The Secret Book of Doctor Knowledge!!!

Doctors are a interesting bunch, there are good ones, interesting ones, bad ones, ones we are not sure how they got through medical school but overall they are a interesting bunch.

Something that sparked my interested is how a doctor will get on a certain type of treatment kick for awhile which will make us RT's look at each other and go hmm, where did this come from and why are we doing it?  This just doesn't make any sense to do this to every patient we see.

For instance we have 2 doctors in particular who get on these treatment kicks, right now one is on this Duoneb with Ezpap QID & Q4prn for anyone who has anything to do with Respiratory, seriously do we need to add Ezpap to a patients home regimine if there are not even in for Respiratory problems and does EzPap really help treat a patient with a history of COPD?  Then we have another Doctor who is on a Mucomyst kick for EVERYONE with nebulizer treatments, yes we get that D/C'd a lot curtosy of our protocols but they also have learned they can write NO RT Protocols and then we are stuck.  

There are cases of other doctors getting on certain treatment kicks like the Xopenex for everyone kick along with not following the company's drug reps recommendations on how to order Xopenex (not created to be used Q2 or continous, still makes heartrate go up), and I'm sure there are kicks that RN's see the doctors get on, but I don't deal with that side of the house.

So this makes me wonder if there is a Secret Book of Doctor Knowledge which has all the information why these treatement are the current "Cat's Meow" in the respiratory world of care because I've look everywhere for some definitive knowledge on how Mucomyst will help all patients or what good does EzPap do for a patient with COPD and this information has eluded me because I'm assuming it's in the Secret Book which of course if probably locked in the doctors lounge.  I just wish they would give us a quick in service on this instead of looking at us like we are stupid when we question these treatments.   

I'm sure these kicks will die down after awhile of use and go away until some other little bit of knowledge gets updated in this book like a Doctors version of Wikipedia, but it would be nice to just share a little bit of information to us troops in the trenches.

Drive on!!!

What a Difference 3 days makes!

I don't really have a lot of time to write much here today but I thought I would put a little something up on the Ol' Blog.

I was off for 3 days and when I get back it's crazy busy here. This is the classic "Feast or Famine" in my little hospital and we are definitely feasting over here.

When I last worked I had a whole two Q4's to do through the night, now 3 days later there are 7 Q4's and a ventilator to keep me busy. Much to my surprise though all of these Q4 treatments are actually really sick. Forgot to mention the 2 bipap's we have running also which are not for sleep apnea but for respiratory distress, so yes they happen to be pretty sick to.

A common theme I noticed with these sick patients and with some of the QID patients also was that there is a Mucomyst craze right now that just seem to have started. Not only is it Mucomyst there is this large concotion of Mucomyst, Albuterol or Xoponex, and Atrovent together ... but wait there is more, not only do we throw in those 3 meds we add it all to a Ezpap. This takes FOREVER! There are also the bonus patients who twice a day get to add in Pulmicort, WOW what treatment that becomes.

Sounds like the last 3 days there have been an extra RT per shift which is good but very unusual at my hospital. My night tonight I had someone here til 2am then again at 4am so I only had to brave it alone for only 2 hours, really wasn't that bad but most of the other RT's have never worked in a Large hospital and are not used to a heavy patient load...I am so I was fine.

Well gotta run just ran a ABG with a CO2 of 91 and a PH of 7.20, time to go save someone.

After that my next task is to get off work and hope my car starts since it is -20 degrees Fahrenheit right now and I will be wearing the nice and thin scrub pants...brrrrr

Keep em breathing.

Protocol's

Well I noticed reading at RT Cave that he is in a smaller hospital were they are not just implementing RT Protocols, well here at my small hospital we are now just starting to implement RT protocols also that started on October 1st.

Our's are just for the delivering of medication, Incentive Spirometers and Oxygen, it goes something like this:

1. Respiratory Order
2. We grab out assessment sheet and assess the patient in the different catagories which are:

• Respiratory History
• Surgical/Trauma Status
• Adult and Peds Respiratory Pattern
• Chest Xray/Abg/Spo2/Fio2 (All one catagorie, doesn't make sense to me)
• Cough
• Breath Sounds
• Activity (ambulatory, non ambulatory ect)
• Level of Conconsious

3. Assign points of severity of those catagories and get a total
4. Use total and assesment to adjust therapy as needed.
5. Reassess Q48 or more and adjust therapy as needed.

O2 Protocol is just set up to keep Spo2 >90%, this is nice because of so many Doc's ordering so many different levels, 93%, 90%, 95% ect, how the hell do you keep that straight.

Now the I.S. Protocol is nice, Surgeons would routinely order EZPAP tx's Q4 x48 hours then QID until discharge, crazy I know this would range for any surgeries from Abdominal to foot surgeries. Now we have to ability to just do I.S. or change to EZPAP as needed. If the I.S. is less than 50% of predicted then go to EZPAP until I.S. is over the 50% mark. So far it works pretty good but were still learning its only 2 weeks in.

Anyways I'm all for Therapist driven protocols, let us do what we were trained to do! If this goes off well maybe in a year or so we would work towards Vent Protocols. I did work at a hospital with a great vent protocol, we were in charge of it and the Doc would just write ABG parameters, easy right.

Until next thought, keep em breathing.