Anti Snoring stuffed bear.

Stuffed bear lightly smacks you in the face if your snoring to get you to turn your head along with a smaller bear to monitor your Spo2 levels.  Not sure if this will take away CPAP machines but a novel idea.  This does look much more comfortable for people with very mild sleep apnea.

Anti Snoring Bear with video

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

Discoid Atelectasis, what might that be?

Tonight I had a patient I was assessing for out therapy driven protocols and was reading this person's xray and I noticed a word I have never came across before in my medical travels and it was describing a type of atelectasis:

Discoid Atelectasis which is also known as Plate Atelectasis.

Now being the good RT that I am, I had to do and look it up so I could do a proper assessment of this patient and what I found was interesting to me and I thought I would share it with anyone who might read this blog of mine.

Discoid or platelike atelectasis is a form of atelectasis which has s disc or platelike appearance on a xray which is linear or horizontal position. They often look like a CD or a dinner plate and thought to occur from shallow breathing or hypoventilation which can occur after a abdominal or thoracic surgery. It can be also seen in other conditions such as painful breathing, general anaesthesia, pulmonary embolism, ascites and diaphragmatic paralysis.

There is really no different type of treatment for this versus any other type of atelectasis because it is just a term to describe what is seen on the xray but overall it's still just atelectasis.

Really there is not to much alarming about this it's just something I came across and have never seen so I thought I would share it with everyone and hopefully if you come across this in a report you will now know that those radiologist are talking about because it seems they like to try and stump us, but because of the Internet things can be looked up quickly now.

If you didn't know, now you know ... Drive on RT's.

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!!!

Oxygen Dependant COPD man to run marathon.

I ran across this article and thought is was interesting:

COLORADO MAN TO BE THE FIRST COPD OXYGEN PATIENT ALLOWED TO RUN IN BOSTON MARATHON!

Its about a man who is oxygen dependent, diagnosed with COPD and is the first person with COPD allowed to run the Boston Marathon. This person is on some serious O2, when asked what is prescription is he responded:

"I have been on supplement oxygen for 4 years. My current prescription is 4-6 liters at rest and 7-18 liters when I’m active or exercise."

Now that's some serious O2 he is on for exercise, just think how many tanks he might go through in a 26 mile race.

This guy has already completed 2 full marathons, 14 half marathons, 1 ten mile, a 5 mile, 4 times did the 10k the Bolder Boulder, a bunch of 5k's and climbed 2 14,000 plus foot mountains. Quite amazing. He says that he went through 5 tanks a marathon and was lucky to have friends to help with the changing of tanks when needed.

This is pretty amazing for a COPD oxygen dependent person to do and it just shows their is life after a COPD diagnosis, you just have to take care of yourself and work to acheive some added health to help cope with the problem.

To add to his accomplishments on March 10 of this year he finished the Climb Chicago event for the American Lung Association. 4 buildings; 180 floors; 360 flights; and 2340 stairs, for a time of 1:06:13. Really amazing, that would hurt me.

Well hope that article was inspiring and hopefully this guy can inspire other COPD patients in the future.

Drive on RT's.

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.

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

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.

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.

30 Minutes past tired.

First off Happy New Years everyone and I hope it's a great one for you all.

So anyways this is my weekend to work and we consider our working weekend to be Friday and Saturday for us 2 night shifters here at my small Hospital and this is why I'm 3o Minutes past tired which in my opinion why I'm so awake right now, I'm past tired but it makes work easier so I'm not falling asleep here.

Friday started early trying to find someone to cover my first 4 hours of my 12 hour shift. Why would I do that, well my daughters (9 and 10) are on a private swim team here in my town and they have a meet this weekend out of town which would of been Saturday and Sunday, BUT the coach put them in to do their first Mile (1650 yards) race. Now as swimmer in High School myself and a proud Dad there is no way I'm missing this. Of course they have to be at the pool at 15:45 and school gets out at 15:35 so of course we have to pull them out early with no complaint from my girls and drive 45 min's away to get to the meet which will officially start at 17:00. All goes well we make it there and they really impress me and Mom with they way they swam their miles. I was amazed, 9 and 10 years old and swimming 66 lengths of a 25 yard pools. Now if you remember one of my earlier posts about athletes who have asthma I now have to put my 9 year old in that categorie also. She has a mild case of it but takes advair and uses her Albuterol MDI before meets and practices and it seems to do the trick and she has only had one issue during practice in 3 years. My 10 year old is fine just has ADD.

