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You see them in isolation rooms. They are usually referred to as Fake Stethoscopes. They are made by Fake Incorporated. Sometimes they are referred to as "Dim Stethoscopes." It's because you can't hear lung sounds for crap. So, you find yourself just writing or clicking, "Diminished." And sometimes you don't even bother using it. I mean, it's been in the same room as a MRSA patient for a week now. And the lung sounds have been the same since the patient arrived. And so you just scan the patient. You start the treatment. And you just (if no one is looking, that is) go right to charting. And, without even touching the Dim stethoscope, you click: "Diminished." There is one exception. If the patient is wet. That's the exception. Because, if that's why the doctor ordered it, it's mainly because of that audible cardiac wheeze . You don't need a stethoscope to here it. So, you can then click on "Wheeze" So, that's you...

How they present when you are in their rooms. A diagnosis sometimes observed in the clinical setting is an exaggeration of asthma ( staticus wheezicus ). These patients often have a diagnosis of asthma/ COPD, although often learn to play it to their advantage. Clinical Presentation : You can observe them from the doorway, such as while they are sleeping, and they are fine. But as soon as you wake them up, they have a forced, expiratory, almost stridorous wheeze. It is often audible. They may appear fine as you enter their rooms, although as soon as you pull out your stethoscope they start forcibly exhaling. Heart rate may be elevated slightly. Oxygen saturation is usually within normal range. (This section was submitted to me by a reader here at the RT Cave, and published with permission. ) Differential diagnosis .  The RT Cave sponsored a committee of 20 respiratory therapists and five doctors. During a meeting on January 27, 2017, they came up with three mechanisms for establishi...

A new version of Ventolin, aptly termed "Keep-me-alive-olin," has been shown to prolong life. This is according to analysis of studies conducted by the Real Doctor's Creed Committee. Keepmealivolin was listed as the #61 most popular version of Ventolin prescribed by doctors by our own experts here at the RT Cave. This version of Ventolin was first recognized by Dr. Happy Lackluster in 1985. He t he ordered a respiratory therapist to give a Ventolin breathing treatment by mask to a patient who was terminally ill, who had an ejection fraction of 20%, and who was in otherwise poor health with terminal bone cancer, diabetes, and kidney failure. Dr. Lackluster sadly passed away in 1998. However, the RT Cave was able to get ahold of Dr. Will Chambers, a longtime coworker of the beloved Dr. Lackluster. "He was a fine fellow," said Dr. Chambers. "We were all so impressed with his discovery. I remember Happy  telling the story. He about keeled over laughing becaus...

I would like to define "Best Practice Medicine" and then analyze it's usefulness as far as it pertains to the respiratory therapy community. My "theory" is that it is not used properly. Best Practice . According to The University of Iowa  College of Nursing , it means: "The use of care concepts, interventions and techniques that are grounded in research and known to promote higher quality of care and living for... people." Best Practice Medicine . It is using the "best practices" available based on the medical research, particularly respiratory therapy research. and in real life practice. Now, let's examine another term: Evidence Based Medicine . According to Sackett, et al, 1996, it "is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence based medicine means integrating individual clinical expertise with the best available externa...

Breathing is important. As respiratory therapists, we know this more than anyone. But a new study conducted by the Bronchodilator Reform Committee of the U.S. Government purports to show that eating is even more important that breathing. The study involved 100 patients at Shoreline Community Hospital, all of whom were prescribed QID breathing treatments with 3cc of normal saline and 0.5cc of albuterol. All of the patients had chronic bronchitis or asthma. They were all typically short of breath when their breathing treatments were due. Treatment times were scheduled for 8 a.m., 12 p.m., 4 p.m., and 8 p.m. The patients were asked to order a tray of food about 30 minutes prior to the time their breathing treatments were due. This gave the cafeteria plenty of time to prepare the meals and deliver them. The patients were told they would be involved in a study, but they were not told anything specific. The therapists were asked to enter the patient's room the sa...

Warning: What follows is top secret information surreptitiously leaked to me via one of the nations elite pulmonologists from an elite teaching hospital. Read at your own risk. This is not edited. Appendix 7 Rules for PEEP/ CPAP/ EPAPt : So, when do you increase PEEP. To answer this we have to understand what PEEP is.  PEEP is an abbreviation for Positive End Expiratory Pressure. When used on a ventilator it is called PEEP. When referring to noninvasive ventilation it is called EPAP, which is an abbreviation for End Positive Airway Pressure.  When used alone, it is referred to as CPAP (Continuous Positive Airway Pressure).  Essentially, PEEP, EPAP, and CPAP are the same thing, only the terms vary depending on what type of machine is applying the pressure (ventilator, BiPAP, or CPAP machine). The unique terms help caregivers tell know what device is being referred to: Ventilator, CPAP, or BiPAP.  Whether called PEEP, EPAP or CPAP, it is a constant flow during expirati...

So one of my respiratory therapist friends, of whom I will not name here even though he said I could, sent me an email a while back explaining why it is that respiratory therapist driven protocols will never result in a decrease in treatment loads. There will always be the belief that if the patient is short of breath we must do something People sitting in leather chairs in Washington decided that in order to meet criteria for admission a patient must have needed at least 3 treatments in ER.  It eludes them that hospitals would have physicians order them just so the hospital can be reimbursed .  People sitting in leather chairs in Washington decided that in order for a patient's stay to be reimbursed for certain respiratory conditions (pneumonia, CHF, COPD) the patient must have breathing treatments ordered.  This is under the fake belief that if treatments aren't needed why keep the patient.  It eludes them that there may be other reasons for keeping the patient, no...

Real Doctor's Creed : Appendix Z: Problem Solving Section 982: Pediatric Croup. By Dr. Richard Crank, Shady Health Medical Center, January 7, 1982 The boy had croup .  Even without auscultation I could hear the inspiratory stridor. Upon auscultation, I could hear it radiating throughout the lung fields. The emergency room physician reported giving the patient a shot of decadron.  Upon admission, I ordered Q2 hour racemic epinephrine if needed. The child did very well during the night, with the exception of one episode where the child became croupy in his sleep.  His sats were always 98% or better on room air.  During the day today the child has gotten progressively worse, per the respiratory therapist, with the need for Q2 hour racemic epinephrine over the past six hours. The therapist said the patient's SpO2 remains 98% on room air. The therapist also suggested that perhaps the decadron was wearing off, and another one should be given. He suggested maintenanc...

Today's version is Ventolin Taking note of the fact that the long-held conventional wisdom that aerosols like albuterol help with secretion clearance and mobilization have been overturned, we can now offer up the eight stages of how a medical hoax, faux theory, or scam is overturned and proven false. 1.  The theory is proposed by scientists on a nonscientific mission. (Example: the study of 4 COPD patients to which the hypoxic drive theory was devised.) 2.  It is believed because it plausibly explains an observation.  It taps into large anxieties about not being able to help those with chronic diseases we actually don't know much about, and make us feel like we are actually doing something good. For example, albuterol mobilizes secretions and enhances clearance, or under oxygenating COPD patients will prevent their hypoxic drive from being blunted.  The solution taps into the hearts of physicians and nurses: it sounds like a good idea; it makes them feel like they...