Respiratory Therapy 101: Just Keep Breathing

Here at Our Lady of Immaculate Grace, we have some problems related to the misallocation of resources. For reasons not entirely clear to me, we have an enormous quantity of administrative supplies but very few pieces of medical equipment. In the Respiratory office we have three filing cabinets and a bin system to handle all of our different pieces of paperwork. There are papers for home O2 setups, several different charting sheets, ventilator sheets, billing cards, therapy cards, noting cards, and equipment tracking papers as well as several enormous P&P binders; amidst all of this we have one smallish closet filled with O2 supplies, syringes and drugs. Because the paperwork takes up valuable space that we could be using to store equipment, we have stolen a broom closet from the janitorial staff to store our ventilators and other large pieces of equipment in. This problem is endemic to the hospital: a couple of nights ago the hospital ran out of IV fluids. We have never ever run out of office supplies. Ever.

But the worst problem we have with equipment in our hospital is with the defibrillators. I don’t know whose job it is to make defibrillator-related decisions in the hospital, but the person whose job it is either spends a good deal of their time at work drinking or is simply a jackass . Probably 60% of the defibrillators in the hospital are from the early 1980’s. They are older than some of the patients we use them on. A number of these defibrillators are actually malfunctioning. I have personally been in a couple of situations where the defibrillator didn’t defibrillate so much as cook the patient.

One of the worst defibrillators in the whole hospital is on the stepdown cardiac unit, a particularly unfortunate place for it. Srtepdown has been plagued with problems. Amazing rates of staff turnover, incompetent staffing patterns, questionable leadership, and actual failures of the facility–rooms flooding, electrical outlets failing or in the case of emergency outlets missing altogether. O2 flowmeters are out of calibration and not actually in many of the rooms. All of this combined gives Cardiac Stepdown a reputation as the floor from hell.

I first noticed the defibrillator there when I was passing through on my oxygen rounds for the night. I don’t usually pay attention to the defibrillators in any detail, but for some reason this one on Stepdown caught my eye. It is a decrepit heap of yellowing plastic, festooned with repair stickers from Clinical Engineering to assure us that it really is safe. For decorative reasons it has some of those faux-wood panels that were so tasteful in the 1980s. I was so enthralled at the sheer oldness of this defibrillator that I found myself searching it for the hand-crank like they had on early automobiles:

“Give me 300 Joules! He’s in V-Tach!”
“Okay, let me crank it up!”
(Crankity crankity crankity crankity crankity crankity crankity crankity)

I remember one code on the maternity unit where a different defibrillator the same age and model as this one was used. The patient was a young woman, in for a hysterectomy after giving birth a few months earlier. She coded in the middle of the night. When we gave her a shock, her body would twitch lightly, not the deeper twitch you often get from 300 joules. The defibrillator didn’t make any noise, no whining on recharge and no notable thump on discharge. The only noticeable effect on the patient was that over a series of shocks we managed to deep-fry the skin on her chest. To add insult to injury, she died, which might not have happened if she had gone to a hospital that stocked real defibrillators on all the units instead of coming here to Our Lady of Immaculate Grace.

There is some hope for the cardiac and other myriad units that are left with hand-pump defibrillators. The ER and ICU have recently obtained newish defibrillators, purchased primarily to stop the torrent of complaints from the staff that negligence on the part of the purchasing department, who had outright refused to purchase new defibrillators, was killing people. For whatever reason, the detox unit has a new defibrillator, which would be fine if the staff there knew how to use it in a code. But that doesn’t change the fact that on many of our floors, even floors like cardiac stepdown where people are likely to require a defibrillator or a monitor, the equipment is old and poorly maintained and likely to fail in a most lethal manner.

While our patients sit surrounded by failing equipment and crumbling infrastructure, our administration building has recently been completely rebuilt. The offices have been expanded, new furniture and expensive decor has been ordered, and every single thing in the admin building has been rebuilt at a cost of millions of dollars. Add on to this the fact that our CEO is bringing home close on half a million dollars a year, and it’s mind-blowing that despite doing all of that we “can’t afford” a new defibrillator to help save someones life now and then. It’s going to take a trail of corpses and a lawsuit to get anything changed.

I wish I was kidding.

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