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Your Question. If you read the package insert for Symbicort, it says not to use with a spacer. What should we make of this? It seems to me that common sense would point to using a spacer with it, considering it is an inhaler. What do you think? My Answer. That is a very good question. There are actually two ways of looking at this. One, that Symbicort is still a relatively new product, and it has yet to have been studied with a spacer. For this reason, their lawyers may require them to make this note on the package insert. Two, the dose of medicine is adjusted based on estimated distribution to the airways. It is well known that only 9% of medicine inhaled by metered dose inhalers makes it to the lower airways where it is needed. To compensate for this low distribution percentage, the dose of Symbicort was adjusted to obtain maximal results. Wanting to limit side effects, the makers of Symbicort (AstraZeneca) and their lawyers decided to put the disclaimer on the packag...

Are we that polarized as a nation that we can't even discuss politics at work. Heck, I hear a political discussion and I salivate, and I don't care what point of view people have. And that's what happened as I pushed my cow to the nurse's station. As I stood there, innocently and cooly surfing through the computer system, I hear the following conversation at the nurse's station. The first someone said, "I don't see how they can let it be legal to poison your brain with alcohol." Now, to be fair, I had no idea what initiated this conversation. I'm just all ears. The second someone said, "The same with cigarettes. People are damaging their lungs. I don't see how we can allow that to happen." The first someone said, "I think alcohol is worse because cigarettes don't change how people think. I just think alcohol is nasty that way." The fourth someone said, "I think it's a free country, and if people want to put stuf...

I'm sorry if I offend people who don't believe, but it is my belief, based on my observations as a respiratory therapist who gets to know many people near the ends of their lives, that Faith makes it easier to die. Faith makes the transition from life to death easier. When I first started out as a respiratory therapist, I remember seeing people in the end stages of their diseases reading books. I see them watching the news. I'd see them worrying about paying bills or fixing a computer at home. I just couldn't fathom why they would be trying to educate themselves, or why they'd spend time worrying about trivial things when they knew they were going to die. How could they do that? Why would they do that? There was one lady I remember in particular. She was told she had basically no heart left. She had an ejection fraction of 20% or something like that. She was essentially told she was going to die, and might not even make it out of the hospital. And she didn't. Bu...

How is it that respiratory medicines work? If your a respiratory therapist like me, a quick review is always helpful. If you're a patient, it might be neat to learn how the medicines you have in your medicine cabinet work. So, here is a quick review. Today's focus will be on beta-adrenergic medicine like albuterol and anticholinergic medicine like Spiriva. For starters, these types of medicines have some impact on the autonomic nervous system. What is the autonomic nervous (ANS) system? It's the system that contains all the nerves, neurons, and neurotransmitters that control all your inner organs, including your heart, blood vessels, and lungs. It also controls other organs, but for our purposes, we'll limit our discussion to these three. The ANS responds to your internal and external environment by releasing certain chemicals (we'll get to these in a moment) that bind to receptor sites (we'll get to these in a moment too) on specific organs to tell them what to...

Your Question : Why aren't there more RT blogs like yours. My Answer: There are a few, as you can see by the "Links" tab above. However, many of those blogs have not been updated in so long that I might as well delete them from my list. This is unfortunate, but I think fear has a lot to do with it. In fact, I know of one blogger who was told to quit blogging or he would lose his job. He had the best RT blog ever. Okay? And now he's done because he didn't want to lose his job. I don't know if you have ever noticed this or not, but sometimes I publish posts on this blog and then think better of it and hit the delete button.  I don't do this very often, but sometimes I have to act as editor and protect the real me from the writer me. I have a tendency to be non-politically correct and truthful, and, Lord knows, the truth can get you into trouble sometimes. Of course, you might be thinking, "What about freedom of speech?" I think that freedom of spe...

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...

One of my coworkers introduced me to this Youtube video where three critical care nurses describe how important it is to respect your respiratory therapists. This is pretty good.