Well the first day of the meet is over and its after 18:00 so we go get something to eat and head back home so I can get into my scrubs and head off to work, so now I've been up since 08:00 and am off to work all night, not to big a deal done it before.

Now I'm at work and I start feeling like crap, itchy eyes, running nose, sneezing and head all stuffed up with sinus pain. Crap this is gonna be a horrible night. I go to our med vending machine (Great prices here, Children's Tylenol for $0.75 in here, yep I stock up, along with other types of meds) and I get a cold anithistamine med out of there for only $1.25 and hey look $0.75 in change I will get some more children's Tylenol for home (I have 4 kids). Anyways I take the med and notice it does say it may cause drowsiness....Ahhh Crap. So I'm like in and out of different stages of tiredness during the night and it's a busy night of little crap like the pulse ox machine isn't picking up, I need more supplies on our floor, EKG this and that just the little things. I think because of the med I took I was also forgetting to sign off my MAR on some patients, leaving my papers around, ect...wow this hit me good but I feel better.

So finally the night is over BUT there is still day 2 of the swim meet so I rush home and get like a 1 1/2 hour nap and my wife wakes me up to get ready, quick shower and off we go. Warm ups at 10:30 and meet starts at 11:30. OK well it was supposed to, the older kids swimming earlier in the day was running late meet now doesn't start until 12:30 and I still have to get some good sleep and work yet Saturday night. So finally it finishes at 15:30 and I feel fine but I'm sure it's from adrenaline from cheering my girls on because they had a great meet. We finally get home about 16:45 and I get to sleep about 17:00 but I have to get back up at 20:30 to take some things to my in laws who are watching my kids (wife is at work) and be on my way to work no later than 21:50. Yep it will be a long night after 3 1/2 hours of sleep, NOT GOOD.

So this brings me to now, I do feel Half past tired. I'm wide away for some odd reason, the night has been relatively uneventful and nothing to exciting, but the day is not over yet I still have Day 3 of the swim meet!! Wonder if I will make it or pass out over the railing into the pool today.

I love my family and will not miss a event of my kids if I can help it at all and my wife is the same way and we want to be there for them. I guess this just shows how night shift can really put a hardship on thing sometimes but due to being used to not sleeping more than 5-6 hours on my work days it can be done, it's just hard and sooner or later something will have to give but for now I'm going to do my best to make it work. One of my goals this year it the classic get into better shape, it's not that I'm in bad shape I do lift weights pretty consistently but I need to add more cardio and watch my eating a bit more, hopefully 20 pounds later things will be good. I guess looking at it being in better shape will help with the harshness of night shift on the human body, namely mine.

That's my story and I'm sticking to it, at least until I pass out from sleep deprivation. I hope you can understand why I might be 30 Minutes past Tired.

Where's the patients?

Now I'm not complaining but it can get a little boring around here without patients to work with. Yes I'm talking about having no patients through the night and this is my 4Th shift in a row where it's been like this. Actually we have only 7 total patients that require our RT expertise, which is 5 more than there was 3 days ago.

It is damn cold here lately with a lot of snow and ice around so maybe the cold is killing all the Bactria's off so nothing to get anyone sick. That's not true the Flu is running through my house. My 9 year old had a Asthma flareup with vomiting from the Flu which then went to my 9 month old who has been vomiting for 4 days now, but better today. Now did anyone know that doc's don't give medication to babies anymore to help stop the vomiting? I didn't!!! Nor did my wife the ER nurse, but the pediatrician said there was a study of some sort and they don't recommend anti-vomiting meds anymore for babies, so we just had to keep washing his sheets and 6 changes of clothes a day. Anyways this also got passed onto my 3 year old, yep more vomiting and laundry washing along with diarrhea also....what fun. Now he was able to get Zofran (spelling) to help but not his brother, but with a ER nurse mom what do you think she did? Yep cut it in half to help the little one and it worked...well he had to eat something and keep it down he was losing weight plus he made me late one night. Just as I was getting ready to leave I was holding my son and of course...BLAAAHhhhhh...all over my scrubs. So of course I have to iron a new pair but what are you gonna do.

