENDS: Will be sitting next to you saying, Damn...we fucked
up...but hey, that shit was fun "

5. FRIENDS: Cry with you.

MILITARY FRIENDS: laugh at you and tell you to put some vagasil on your
mangina.

6. FRIENDS: Borrow your stuff for a few days then give it back.

MILITARY FRIENDS: Steal each other's stuff so often nobody remembers who
bought it in the first place.

7. FRIENDS: Are happy that someone picked up a one night stand and leave
them alone.

MILITARY FRIENDS: Will Low Crawl naked into the room with a camera and
Hope
for the tag team.

8. FRIENDS: Know a few things about you.

MILITARY FRIENDS: Could write a book with direct quotes from you.

9. FRIENDS: Will leave you behind if that's what the crowd is doing.

MILITARY FRIENDS: Will kick the whole crowds ass that left you.

10. FRIENDS: Would knock on your door.

MILITARY FRIENDS: Walk right in and say, "I'm home!"

11. FRIENDS: Will try and talk to the bouncer when you get tossed out of
the bar.

MILITARY FRIENDS: Will man up and go after the bouncer for touching you
on
the way out.

12. FRIENDS: Will wish you had enough money to go out that night, and
are sorry you couldn't come.

MILITARY FRIENDS: Will share their last dollar with you, drag you along,
and
try to steal free drinks all night

13. FRIENDS: Will take your drink away when they think you've had
enough.

MILITARY FRIENDS: Will look at you stumbling all over the place and say,
"Bitch, you better drink the rest of that shit, you know we don't waste.
That's alcohol abuse!!!" HAHAHAHA !!!!

14. FRIENDS: Want the money they loaned you back next week.

MILITARY FRIENDS: Can't begin to remember who owes who money after
taking
care of each other for so long.

15. FRIENDS: Will say "I can't handle Tequila anymore".

MILITARY FRIENDS: Will say "okay, just one more..." and then 2 minutes
later
"okay, just one more!".

16. FRIENDS: Will talk shit to the person who talks shit about you.

MILITARY FRIENDS: Will knock them the Fuck out!!

17. FRIENDS: Will tell you "They'd take a bullet for you."

MILITARY FRIENDS: Will actually take a bullet for you.

18. FRIENDS: Will ignore this


Just though I would share this with everyone.
Thanks for reading and Please support our troops.

Nothing to do but keep busy.

I am back out of a busy time at my place of business. We have gone from 8 patients with treatments through the night, 3 bipaps and 1 ventilator running back to just having one Q6 during the night now, actually only 4 patient with breathing treatments in the whole hospital, wow what a change huh.

This got me wondering what do people do at their hospital when they have nothing to do? What are some things to keep you mind from total boredom?

This list below are some of the things that I know of from different places I have worked at, some current and some not so current. In my current job I am the only night person on in my department at a time so we have to find things to do, if there was 2 of us here we could take turns being on call, but as you see that isn't possible.

Things to do when you patient load is down:

• Catch up on some reading, personal or work related. A library card is nice to have for this.
• If you have internet access take a online college class. Great time to do homework
• Bring in your laptop and rent some movies or T.V. series. I now have seen all 3 seasons of Lost, which I now am hooked on, all of Entourage which I fully recommend, and in the 3rd Season of Soprano's. I have been watching these at home also on days off. We had a lot of downtime this summer. This is a good reason to use Netflix.
• Learn to program different languages on your laptop.
• Learn to speak a different language.
• Enter Photoshop contest's on Worth1000.com.
• Play games on the laptop.
• Work on your skills with paper football.
• Blog
• Write articles or edit articles on Wikipedia.
• Terrorize the nurses by going into a empty and pushing the call light and hide.
• Explore the hospital. I have noticed in the different hospitals I have worked at that there are some interesting areas and to find. Little nooks and crannies.
• If you hospital has a Physical Therapy gym you can use, life some weights or get on a the treadmill or bike.
• Play hackey sack.
• Do some checkbook balancing and pay some bills.
• Play online poker, never done this at work but would be nice if it wasn't blocked.
  Old school ETT tubes used to come in a Long hard plastic tube. Well in the military we figured out how to make a blow dart gun out of it and I.V. needles. Then we would use a dartboard and have contests. Lots of fun.
• Tackle you colleague, wrap him up in ace bandages and Kerlex like a mummy, carry him up the elevator to a medical floor, toss him out and yell help. Umm I might of seen that happen one time.
• One Military hospital I worked at we would bring in a Playstation and have Madden Football tournaments.
• Hook up a ekg training module to a beside monitor in the ICU of a patient who has a brand new nurse and have it run different rythm's on the monitor and watch the new nurse freak out. Sorry nope never seen that happen.
• Actually learn something new, or refresh something you know about your job.
• Work on something you can improve in your department.
• Find a place, take a catnap.
• Go out to the floors and socialize with the nurses and tech's. This is a good thing to do because they get board also and it makes a stronger relationship between RT and RN's and other support staff like Xray and Lab. I recommend doing this once a shift. Funny thing I actually had a night where I was just tired and didn't feel much like talking with people and a Nurse from the ICU paged me just to see if I was ok and what I was doing. Kind of nice.

That's about all I can think of right now but would like to hear any other RT's ideas of what they do when there is nothing to do.

When you bored you can either make the time productive or just have fun with it and relax, I guess it's up to you and how you department its.

Take care.