Symptoms of asthma can be treated with a roller coaster ride?

Not the most practical way to decrease the effects of asthma but...

A pair of Dutch researchers discovered that the symptoms of asthma can be treated with a roller coaster ride where among the recipients of this years lg Nobel awards, the annual tribute to scientific research that seems wacky but actually could have some real world applications.

This study here has more to do with how asthmatics perceive dyspnea during times of either positive or negative stress. It seems in this study that dyspnea seemed less after the ride on a roller coaster was over. To me it just seems like it can't breathe good because I'm scared versus the scary stuff is over and I feel better, but I thought is was a bit of interesting asthma research whether practical or not.

Take a look at this article on the lg Nobel Awards.

Something fun, drive on RT's

The Air up there!!!

Well I haven't wrote anything in awhile here but I have a reason for this lapse in time. I was on vacation in the Rocky Mountains and surprise I can relate this to something respiratory.

Now this is not my first time up in the mountains of Colorado because I was stationed in Colorado Springs in the early 90's but this is my first time in the mountains up there as a Respiratory Therapist. With my profession being in the respiratory department I did notice how much harder it was to breathe between 8,000 and over 10,000 feet above sea level and I couldn't help but try and remember the full explanation of why this is so I thought I would look it up and blog about it.

One experience that I really noticed besides my hikes to up over 10k was when my wife and I went to Leadville which is the highest incorporated city in the USA, topping out at 10,600 feet above sea level. My wife and I were walking around the downtown area and we were talking away and I noticed that I actually had to stop and take a couple deep breathes as I was getting quite winded just walking and talking this really kind of stunned me as I'm not in bad shape, even my wife who runs 6 miles at least 5 times a week was noticing this with herself it's really kind of amazing the difference here with your breathing. I do recall however that the Army gave new soldiers to Ft. Carson Colorado a month to acclimate before they really started making you run hard and on this trip I didn't have nearly that long so I never fully acclimated to this air.

Why is this? Well I found a good analogy to this effect, if you take a jar of air at sea level and compare it to a jar of air at 10,000 feet above sea level there will be less molecules of air in that jar at the higher sea level, this is due to basically less partial pressure of the oxygen and less barometric pressure which helps make the molecules more dense at lower levels so in actuality I was getting less molecules of oxygen in my lungs with a breathe at higher altitudes than I would get with the same size breathe at the lower sea level.

Makes sense to me.

Here is a nice article on asthma in higher altitudes on Livestrong.com. Yes it's worse up there, when I was stationed in Colorado I seem to remember more people coming down with "Asthma" it seemed like, not I wasn't a RT but I was a Medic so I did have some medical knowledge there.

Some diseases make going to a high altitude very dangerous. People who have sickle cell anemia shouldn't go to a high altitude. A high altitude is also dangerous for people who have severe lung disease, such as chronic obstructive pulmonary disease (COPD) or severe emphysema, and for people who have severe heart disease.

Well all in all my wife had a great time together in the mountains with no kids thanks to my mother in law, one other side note about higher altitudes, if you like have some alcoholic drinks they WILL affect you quicker ... I'm just saying!!!

Keep driving on RT's.

Metabolism induced asthma?

A new study is showing that a poor diet and being inactive can increase the chances of kids to develop asthma, which is coined "Metabolism induced asthma".

The article can be read here: Poor Diet, Inactivity May Lead to Metabolism-Induced Asthma

This I've always had a sneaking suspicion of when we see people in the hospital who are obese and are taking inhalers and told they have asthma but with no actually family history of asthma. I do understand that obese people have shortness of breath due to increase body mass causing them to have a harder time taking a breath or just getting short of breath with exertion. Now I'm not sure I believe it's acutally "asthma" in those already obese people but as we all know if you lead a unheatlhy lifestyle you chances of having medical problems do increase a lot, so why should it not be possible for kids to develop asthma if they grow up with poor dietary habits and a inactive lifestyle? It's up to us parents to create a healthy lifestyle for our kids and be examples. Now don't get me wrong I have not problem with partaking in the good foods like pizza, cheeseburgers but moderation works well along with getting kids involved in active things like sports or just getting outside.

I was watching "The Biggest Loser" last night and there was some scary facts about our county and cities in general. I wish I had the direct quotes but I don't and cannot find a transcript online anywhere but here is just basics of what Jillian, Bob and Ali were saying that stuck out

-Our country is at the highest obesity rate in our history
-The 5 cities they went obesity was costing the city over $1 billion per year due to
hospital costs and other issues.
-Our countries hospital admissions have increased over the years due to a increase
obesity.