Is anyone else's census down? I'm curious how long this will continue because winter is usually the busy season. As of now I'm catching up with some DVDs I've been meaning to watch, cleaning the department a bit and just wandering around to stay awake.

Take care and Happy Holiday all.

Does smoking drive our profession?

Is it possible that smoking drives out profession? Is it also possible that the patient load of our profession could be decreasing significantly in the future?

This is just maybe a theory I have thought about but let me explain myself. If you look at the patients who we give nebulizer tx's to on a regular basis the majority of them are COPDer's and Asthmatics in trouble. Now say we cut out the COPDers and notice how much our census will drop because to me it seems that I see more COPDers than I do asthmatics so if we see less of them our census goes down right, also with more education and better use of medications there can be less of the admitted in the hospital. Here is a article showing this.

Self-Management Education for COPD Patients Cuts Hospital Admissions

There are a couple of sites that have shown that study that I have found, but I'm only going to post one for now.

Another way to look at my thoughts on how our census will decrease in the future goes like this: The majority of COPDers in the world are of a older age. Now here is where my thinking comes in so stay with me, but it shouldn't be that hard. Due to the fact that the COPDers are older and there wasn't a whole lot of education on the harmful effects of cigarette smoking at that time versus the education there is now (seriously the military packages cigarettes with the soldiers meals in WW2) and the perception of smoking has in the United States in today's day and age. It's getting banned everywhere, the price is increasing, there are warnings everywhere, you have to be a certain age, and it's almost getting to the point where it is illegal to smoke anywhere anymore. All of this in my opinion equals less COPDers in the future which will in turn should decrease the census for nebulizer treatments with COPD patients.

Lets look a little deeper now also. In the past there was asbestosis which caused respiratory problems and this is now outlawed. Different jobs that have fumes that can be inhaled are not required by OSHA for the personnel that do these jobs to wear a mask that filters out these fumes which can cause respiratory issues for example automobile painters which have the paint that can be inhaled. These precautions can cause a decrease of people with lung problem due to inhaled fumes, particles or whatever is able to be inhaled at certain jobs.

Well there you have it my ideas on how our job census will decrease in the future, basically when the current population over 65 passes on there is a possibility of a decrease in patients due to education and studies of smoking and harmful inhalants. According to this study Half of elderly patients discharged from hospital following a first admission for COPD are dead within 3 to 7 years. So that right there could show that it really might not take to long.

Remember this is in no way a scientific study but just a thought I have had, but I would love to hear anybody else's opinion on these ideas. Of course there are also the studies about air pollutants causing COPD like symptoms in people also, so maybe if we don't get green enough as a country it will stay the same but the cause will be different.

Drive on RT's

The Calm Before the Storm

Only 2 patients tonight, one a Q4 and one a Q2, yep nice and quiet. This actually give me 2 more nebulizer treatments I have to do than the last shift I worked, of course the Q2 isn't as bad as this person is thought to be, but no protocol is wanted on him so I kind of feel bad waking this patient up and taking loudly just to keep him awake and deep breathing. So ok he is wheezing and sats do drop without O2 so there is a need for something.

Wow ER just paged for a EKG....
Turns out nothing exciting, patient just left 10 days ago and has a Doctor appointment tomorrow oh and yep EKG was fine, doc says it's probably musculoskeletal pain, now get out of here and go home.

There has been some lazy shifts lately for my old RT department but isn't that how this job goes the patient load ebbs and flows like the tide. Feast or famine, you either run all night or you might sit all night and chat with the nurses or better yet blog about it.

Over my time in the profession I have noticed some trends of things where the patient load with increase or decrease and most of these have been fairly consistent, I'll try and lay them out and explain the idea behind these times.

