Respiratory Therapy 101: Just Keep Breathing

“Hey. That guy in 12 needs a breathing treatment.” I looked up from my paperwork and saw a nurse standing over me, arms folded.

“Ok…why?”

“Well, they were ordered Q4 hours.”

“Okay, I’ll get to him.”

“It’s been more than four hours since that order was written.”

“Alright, I’ll see him. He’s on my list.”

“I think he really needs it now.”

“Why? Is he in distress?” As I asked her, I pulled up the patients H&P on the desktop computer next to me.

“Well, no–”

“So if he’s not in distress, why does he need it right now? I see here that he doesn’t take any treatments at home. In fact he has no history, other than he smoked ten years ago. If he isn’t in distress and he doesn’t even have a respiratory problem why does he need it?” The nurse was getting mad, and she raised her voice at me.

“I just think he needs it! Why are you asking me these questions?”

“Because I get pissed off having to do useless damn treatments all day, that’s why!”

“Well he needs the stupid treatment!” she screamed, turning around and stomping away. I resisted the growing urge to throw his chart across the room, and instead swallowed my rage and took a few deep breaths. I stood, walked over to the patients chart, looked at the nurses notes. Lung sounds clear. Respirations 17 and unlabored. I double checked the order: Q4 Albuterol. I sighed and asked myself why I even show up to work as I initialed the order. I took a few deep breaths and put on a smile before stepping into the room.

“Hi there, Mr. Anypatient. I’m KB from respiratory. Apparently you need a breathing treatment?” The patient, sitting upright in bed and breathing evenly, looked up from his magazine and stared at me like a fish stares at a submarine.

“Why would I need one of those? I don’t have any breathing problems…”

“Excuse me for a moment. I’m going to go find a wall to bash my head on, and then we’ll discuss this a little more.”

Every now and then, you get a really nice, engaging, intelligent, delightful patient to take care of. You get one of those people who really wants to get better, who has the desire and the motivation and the oomph to get up and assist you in their care. You get one of those patients who makes it all worthwhile.

I had one of those a few days ago, and man, it made me glow. Most of my patients are crusty and angry people, which I think is mostly to do with the population and demographics of Scumble County. Those who aren’t crusty and angry are feeble and old, and while I like caring for those patients because it can make such a difference for them, it’s very depressing when nice Mrs. Thompson from room 501 codes and dies. Nobody wants to do CPR on granny, but the family wants it, so…

…Anyway, the point of this was that I actually had a couple of really nice, really engaging patients. They wanted to get better. They were older, mid-70’s, and definitely sick–but they worked with me, worked with the nurses and the doctors, and worked their way out of the ICU and back to good health. And I have to tell you, that small reward, those two out of ten thousand patients, make it all worthwhile.

A glimpse of the future? An interesting article in the Daily Mail about hospital failings in the UK. I’ve quoted liberally from the article, but the one quote that scares me the most is in bold toward the end:

A damning report form the Healthcare Commission yesterday detailed a catalogue of failings at Mid Staffordshire NHS Foundation Trust, which runs Stafford and Cannock Chase hospitals.

Dehydrated patients were forced to drink out of flower vases, while others were left in soiled linen on filthy wards.

Relatives of patients who died at Staffordshire General Hospital told how they were so worried by the standard of care they slept in chairs on the wards.

The ’shocking’ catalogue of failures was released yesterday after an independent investigation by the Healthcare Commission.

It found Government waiting time targets and a bid to win foundation status were pursued at the expense of patient safety over a three-year period at Mid-Staffordshire NHS Trust.

Mr Brown insisted it was an isolated incident, saying the Healthcare Commission had assured him there were no other hospitals or parts of the NHS which had displayed similar failings.

“I believe we should focus on the individual mistakes made at the hospital,” he said, adding that what had occurred was “unacceptable and should never be allowed to happen again”.

Health Secretary Alan Johnson pledged high-level reviews of A&E services at the trust, and insisted the scandal was not being repeated at other NHS hospitals.

He said: ‘It was a failure of management. Using targets as some kind of excuse is just poor management. There was a breakdown of communication.

‘I can give a reassurance that what happened in Stafford is an aberration, it is not indicative of what is happening in other hospitals. As soon as the commission started to investigate they told the chief executive.

The commission launched its investigation in March last year after receiving 11 alerts about high mortality rates through an early warning system.

Sir Ian Kennedy, chairman of the Healthcare Commission, said the true scale of the hospital’s failures was not known.

But he said patients had died because of deficiencies at ‘virtually every stage’ of treatment.

Among the findings of the report were:

• Receptionists carrying out initial checks on patients;
• Two clinical decision units – one unstaffed - used as ‘dumping grounds’ for A&E (Accident & Emergency) patients to avoid missing waiting targets;
  
• Nurses who turned off heart monitors because they didn’t understand how to use them;
• Delayed operations, with some patients having surgery cancelled four days in a row and left without food, drink or medication;
• Vital equipment such as heart defibrilators was not working;
• A savings target of £10million met at the expense of 150 posts, including nurses.

