Respiratory Therapy Driven

Allergy Season is on it's way.

noreply@blogger.com (Djanvk) — Fri, 17 Apr 2009 07:19:00 +0000

It's becoming that time of year for another bout of respiratory problems, the allergy season. This time of year brings on the great problem called Hay Fever and there are more than 35,000,000 Americans who suffer from this type of problem.

Hay Fever is a type of allergen rhinitis triggered by pollens from different plants this time of year because they are all beginning to grow. Some major players in the problem of pollen are the Birch tree which can cause problems for 15-20% of suffers and then the largest player for people who suffer from the type of problem is grass pollen, it is estimated that 90% of hay fever sufferers are affected by grass pollen. Hay Fever is not caused by a virus its caused from a allergen. Hay fever can begin at any age, you're most likely to develop it during childhood to early adulthood. It's common for the severity of reactions to change over the years and for most people the symptoms tend to diminish slowly, often over decades.

Some common trigger of Hay Fever can include:

Tree pollen, common in the spring
Grass pollen, common in the late spring and summer
Weed pollen, common in the fall
Spores from fungi and molds, which can be worse during warm-weather months
Dust mites or cockroaches
Dander (dried skin flakes and saliva) from pets such as cats, dogs or birds
Cockroaches
Spores from indoor and outdoor fungi and molds

Some of the signs to look for in a allergen problem are:

Sneezing more than usual
Eyes that continually water
Cold symptoms that last more than 10 days without fever
Repeated ear and sinus infections
Prolonged loss of smell or taste
Frequent throat clearing or hoarseness
Persistent coughing
Sinus pressure and facial pain
Swollen, blue-colored skin under the eyes (allergic shiners)
Decreased sense of smell or taste

Where this comes in for Respiratory Therapy is the coughing, doctors really like to give nebs for coughing to help it stop so there goes our case load in the E.R. more neb treatments for coughing. Asthma though is one problems which often occur along with Hay Fever, along with Sinusitus, Eczema, and Ear infections.

The best way for these patients to limit problems to these allergens is to keep from being exposed to much to these allergens:

Close doors and windows during pollen season.
Don't hang laundry outside — pollen can stick to sheets and towels.
Use air conditioning in your house and car.
Use an allergy-grade filter in the ventilation system.
Avoid outdoor activity in the early morning when pollen counts are highest.
Stay indoors on dry, windy days.
Use a dehumidifier to reduce indoor humidity.
Use a high-efficiency particulate air (HEPA) filter in your bedroom.
Avoid mowing the lawn or raking leaves, which stirs up pollen and molds.
Wear a dust mask when doing outdoor activities such as gardening.

These are just some ideas I found reading about this online and if you suffer from hay fever you might want to take some of these precautions.

There are quite a few types of medications which help with Hay Fever:

Nasal corticosteroids. These nasal sprays help prevent and treat the inflammation caused by hay fever. Examples include fluticasone (Flonase), fluticasone (Veramyst), mometasone (Nasonex) and beclomethasone (Beconase).
Oral corticosteroids. Corticosteroid medications in pill form, such as prednisone, are sometimes used to relieve severe allergy symptoms.
Antihistamines. These oral medications and nasal sprays can help with itching, sneezing and runny nose, but have less effect on congestion. Older over-the-counter antihistamines such as diphenhydramine (Benadryl) and clemastine (Tavist) work as well as newer ones, but can make you drowsy. Newer oral antihistamines are less likely to make you drowsy, but are more costly than the older antihistamines. Over-the-counter examples include loratadine (Claritin, Alavert) and cetirizine (Zyrtec). Fexofenadine (Allegra) is available by prescription. The prescription antihistamine nasal spray azelastine (Astelin) starts to relieve symptoms within minutes of use. It can be used up to eight times a day, but can cause drowsiness. Side effects include a bad taste in the mouth right after use.
Decongestants. These medications are available in over-the-counter and prescription liquids, tablets and nasal sprays. Over-the-counter oral decongestants include Sudafed, Actifed and Drixoral. Nasal sprays include phenylephrine (Neo-Synephrine) and oxymetazoline (Afrin). Because oral decongestants can raise blood pressure, avoid them if you have high blood pressure (hypertension). Oral decongestants can also worsen the symptoms of prostate enlargement, making urination more difficult. Don't use a decongestant nasal spray for more than two or three days at a time because it can cause rebound congestion when used longer.
Cromolyn sodium. This medication (NasalCrom) is available as an over-the-counter nasal spray that must be used several times a day. It helps relieve hay fever symptoms by preventing the release of histamine.
Leukotriene modifiers. Montelukast (Singulair) is a prescription tablet taken to block the action of leukotrienes — immune system chemicals that cause allergy symptoms such as excess mucus production. It has proved effective in treating allergic asthma, and it's also effective in treating hay fever. Like antihistamines, this medication is not as effective as inhaled corticosteroids.
Nasal atropine. Available in a prescription nasal spray, ipratropium bromide (Atrovent) helps relieve a severe runny nose by preventing the glands in your nose from producing excess fluid. It's not effective for treating congestion, sneezing or postnasal drip. The drug is not recommended for people with glaucoma or men with an enlarged prostate.

