All this buzz about inhalers ,nebulizers and hospitals , got me to thinking of various situations, in which Ive been involved.
Not always practicing what I preach.
As I’m sure Rick would agree, It’s a not always easy being a Respiratory Therapist/Asthmatic. Many times, what you’ve learned as a health professional is at odds with how you deal with your own disease. I cant tell you how many times Ive gone to the ER to instruct a patient on the “correct” way to use their inhaler and spacer, only to turn around a few minutes later and take a few puffs off my own inhaler with complete disregard for technique… or even a spacer for that matter!
RT/Patient
Imagine, you have a really bad asthma flare-up, you’re admitted to the hospital, and first words you hear out of peoples mouths is….” So I heard you’re an RT! ” or ” So , is this why you decided to become an RT?”
I don’t know why, but when I’m the patient, I prefer that the medical staff taking care of me not know that I’m an RT. It just seems to make things more awkward. I think mainly because you can sometimes sense that the people taking care of you, are a little uneasy or let’s say.. not too thrilled about the idea of taking care of an RT/patient.
On the plus side though, I’m sure it keeps the staff on their toes. You can pretty much bet that everything is going to be done by the book. For example: With every single breathing treatment, you’re also going to get; pre & post breath sounds (listening to your lungs with a stethoscope before and after breathing treatments) pre & post oximetry (checking you oxygen saturations) , pre & post PFs, (checking your PFs before and after your treatments)… etc etc. Many times Ill try to put the RT’s at ease by telling them… its OK ..You don’t have to hover over me..my breath sounds haven’t changed in the last hour. Just give me the neb. Go ahead and do another patient while I do my own neb ( a big no-no by the way).
But you know what the most awkward moment usually is? It’s when they need to do an ABG ( arterial blood gas) on you. Even if they don’t show it, you can tell they’re sweating bullets hoping like crazy to hit that artery on the first poke.Nothing more frustrating for an RT, than missing a bounding pulse ( been there–done that).
Come to think of it, the only time I’m treated like a “regular” patient is when I’m intubated (you can’t really talk back). They’re going to suction you no matter what. And when it’s time for you to breath on you’re own ( cpap trial or t-piece) ..they’re ruthless.
Of course when you’ve been admitted to the hospital as many times as I have, its almost impossible for people not to know……its all over my medical records.
MDI Protocol
The last time I was hospitalized, they put me on a continuous Albuterol neb at 20mg/hr. (In case you don’t know, that’s the equivalent of 8 Albuterol treatments PER HOUR! .) And to make the medication work even better, they nebulized it with Heliox . As is pretty typical, they kept me on the continuous neb for about 96 hours. That’s’ around 736 Albuterol treatments in just a 4 day period ! Though my potassium always drops big time, amazingly, my heart rate never gets that high, maybe to about 120-130…(but that’s another blog post).
The point is, when they finally transferred me out of ICU over to the step-down unit, the hospital’s respiratory care protocol kicked in and I was switched from a continuous neb ( which was now at 10mg/hr ), to an Albuterol inhaler of 2-4 puffs Q6 prn. That’s a pretty drastic cut. Needless to say, it didn’t work and a couple hours later I re-flared almost ended up back in the unit.
They ended up putting me back on nebulized treatments , this time Q2 ( every 2 hrs) as needed , which I remained on until discharge. Which brings me to another point. One of things RT’s hate the most (though they may not admit it), is having to give neb treatments to a patient every 2 hours…especially at night. Knowing this, I try to tough it out for as long as I could so dont have to bother them as often.
In the good old days, if they trusted you, and you were physically able, they would leave extra meds at your bedside and let you do your own neb treatments.
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In the UK, we don’t have RT’s so we’re given our treatments by a regular nurse who comes round and does the drug round as needed or if you need extra drugs or are due them, they write notes to remind themselves to give them to you. I’m pretty well known in my hospital so they usually just (if I’m well enough) hand me the nebule and let me get on with it, and if I’m on my normal ward, I’m left the nebules for pending treatments to do myself at the right time to save them having to come back.
As far as inhalers go, I’m never put on one, whether I’m in ICU or HDU (or “step down” as you call it) because it was decided long ago they just aren’t strong enough to deal with the level of tightness I deal with on a daily basis. As you also know, I don’t do pre or post PF’s thoughn some doctors insist on them and then get mad when they prove my point.
I don’t think I can remember I was treated like a “normal” paitent, my reputation preceeds me.
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Steve,
Do RT’s still give percussion treatments or do they use flutter valves? It’s been decades since my last hospitalization.
Jay
They still do PD&P (postural drainage and chest percussion), but not as often. Nowadays it done mostly on CF patients.
Did you know that chest percussion was originally done by Physical Therapists? RT’s didn’t come on the scene until the late 60’s.
As far as I know they still use flutter valves as well.
Hi Steve and Jay!
Because my hospital is a specialist lung one, we do have specialist Chest nurses/Physios/Clinical specialists (the equivalent of RTs). There are 2 kinds, one for the asthma team and one for the CF team-they work wonders with us and know most of us pretty well. Even my local general hospital has a chest ward with a separate team of respiratory nurses. I guess it’s who you are and what you’ve got, as well as where you live here.
We can sign a compliancy form in clinic-which means if you are able to (ie in step down and not still on the critical list), you can if you like administer your own nebs etc. The drugs chart is checked off religiously and the number of nebs you’ve had gets counted-they also listen at the door if you’re sneaking a few extra nebs at night so as to get out of trouble! It is pretty hard to hide it from them! I find it is better to do my own nebs as soon as I can, helps get back into the routine before going home.
I generally go from their continuous to being given hourly, to my doing 2 hourlys, and occasionally to 4 hourly plus PRN. Although these days am more likely to be discharged on 2 hourly. If you can cope with doing it yourself and are off the IVS, then get your butt home!
Depending on one’s chest needs, PD and pummelling is done, plus we do get walked up the corridor with the SATS monitor on (Physio’s job) and I usually have an exercise bike in my room too (what-yes, quite!)
PEP therapy is more common amongst the CFers but I do it esp when really gunky and when on a long admission that requires drainage.
Pre and post neb obs etc-always done when you’re critical, can relax a bit when you are so sick and tired of the PF meter you start telling them where to shove it!
Sprio never escapes me (darn it!)
Hugs guys xx
Hi Sus,
Nebs every hour?? The RT’s here in California would go on strike (lol)
Pulmonary or chest wards ( to my knowledge)in the USA, are rare. Most hospitals here have medical, surgical and sometimes cardiac and neuro units for their standard wards.
Most COPD and asthma patients are treated on the regular medical floors or in the transitional care units if they really sick
Thankfully in this day and age, you don’t see very many asthmatics requiring ICU care unless their crashing or are at risk for crashing. In my case, unless Ive been intubated or on bipap , I’m usually put in the ICU as a matter of logistics. Everything and everybody is right there if you need it.
Like you, Ive learned that it’s very important to establish some kind of normalcy as soon as possible while you’re still in the hospital. As soon as I’m able, I request pills instead of IV meds, I get out of bed and force myself to walk on the very first day Im transferred to the medical ward , and I try to cut my neb treatments to a minimum.
You also made a good point about being too sick to do PFs.
I forgot to mention, that where I go, they only do ONE PF in the triage room in the ER and only if you’re able.
But they resume them religiously once you get over the hump.
Stay well.
I know medical professionals (or retired ones) don’t make good patients, but I learned it from watching ER. 😉
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