All this in turn comes back around to us as hospital workers, we deal with the issues of people who are obese and in my opinion if doctors help patients lose weight versus just treating the symptom which present themselves these patients will have less hospital admissions, less medications to take and just be healthier in general. This in turn will save hospitals money in the long run along with helping keep insurance premiums down.

Now this is all just my personal opinion and I'm not some health nut who only weights 170lbs. I am 5'10" 230, but I hit the gym 4 days a week, lift heavy weights and try to eat decent except for some splurges and I like beer, but I can still run a couple miles at a time and I have to keep in shape to keep up with my wife she runs all the time and workouts out at the gym a lot to. This is stuff I like to do, it's instilled in me from my years of Football, Swim team, baseball, and 10 years in the military, I'm just putting this out there so people don't call me a hypocrite.

Anyways whats you opinion?

Drive on RT's

Healthcare Aquired Infection Website HAI

I was contacted by this website HAI Watch to try and pass on the information on this site about Healthcare aquired infections(HAI) and their "Not on my watch" campaign to further educate healthcare workers about new things involving this HAI. This site has a backing of Kimberly-Clark Health Care.

This site seems to be worth checking out for some good information about helping out combating HAI's. I'm not a all affiliated with this HAIwatch site or getting any kickbacks from it, I just thought it sounded interesting and it seems like a worthy site for some upcoming information. Tjere are also about 5 youtube video's on here talking about HAI's.

Let me know what you think.

Seriously, that wheeze is not Asthma!!!

As any good RT knows, not all wheezing is associated with asthma but this knowlege that we have about wheezing has not been disseminated to all the masses that walk the halls of a hospital. I know for myself that I do attempt to educatate nurses about the different types of things that can cause wheezing, for example congestive heart failure wheezes versus asthma. CHF wheezes are more wet sounding and normally are in the upper airway, just have them put their stephescope on the patients larynx and listen, then the sound "echo's" down into the lower airways. In the classic asthma wheezing it's a more cleaner wheeze and it is usually without the coarseness of the fluid buildup of the CHF wheeze, plus it tends to start in the lower airways instead of the upper, CHF of course you can hear some nice crackles also.



Here are some common reasons for that sound we call wheezing:



By Age:



Infants and Children

• Congenital anomalies
  Bronchopulmonary dysplasia
  Bronchomalacia
  Vascular rings
  Cystic fibrosis
  Foreign body aspiration

Adults

• Asthma
  Chronic obstructive pulmonary disease (COPD)
  Congestive heart failure (CHF)
  Primary endobronchial tumors
  Endobronchial metastasis (from colon, breast, melanoma, kidney, pancreas)

By Onset

Acute

• Asthma
  CHF
  Pneumonia
  Pulmonary embolism
  Anaphylaxis
  Aspiration syndromes
  Foreign body aspiration

Chronic/Insidious

• Bronchogenic carcinoma
  Tracheal tumor
  Endobronchial metastasis
  CHF

Course:

Intermitant

• Aspiration syndromes
  COPD
  Asthma
  CHF
  Carcinoid syndrome
  Vocal cord dysfunction

Persistent

• Endobronchial tumor
  Tracheal stenosis
  Bilateral vocal cord paralysis
  Asthma
  Churg-Strauss syndrome

Progressive

• COPD
  Tumors
  Pulmonary infiltrates/eosinophilia syndromes

Well there you have it, i'm just throwing out things I found which might cause some wheezing in our patients and with what you can see, not everything is from Asthma or COPD there are other things which can cause this lung sound. There are different ways things can wheeze, it can be expiratory, inspiratory, both, or even considered musical but not all of those are asthma related. In reality there can even be asthma issues without even having a audible wheeze associated with it which is something that occurs quite a bit in kids. There are many people in the medical profession who hear wheezing and think, ohhh they need albuterol to stop the all and powerfull wheeze because it MUST BE ASTHMA!!!

Ok well if you would like some really good information on asthma look over at

The Respiratory Cave, Rick is well informed and educated in many things related to asthma.

Thanks for reading,

Drive on RT's

RT's should manage the O2

I have worked in a few different hospitals in my 15 years as a Respiratory Therapist, and over the years I have noticed there have been different ideas in as to how to utilize the role of the Respiratory Therapist in their facility. The role I want to talk about is the role of the RT to manage oxygen therapy which patients are using.

I have worked in places where RT's monitor and manage patients on O2 and I have worked in places where the nurses and techs have free range to do what they want to with patients on O2. The second part is the one I don't agree with and I have worked in a place like this where the RN's just place a patient on any O2 the see fit and it seems that 3 lpm by nasal cannula was the norm here. I would come by and decrease the O2 on a patient on the 3 lpm patient who's spo2 was 99% and I would come back later to find them back up to 3 again with the spo2 at 100% even though they were 92-93% on 1 lpm which I dropped them to. Now this patient was on neb treatments also which were the only patients we knew were on O2 just because we were not informed of anyone placed on just O2. This I totally disagree with.