This turned out longer than I expected it to but as a Therapist I figured it something we will deal with in the coming months and one little more tidbit of information about Hay Fever:

Hay fever doesn't mean you're allergic to hay. Despite its name, hay fever is almost never triggered by hay, and it doesn't cause a fever.

Keep driving on RT's.

Need a Prayer for a young boy.

noreply@blogger.com (Djanvk) — Thu, 16 Apr 2009 05:30:00 +0000

I'm posting this to reach out for a family I know who is having hard times right now with medical problems. The mother of this family is having to deal with her 9 year old son in a pediatric ICU and needs some extra prayers to get this boy to turn around. This 9 year old child has been having small strokes and is in and out of a coma. He was starting to turn around a little bit and was off he ventilator for a couple days then had another stroke which put him back in a coma state and again on the ventilator.

This child was born with hydroencephalitis and had an operation to place a shunt in his brain and the parents were told he would not live to be more than 2 years old. Well he is 9 and was doing everything a normal child would do, did good in school, loved the Iowa Hawkeyes, and played with his friends and brother. These current events started when he went in for a checkup on his shunt and things went bad, this was about 2 weeks ago. The medical staff at the medical center he is at are still trying to track down what is going on and the cause of the strokes but nothing is promising yet at this time, but we are still hopefull.

What makes this so hard for the mother of this child is that just over a year ago her husband, this boys father, lost out on his battle with brain cancer and he was only 39 years old. This woman now has to deal with her youngest son possible not pulling through which would be devastating to her as this would be 2 major losses to her family in under 2 years. Something like this would be hard to fathom by most people, and she has another son to stay strong for with all this going on.

I'm just asking for a little prayer, thought or anything just to help this family get through this time of need and sadness. I do believe there is the possibility of the power of prayer and thought to help people in need. Thank you for any thoughts and prayers, and if you where wondering, this boys name is Jack, and her is a HUGE Iowa Hawkeye's Fan like his father was.

Shortage of Health Carre Workers in 6 years predicted.

noreply@blogger.com (Djanvk) — Mon, 06 Apr 2009 09:37:00 +0000

I was recently reading through the April 2009 AARC journal magazine and there were predictions on different health care topic which would affect RT's. One I saw that interested me was:

"There will be a national shortage of all health care providers in all sectors, Even those who frequently interact directly with patients."

This struck me as interesting because you would thinks with the unemployment rate as high as it is this would be a job sector which people would maybe flock to because of the job security of there always being sick people to take care of, but I guess this isn't so.

I starting thinking about this and realized there are large portions of society who are hardly even tapped to work as health care workers. These people would be the men of the United States. If you work in the health care sector think about it, who so you see mainly working directly with patients as a majority? Women right. There you can even break it down even more, these would mostly be white women also as a majority. Now I'm not trying to bring in the race card it's just a observation and I tried looking up some facts which I could find on this topic.

As for men in the health care workforce I wasn't able to find a overall men in health care number but I found a number for male nurses. According to the American Nursing Association only 6% of all RN's are male. Here in this article: "Is there a male nurse in the house?" about 7.5% of male nurse graduates leave the profession within 4 years of graduating. These are not good numbers.

