sade082

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...

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...

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...

So, we in the medical profession often refer to some patients as train wrecks.  The official term here is "Medical Train Wreck," although we Americans are good at shortening longer words that take too long to say, which is why some of us refer to them as MTWs. That in mind, We figured we would officially define the term for our Faux Lexicon . Word :  Train Wreck Definition .  A person with greater than ten co-morbidities; treatment of one condition may exacerbate another condition "The patient might be here forever, she is a medical train wreck." Example #1 :  A patient with heart failure, COPD, small bowel obstruction, hypertension,, CVA, myocardial infarction, chest pain, renal failure, sepsis, etc.  Surgery to repair the small bowel obstruction will probably require high doses of fluid; Due to bad lungs the anesthesiologist will refuse to extubate the patient, who will now be moved to intensive care.  The patient will be treated as exacerbation of COPD f...

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...