The reason's why I don't agree with this are the fact that I feel we can be of more use to these patients who need oxygen and notice if there is more oxygen consumption being used and more treatment modalities are needed, also on the other hand we can do a better job at weaning patients off of oxygen for people who don't need this much oxygen or are just plain getting better this in turn can save the patients and the hospital money is we are able to reduce the amount of time a patient is on oxygen. Then there is the whole getting paged to a room because a patient is being increased in their amount of oxygen they are using because they cannot keep their sat up to acceptable levels, and we have not been involved or notified of this patient being on O2 prior to this and now the RN's want help and answers. We are coming into this patients room blind with no prior knowledge of this patient and really no baseline as to what this patient is like but if we were following this patient due to being on O2 better decisions on our part can be made.

I guess all in all I am more a proponent for RT's being involved in patient care not just because they are on a vent or on neb treatments but also if they are using some type of respiratory modalities like oxygen, which IS A DRUG, and we have a real good working knowledge of. I believe we are RT's can really improve patients recovery or stave off possible problems because we might notice something with the patients oxygen which RN's and Techs might not see. If the RT's are keep out of the know of patients who are on O2 we can't be expected to really know much of what might be going on with a patient. Really how many times have you come upon a COPD retainer patient where the RN says they seem really lethargic and they are sitting there on a 6 lpm nasal cannula because their spo2 was only 90% on a 2 lpm nasal cannula. This is something we know, COPDers are good between 88-92%, that's where they usually live.

Drive on RT's

Giving Albuterol to decrease potassium.

Lately we at my humble hospital have been getting more and more orders for albuterol nebulizer treatments to decrease a elevated potassium level in a patient. This has made me curious as to why this works and if it really is a viable reason to give albuterol and a elevated potassium situation so I did some digging and here are some facts I found:

- Potassium is both an electrolyt and a mineral. It helps keep the water and electrolyte balance of the body. Potassium is also important in how nerves and muscles work.

- The normal level of potassium is 3.5-5.0 mEq/L

- Albuterol works to create smooth muscle relaxation through the beta-2 receptor site but one of it's other effects, is to reduce extracellular potassium concentrations by pushing the potassium into the cells. This action is quite handy, in a pinch, but do not rely on it because the action is too slow in it's onset to be of emergent help.

- Doses of 15 mg albuterol via nebulizer, hyperkalemic patients on hemodialysis experienced a 0.9 mEq/L decrease in plasma potassium which was sustained for 6 hours. Albuterol may stimulate sodium-potassium ATPase, resulting in an intracellular shift of potassium.

- Albuterol works to lower potassium concentrations by stimulating the release of insulin. This release of insulin shifts the potassium into the cells thus lowering the potassium level.

- Albuterol also stimulates the Na/k+ pump causing potassium to be shifted into the cells.

- A study compared the efficacy of 1) insulin + glucose. 2) albuterol and 3) both regimens combined when used to lower potassium concentrations. The study found that albuterol was just as effective and quick at lowering potassium concentration as insulin + glucose. The study also found that the two treatments administered together worked even better in reducing potassium level. Albuterol reduced the potassium level by up to almost 1mEq (0.62 - 0.98mEq).

Source: http://www.ncbi.nlm.nih.gov/pubmed/2266671

- Using a large amount of albuterol in a patent not in hyperkalemia may cause the patient to become hypokalemic.

- The dose for albuterol when administered in hyperkalemia is 10-20mg.

- It is mentioned in ACLS for Experienced Providers (2003) p.162.

• For moderate elevation of potassium (6 to 7 mEq/L):
  
• Initiate a temporary intracellular shift of potassium using the following agents:
  
• * Sodium bicarbonate: 50 mEq IV or up to 1 mEq/kg over 5 minutes
  
• * Glucose/insulin: Mix 10 U regular insulin and 25 g (50 mL of D50) glucose, and give IV over 10 to 15 minutes
  
• * Nebulized Albuterol: 5 to 20 mg over 15 min.
  

Well after doing some research on the subject to me it does look like a viable treatment to assist in the treatment of Hyperkalemia in patients, but from what I have been noticing is that the Doctors are not ordering this properly to even make a dent. We here at my hospital get orders for just a regular nebulized albuterol treatment of 2.5mg which is nowhere near the recommended 10-20mg to even cause a dent in the potassium levels.

To be curious about why your doing something is a good thing and the internet is a plethera of information to be found in our profession. If you have questions, research it.

Keep driving on RT's.