Now when we look at the minority sector of the health care work force I found out that 1/4 of our population is made up of African American, Hispanic and American Indians but only 10% of them are in the health care field, this is according this this article: Diversity in Health care. This leaves a lot of possibilities for more health care workers.

Why don't more men work in the health care field? I believe it's the stigma and stereotype of women always being the nurses. When I say nurse I do picture a female and it's because of stereotype. Men also are not normally brought up to be caregivers like mothers. More men should really look into health care because were going to need to fill the gaps if this prediction is correct. Honestly there are a lot of perks, good pay, stability, job security, air conditioning and heat, hot looking nurses, friendly atmosphere, and the list goes one. If we are to fill these gaps in health care jobs were going to need to disperse of the stigma of men being in health care other than being doctors. Like we all know, Respiratory Therapy is a good field, and the women dig us.

Discoid Atelectasis, what might that be?

noreply@blogger.com (Djanvk) — Fri, 03 Apr 2009 09:35:00 +0000

Tonight I had a patient I was assessing for out therapy driven protocols and was reading this person's xray and I noticed a word I have never came across before in my medical travels and it was describing a type of atelectasis:

Discoid Atelectasis which is also known as Plate Atelectasis.

Now being the good RT that I am, I had to do and look it up so I could do a proper assessment of this patient and what I found was interesting to me and I thought I would share it with anyone who might read this blog of mine.

Discoid or platelike atelectasis is a form of atelectasis which has s disc or platelike appearance on a xray which is linear or horizontal position. They often look like a CD or a dinner plate and thought to occur from shallow breathing or hypoventilation which can occur after a abdominal or thoracic surgery. It can be also seen in other conditions such as painful breathing, general anaesthesia, pulmonary embolism, ascites and diaphragmatic paralysis.

There is really no different type of treatment for this versus any other type of atelectasis because it is just a term to describe what is seen on the xray but overall it's still just atelectasis.

Really there is not to much alarming about this it's just something I came across and have never seen so I thought I would share it with everyone and hopefully if you come across this in a report you will now know that those radiologist are talking about because it seems they like to try and stump us, but because of the Internet things can be looked up quickly now.

If you didn't know, now you know ... Drive on RT's.

The Secret Book of Doctor Knowledge!!!

noreply@blogger.com (Djanvk) — Thu, 02 Apr 2009 09:23:00 +0000

Doctors are a interesting bunch, there are good ones, interesting ones, bad ones, ones we are not sure how they got through medical school but overall they are a interesting bunch.

Something that sparked my interested is how a doctor will get on a certain type of treatment kick for awhile which will make us RT's look at each other and go hmm, where did this come from and why are we doing it? This just doesn't make any sense to do this to every patient we see.

For instance we have 2 doctors in particular who get on these treatment kicks, right now one is on this Duoneb with Ezpap QID & Q4prn for anyone who has anything to do with Respiratory, seriously do we need to add Ezpap to a patients home regimine if there are not even in for Respiratory problems and does EzPap really help treat a patient with a history of COPD? Then we have another Doctor who is on a Mucomyst kick for EVERYONE with nebulizer treatments, yes we get that D/C'd a lot curtosy of our protocols but they also have learned they can write NO RT Protocols and then we are stuck.

There are cases of other doctors getting on certain treatment kicks like the Xopenex for everyone kick along with not following the company's drug reps recommendations on how to order Xopenex (not created to be used Q2 or continous, still makes heartrate go up), and I'm sure there are kicks that RN's see the doctors get on, but I don't deal with that side of the house.

So this makes me wonder if there is a Secret Book of Doctor Knowledge which has all the information why these treatement are the current "Cat's Meow" in the respiratory world of care because I've look everywhere for some definitive knowledge on how Mucomyst will help all patients or what good does EzPap do for a patient with COPD and this information has eluded me because I'm assuming it's in the Secret Book which of course if probably locked in the doctors lounge. I just wish they would give us a quick in service on this instead of looking at us like we are stupid when we question these treatments.

