Respiratory Therapy 101: Just Keep Breathing

Long day: I had a dozen ICU patients. Two were intubated; both were chronic COPD trache patients who have been here and been vented for more than six weeks. My other ten patients were all ordered on Q4 albuterol nebs. Several were ordered on chest PT; several more on “volume expanders” like the long-outdated IPPB.

I spent twelve long hours in this pit of despair, and I effectively did nothing. I gave unindicated treatments to people who didn’t need them, I did therapies that I know to be ineffective simply because a doctor who is afraid of being sued ordered them, and I did treatments that nurses thought might help that anyone with a working brain would realize do no help at all.

That old joke from the late George Carlin came to mind. “The difference is, when I finish masturbating, I have something to show for it.”

Curtis, a loyal reader and NREMT-P, has emailed me the following story and poster:

“…saw your wall of motivational posters, and wanted to submit one I made after a particularly obnoxious patient. Long story short, 10 of Valium, 10 of Versed,  20 of Haldol and 30 of Etomidate couldn’t calm him down. 140mg of Sux later, all was well. Until he woke up 5 minutes later, and…after Diprivan (wide.. no joke), didn’t fix his attitude, twice the normal dose of Vec did the trick.

…The 3MF rule should be taught in high school.”

With that in mind, Curtis has submitted the following poster to add to the Wall Of Inspiration:

Thanks, Curtis!

If you’re a young, cocky bicyclist, perhaps recently in some trouble with the law and itching to prove your manliness in front of your friends, it’s probably best to avoid playing chicken with tractor-trailers. Those C-1 fractures and spinal cord tears and whatnot are really not compatible with your objectives of impressing chicks and proving your manliness.

Chief Complaint:

Eyelash.

I think EMTALA should have a provision where, if your chief complaint is sufficiently idiotic, the examining healthcare provider should be allowed to slap you. Hard.

I follow several of you loyal readers on Twitter. Someone posted the following cartoon, which strikes me as just hilarious:

Click for Cartoon

But then I have a warped sense of humor. In other smoking news, cigarettes now cost 23 quadrillion dollars a pack…expect muggings to pick up a little.

The best beverage to drink while roofing in the middle of the day in the middle of the summer is probably not beer. Especially not vast quantities of beer chugged on the roof of a three-story building while applying hot tar in the mid-day sun. Those falls from three stories can be killer, as no doubt you have recently learned.

Water might be a better beverage choice. At least until you’re on the ground again.

Maybe I am being judgmental, but it seems to me that when you revoke Grandpa’s recent, clearly worded, clearly signed and prominently posted DNR and ask us to intubate him and place him on heavy pressors and full-on life support in clear violation of his clearly stated desires, all because “we wanted him to live to 100,” you are being a total dipshit. In fact, I’d stab you in the eyeballs over and over with a cafeteria spork just to drive home the fact that there is a special place in hell for people who do things like this.

You know, I could understand this violation of the DNR if you didn’t know he had a DNR, or if you panicked and then asked us to make him CMO once the DNR was brought to light. I could understand violating it or temporarily rescinding it for minor surgery or other procedures. There are exceptions to rules, and there are occasionally solid reasons to violate a signed and clear-cut DNR. But “we wanted him to live longer” is nothing more than a selfish, terrible reason to put someone through the uncomfortable rigors of the ICU against their wishes. I wanted my grandfather to live longer too, but nobody in my family had the unmitigated audacity to rescind his DNR and violate his wishes. No, we made the hard choice and let him die peacefully, as he wanted it. I’m sad he’s gone but I’m glad he passed peacefully in his sleep, instead of horribly in an ICU somewhere.

Your grandfather wanted to die a peaceful, dignified death. Because of you he will linger in the ICU for a few weeks before he ultimately dies of something unpleasant, painful, and expensive. There is almost nothing worse you can do to someone than to remove whatever control they tried to exert over their own inevitable death. You have ruined the last few weeks of his life, and that is an awful thing to do to another human being.

I hope he haunts you. From the grave, I hope he haunts you.

*CMO = Comfort Measures Only

Michael Jackson is still dead!

Madness gets it right with the media circus surrounding this. The whole thing disgusts me.

I think the funniest thing I heard was somebody who was saying they hoped he popped out of the casket and started performing “Thriller.”  The best comeback ever? I think CNN would shit their collective pants if that happened.

Happy fourth of July!

Just remember: Jubilation good, severe ETOH abuse and fireworks bad.

Fingers good, explosives held at arms length bad.

Happy times good, ending up in the ER bad.

Have fun. Be safe. Happy 4th!