Things that cause patient load to INCREASE or decrease:

• Summertime causes a decrease due to it being nice outside, and who wants to be stuck in a hospital when it's nice outside so more people come in for injuries than breathing.
• Exception to summertime is when humidity is high there is a increase, bring in the COPD'ers.
• Wintertime there is a major increase, it's cold outside and there are more sicknesses, cold air can set off a asthma attack, RSV is back along with croup.
• The night of or day after Thanksgiving there is a increase. Why you ask? Here you will see a large amount of Congestive Heart Failure patients because of the large amount of food people eat with a large amount of SALT which cause fluid retention.
• Christmas and Easter see directly above. Same thing with the CHF.
• Holidays in general you will see a surge of Frequent Fliers. Now these are mainly nursing home frequent fliers who want attention from the family during the holidays so on comes the sickness. I have seen this and could pretty much track it, when the holiday came so did these people.
• A Full Moon. I don't care what anyone says but a full moon always brings in more people, superstition or not. I have also read that the closer the moon is to the earth there is a larger gravitational pull on fluids which can affect fluid retainers.
• After the Super Bowl. The excitement of the game, the drinking, and the major one is the eating. Here you will get asthma attacks, CHF, and chest pains. Mainly this is evident in the ER but it's true.

Well these are the major ones I have noticed but of course there are other trends for different places in the hospital like the ER, for example the weekend magic hour is about 02:30 am, this would be the end of bar time....let the drunks get hurt and sick. Never know whats going to happen at any given time in the world of health care but some things just seem to fall into place.

I would like to hear any other trends that people have figured out, I'm sure there are more.

Drive on RT's

You Heard What?

A patient comes into the ER the other night with complaint of chest pain so I'm called down to do a EKG on the 35 year old with chest pain. I get into the room start to do the EKG and she becomes very shy about me putting on leads. Every lead I put on she quickly pulls up her gown and the lead falls off. "Sorry ma'am I have to get this back on could you please wait until we have the EKG done, I will go as fast as possible." So I finally finish and EKG is showing normal sinus rhythm and she going into this excruciating pain look and perfectly complaining "Owwww it's hurting right over my heart and very heavy right now with the pain going to my jaw and radiating down my arm." So I give the EKG to the Doc and she say this person has been here like 20 times in the last week, she is a nut case. Great so off I go.

35 Minutes later I'm called to come down and do a nebulizer treatment in the ER and when I get there the Doc tells me it's in the same room as the nut case. I ask "Is she short of breath, she didn't seem short when I was in there and didn't complain of that?" Now here is the response I received from the great and powerful doctor, "She is having a slight wheeze with a forceful exhalation, so maybe she has a little asthma component with exertion." Okay key phrase here if you didn't notice it, "With a FORCEFUL exhalation...".

Damn right she does with a FORCEFUL exhalation, so do I watch.....wheeeeezzzzeeeeee....See I can do it also and I have no breathing problems what so ever, and I'm sure you can do it to. The Doc actually told her to breath out as hard as she could, what the *&^%!!!

Well so I didn't actually say all that to the Doc. But I took a peak flow meter in the room with me to check the patient, we use the low flow ones in the ER (don't ask why) but it only goes up to 375. I give the PF to the patient and she all about blows the room off the room with that thing, plus her lungs are clear as a bell. Off I go and let the doctor know my observations and she is stunned and says "Wow maybe I just heard something at the right time, I guess her lungs are good, but lets give the neb anyways because I might soothe the patient a bit." Alright whatever again the nebulizer works as a pacifier.

After the nebulizer the doc then tells me that she is indeed a nut case and a attention seeker and it's thought that she does a bit of research so she can use the correct symptoms of the problem she is seeking help for. Ya have to love these types of patient and how they can just take up your time and run you schedule right into the ground.

Oh well all is life in your friendly community hospital. I work in a small town hospital now instead of the big city one I used to and when you compare the to there is a difference but in a small town one it seems there are a lot of bored people, namely elderly, who just want some attention so they go to the ER. Job security is the way to look at it.

Until next time, don't inhale chasing it with a exhale.