I'm sure these kicks will die down after awhile of use and go away until some other little bit of knowledge gets updated in this book like a Doctors version of Wikipedia, but it would be nice to just share a little bit of information to us troops in the trenches.

Drive on!!!

Oxygen Dependant COPD man to run marathon.

noreply@blogger.com (Djanvk) — Wed, 01 Apr 2009 10:48:00 +0000

I ran across this article and thought is was interesting:

COLORADO MAN TO BE THE FIRST COPD OXYGEN PATIENT ALLOWED TO RUN IN BOSTON MARATHON!

Its about a man who is oxygen dependent, diagnosed with COPD and is the first person with COPD allowed to run the Boston Marathon. This person is on some serious O2, when asked what is prescription is he responded:

"I have been on supplement oxygen for 4 years. My current prescription is 4-6 liters at rest and 7-18 liters when I’m active or exercise."

Now that's some serious O2 he is on for exercise, just think how many tanks he might go through in a 26 mile race.

This guy has already completed 2 full marathons, 14 half marathons, 1 ten mile, a 5 mile, 4 times did the 10k the Bolder Boulder, a bunch of 5k's and climbed 2 14,000 plus foot mountains. Quite amazing. He says that he went through 5 tanks a marathon and was lucky to have friends to help with the changing of tanks when needed.

This is pretty amazing for a COPD oxygen dependent person to do and it just shows their is life after a COPD diagnosis, you just have to take care of yourself and work to acheive some added health to help cope with the problem.

To add to his accomplishments on March 10 of this year he finished the Climb Chicago event for the American Lung Association. 4 buildings; 180 floors; 360 flights; and 2340 stairs, for a time of 1:06:13. Really amazing, that would hurt me.

Well hope that article was inspiring and hopefully this guy can inspire other COPD patients in the future.

Drive on RT's.

Peds Pneumonia VS. Adult Pneumonia

noreply@blogger.com (Djanvk) — Sat, 28 Mar 2009 10:16:00 +0000

We are not in a time of year where there seems to be a larger than usual amount of Pneumonia cases coming into my hospital. There are many different types of pneumonia out there but we mainly deal with only a couple of them.

Some Different types are:

Viral

Bacterial

Fungal

Parasitic

Comunity Aquired

Hospital Aquired

Severe Acute Respiratory Syndrome(SARS)

If you want more information on the different types of pneumonia just go look it up, many sites are out there with this information.

Now if you noticed in my title of this post I'm talking about Peds VS. Adult pneumonia's. The reason I am talking about this is because my hospital will isolate all pediatric patients for Droplet Precautions if they have any lung problems, including pneumonia. Now my question is why do we just isolate the kids with pneumonia and not the adults with pneumonia? This I am confused about, but I do understand the the underlying virus or bacteria which cause pneumonia could be contagious but why more so in kids than adults?

With our kids we need to gown and mask but with adults nothing extra as of precautions is taken which is perplexing to me as I cannot find a decent answer to this question and unfortunately I don't see the Peds doc very ofter as I work nights.

So if anyone can shed some light on this for me I would be much obliged, but until then I will keep searching and wearing my gown and mask for the kids, but I'm sure we would look less scary to them without that garb on.

Thanks for reading

Keep driving on RT's.

We need a law for resusitation age limits!!!

noreply@blogger.com (Djanvk) — Thu, 19 Mar 2009 12:05:00 +0000

Just a quick note of something that I think needs to be implemented for the humane treatment of older adults who would happen to have their heart stop beating:

"Anyone over the age of 90 years should automatically deemed DNR."

I would even go as low as 85 years old if allowed. It's almost inhumane to code an patient who is over 90 years old and put them through that.

Maybe I will get into this more in depth later.

Just a thought.

Video of Lung Recruitment

noreply@blogger.com (Djanvk) — Wed, 18 Mar 2009 09:40:00 +0000

I ran across this video of a rabbits lungs being ventilated outside of the body, yes not rabbit just the lungs, and it show the expansion of the lungs after different levels of peep are applied. Quite interesting.

Hope you enjoyed this.

