Respiratory Therapy 101: Just Keep Breathing

We could use one of these at the hospital. It would save a lot of time and aggravation for the folks on the Memory Floor.

Lately I have experienced a number of ventilator problems. Here at Sunny Flats we use the Drager Evita ventilator, which up until now I have found to be an excellent piece of equipment. It’s reliable, user-friendly, and packed with all the modes and features an RT could dream of. It’s easy to find what you’re looking for and it’s easy to troubleshoot. The flow sensors (which are at the end of the exhalation line and use some kind of pisoelectric magic to calculate flow and volume) have a tendency to go out of calibration depending on factors like humidity, but that is easy to fix. Up until now the flow sensors fragility has been my only complaint about the ventilator.

Within the last week, however, I have had several ventilators which have had total failures of the O2 sensors. It usually begins with the sensor drifting too high which resolves after a couple of sensor calibrations. But the O2 sensors continue to drift, and finally they go completely out of calibration and will not recalibrate. Luckily the sensor derangements have mostly occurred during our pre-use ventilator testing, but I have had to physically remove two patients from the ventilator and get a new machine due to sensor failures. It seems like a little thing but it’s difficult to manage a ventilator when you do not know the FIO2.

The O2 sensor drift and derangement has become a big problem here. My question is: have any other Drager users out there experienced this problem, or is it something we’re doing to our ventilators that is making them go out of calibration?

All this being said I would like to point out that I love the Drager. It has all the bells and whistles, but it also works just fine for simple mechanical ventilation. We use it for everything from neonates in the NICU to difficult-to-wean COPDers to our postoperative surgical and cardiac patients. We use it in the ER and the PACU and occasionally on the stepdown floor. It’s a great machine and I like it; I’m just wondering whether any other users have had this problem and what we can do to prevent or solve it. Any feedback is appreciated!

A big hearty thank you! goes out today to “Too old to work, too young to retire.” TOTWTYTR is a paramedic who writes a blog about many things, but the post that caught my eye was entitled The One Where He Rants About Pulse Oximetry.

Pulse oximetry is vastly overused by everybody. Instead of taking two minutes to assess a patient, to look at a patient and watch them breathe, people will slap a probe onto a finger and then write down a number. I can guarantee you that if somebody sees a Pox reading of less than about 92 in the ICU, I will be getting a phone call regardless of the patient’s respiratory status. I have had people call me to look at patients who have “sats in the eighties!” and it turns out that the probe is on wrong or the patients hands are cold or they have parkinsons or…the list goes on.

As they tell us in training: look at the patient, not the numbers.

Go and read TOTWTYTR’s blog. It’s well worth the time.

I just got word that a former co-worker of mine has died. This is deeply saddening. She was a kind woman, always with a happy word and an optimistic point of view. She was sweet-tempered and thoroughly likable in every way. Anytime we worked together it was a good night; she was just a kind, wonderful person.

Rest in peace Glenda.

I’d like to add Crusty Ambulance Driver to the blogroll here. Crusty’s got some great stories from the field that illustrate perfectly why the cost of healthcare is spiralling upwards in our country. Go on over and check them out…

I happened to be on an ambulance the other day doing a critical care transfer. I listened to the radio while I was watching the patient. The service I was riding with got 911 dispatches for: a headache, a loose PEG tube, and a forty year old woman with a q-tip stuck in her ear. All of these ambulance dispatches are going to cost 500 to 700 dollars at least, and I’d be willing to bet that none of the ingrates who called will be willing or able to pay. You talk about the rising cost of healthcare? Let’s stop giving rides to people who could easily drive themselves in or get a cab. For heavens sake I drove myself to work with a broken elbow a couple of years ago; didn’t even cross my mind to call an ambulance for it. How these people have lived forty years if they can’t even figure out how to properly use a q-tip is beyond me, and I really do wonder why it is that my paycheck must be garnished by the government to pay for these morons. If you can’t use a q-tip that’s one thing; if you think the appropriate solution is to call 911 that’s another thing altogether. In fact, I’d just go ahead and say that if you think that 911 is needed because your ear-gold mining experiment ended in a collapsed shaft, you probably shouldn’t have children or drive or vote. In fact…you should probably just give up.

Not that I am bitter.

I was just on Yahoo! and I noticed that among their top ten searches, “staphylococcus aureus” came in at number ten.

I have no idea what to make of that. I didn’t even think most people could spell it, let alone would bother to search for it.

One of my hobbies is to get people going. If you know exactly where the line is, you can walk along it for a few minutes without stepping over it. This gets people pretty worked up, but when they discover that you’re just kidding they usually see some humor in things. And the agitation is good for them: the increase in blood pressure, heart rate, and respirations is sort of like exercise. I view my hobby as a public health service: getting people going is good for them!

So the other day when I ran into my boss standing near our hospital’s infection control officer I had to see what I could do. I walked inconspicuously past, then stopped and smiled.

“Hey boss.”

“Hey, RT. How’s it going?”

“Just fine. My patients are eating so I figured I should too, (insert phony conversational laughter here.) Say, infection control, have you seen that guy in CCU with the crazy infection? What is that?”

The infection control officer frowned for a moment.

“That’s a weird case because we don’t really know what he has. It’s some unknown new pathogen. We’re hoping we can figure it out. It would be awful if that spread around.” I nodded knowingly and crossed my arms, putting on The Serious Face.

“Well I’m doing my part. I believe that exposure is the better part of immunity.” The boss became perceptibly nervous as I said this, shifting her weight between her feet and looking uncomfortable. The time was right to deliver the killing blow. I took a deep breath and carefully controlled my expression.

“That’s why I never ever wash my hands.”

There was an awkward pause. I stood straight and focused on not smiling. The Boss began to laugh nervously. The infection control officer seemed extremely startled and there was a glorious moment of complete awkwardness as the two of them stared at me in disbelief. Finally I couldn’t control myself any more and I burst into laughter. Once the two of them realized I was just kidding they began to chuckle nervously, and I reassured them that I was merely joking and made my escape before retribution could begin.

Another notch in the gun, so to speak. I’ll just have to steer clear of the boss and hope she doesn’t manage to get me back.

I gave myself a nosebleed. I had an itch and I was trying to scratch it when I made a slight miscalculation. Instead of lightly scratching a minor itch, I accidentally rammed my fingernail into the soft flesh of the median of my nose. I don’t know why I am sharing this with all of you; I suppose I am hoping to impress you with the breadth of my manual dexterity skills.

From the RT perspective, I found myself staring at the blood as it came out and taking note of the color. It was lovely: none of the dark blue or even purple blood indicative of imbalances, but the bright red blood of healthy functioning organs.

Is that weird?

I may be less posty than usual this week. My computer has picked up some sort of virus and has been very sick. In medical terms, it’s in the ICU on BiPAP and not looking especially well. I’ve busted out some new antivirus and deep-scanning stuff and hopefully I can remove or quarantine whatever offending code has caused my troubles here.

More posting later.

I have just rolled over 100,000 hits since the initiation of this blog! I can’t believe that people actually read the things that I write. 

Thanks for reading, readers. Tell me, what can I do to keep you here? What do you like and not like? Inquiring minds want to know.