Hundreds of patients may have died after bosses at Staffordshire General focused on Government targets rather than safety.

Sometimes, words aren’t good enough. Lucky for me there are LOLcats:

see more Lolcats and funny pictures

This is what I need to be able to say to, oh, 70% of the people I interact with in a day at the hospital.

I need money. So I’m thinking of selling myself out to Google AdSense for a little extra money. Readers, how would this affect your views of the website?

Anybody out there in Readerland who’d like to follow me on Twitter, I just signed up! My username is KBRRT because some imposter stole Keepbreathing from me. This is part of my attempt to expand into social networking as well as blogging; anybody who wants to who hasn’t yet, I am also on facebook as Keepbreathing RRT. By my cyber-friend!

I had to wonder if I’d been drinking. An enormous, 450-500 pound guy, wearing neon green pants and a purple checked shirt with a bright yellow bow tie, was tooling through the hospital on a flourescent green motor scooter.

I had to check my thermos and make sure I hadn’t been drinking.

In RT school, we learned a little bit about air purifiers. Many people with asthma, COPD, small children, or pets will place air purifiers in their homes to filter allergens, pollen, dust, and so on from the air. It’s the airborne equivalent of getting a Brita filter for your drinking water.

No filtration system is ever 100% perfect, but for a lot of people with reactive airway conditions or other respiratory issues it’s not a bad idea to keep a filter running. Some people will tell you that air purifiers pick up and dissipate mold spores, pollen, and other nasties into the air, but I’ve never seen the evidence to verify those claims and as such I file those assertions with other tin-foil hattery and nonsense. When I was a wee lad my parents used an air purifier in an effort to contain my own asthma.

If you’re looking to learn a little more about air purifiers, you can find a good resource at the Air Cleaners/Air Purifiers Guide. It’s full of useful information, FAQs, product guides, and more. Go nuts!

Recently, I spent an entire post bitching about my managers. Freadom at the RT cave has also written about the same sort of thing, but he provides an excellent example of micromanaging nincompoops in action at his blog today. Go have a look!

I’m sure you’ve all heard that now-famous song by Sara Bareilles? The one where she informs you that no, she will not in fact write you a love song?

Well, I’ve decided that it’s time for another Respiratory Therapy Music Hour. I was insI give to you: Treatment Song! Original lyrics can be found here. Instead of a song about betrayal and confusion and love, it’s a song about lies and albuterol and poor auscultation and assessment skills. My suggestion for your viewing pleasure: queue up the youtube vid or MP3 if you have it, replace the lovely singing of Ms. Bareilles with my less poetic lyrics, and enjoy.

Head under water
And you tell me
You’ve been wheezy for a while
The breathing gets harder
Even I know that
Made room for me
It’s too soon to see
If I’m hearin’ those breath sounds
They’re unusually hard to listen to

Blank stares at mad rages
No easy way to say this
You mean well but you make this hard on me

I’m not gonna give you a treatment
Cause you ask for it
Cause you “need one”
You see, I’m not quite hearin’ those lung sounds
Cause you tell me it’s make or break in this
If you’re on your way (to discharge)
I’m not gonna help you to stay
If all you have is wheezin’
I’m gonna need a better reason
To give you a treatment
Today
Today..

I learnt the hard way
That they all say
Things you wanna hear
My stethoscope hears deep down under
You and Your twisted words
Your help just hurts
You are not what I thought you were
Hello to clear lung sounds

Convinced me to treat you
Made me think that I need this too
I’m trying to hear the lung sounds that you say

I’m not gonna give you a treatment
Cause you asked for it
Cause you “need one”
You see, I’m not gonna give you a treatment
Cause you tell me it’s make or break in this
If you’re on your way (to discharge)
I’m not gonna write you to stay
If all you have is leavin’
I’m gonna need a better reason
To give you a treatment today

Promise me
You’ll leave the light on
To help me see
The daylight my guide, gone
Cause I believe
There’s no way
You can believe me
Because I say

I won’t give you a treatment
Cause you ask for it
Cause you “need one”
You see, I’m not gonna give you a treatment
Cause you tell me it’s make or break in this
Is that why you wanted a treatment?
Cause you asked for it
Cause you “need one”
You see I’m not gonna give you a treatment
Cause you tell me it’s make or break in this
If you’re on your way (to discharge)
I’m not gonna write you to stay
If your lungs are clear not wheezy
I won’t make it nice and easy
Babe, I walk the seven seas
When I believe that there’s a reason to give you a treatment
Today.
Today..

(Sincerest apologies to the talented Ms. Sara Bareilles.)