Really there is a proper way to wean a vent.

noreply@blogger.com (Djanvk) — Wed, 18 Mar 2009 08:59:00 +0000

One of the problems with small town hospitals is that there are usually only one specialist in a certain field. In our field as Respiratory Therapist we use the the pulmonologist specialist for our profession because they are the specialty doctor who deals with the lungs.

Here is a good page on what a pulmonologist does if your interested: Pulmonology

So anyways because I work at a small hospital we only have one pulmonologist on staff which creates the problem of not having the chance to consult another pulmonologist on a case. With only one of these doctors on staff also lets them be the know all do all doctor in this field, saying we do it they way he/she likes it done.

On with my problem of weaning ventilator patients. When I was in school and also when I was at other hospitals vent patients were weaned much more smoother, the rate was slowly decreased as needed, the oxygen level was decreased, they were given time to just breathe on only pressure support ventilation, and then if they survived that we would run weaning parameters and extubate. This to me is a humane way to wean and extubate a patient, much more friendly. Now back to my one pulmonologist and the way he does it. First off we use Assist Control mode like it's going out of style (which is actually is) and SIMV is almost unheard of as if this pulmonologist forgot to renew his subscription to Pulmonology Today. These poor patients are always put on Assist Control with a rate of 12 or greater but now here is the part that drives me nuts we wean directly off of this, for weaning parameters or a Tube Compensation trial we got straight from Assist Control with a Rate of 16 to NOTHING and hope there are good weaning parameters!!! How can you expect a patient to do well if you go from full support to nothing, this is not weaning. Weaning is a gradual process to remove something from something, like a bottle from a baby, you slowly give the child less and less bottles and more sippy cups or whatever. We do a sink or swim type of wean. Full support to nothing, this is not how I was taught nor how I've ever seen it done at a hospital where I have worked.

Amazingly though this doctor is well liked and respected with how he treats patients and their illnesses but when it comes to vents, my department cringes but does our best to deal with it.

Any comments would be much appreciated, I would like to hear if anyone else weans like this.

Keep driving on RT's.

It's been awhile.

noreply@blogger.com (Djanvk) — Sat, 14 Mar 2009 01:28:00 +0000

I've been gone for awhile, I started taking classes again and just got myself busy trying to get back into this school thing and realized I missed having a outlet to post things on my mind when it comes to Respiratory Therapy. So, I'm back and hopefully I can get some good posts out here in the RT blogosphere which can spark some thoughts and conversation.

There that's my 2 cents worth and I will be posting something more substantial later.

Thanks for reading.

Attempt to stop teen teen smoking

noreply@blogger.com (Djanvk) — Thu, 03 Jul 2008 13:56:00 +0000

We all know that smoking makes you look really cool these days and who doesn't want to look the coolest ... well Teens of course.

Japan have rolled out a cigarette machine that is supposed to verify if you are of age to smoke or not. How this worked is the machine has a face recognition camera that supposedly can detect your age. Interesting enough, and of course it's in Japan where they are quite good a finding ideas for things via technology.

So now these machines have been rolled out onto the street and they did seem to be working until someone figured out a way to hack it. How you ask? Well the kids are able to use a picture of a someone older and hold it up to the machine and look at there you are verified.

Here is the link to the article: Linky

Why did I post this, well it relates to smoking and the fight against it. And of course us RT's are anti-smokers right! Just thought it was interesting and fun. People are trying to cut down smoking.

Enjoy.

New Device helps a paralized person breathe.

noreply@blogger.com (Djanvk) — Tue, 01 Jul 2008 09:22:00 +0000

Interesting respiratory related news, the FDA as approved a device called the NeuRx DPS RA/4 that can be implanted in the diaphragm which in turn stimulates the diaphragm and allows certain spinal cord injured patients to breathe for at least 4 hours a day off of the ventilator.

Here is a article to read more in this device. Diaphragm-Pacing Device.

This can definitely improve the quality of live for a person with paralysis. This device was approved by the FDA under the Humanitarian Device Exemption which is a approval process that in intended for devices that treat less than 4000 people per year.

I'm all for this, but really will be start seeing many people on this type of device? Is this something we might need to have a little training on? Who knows, I just thought it was interesting technology to know about.

Keep on driving on RT's.

What we see, not everyone does.

noreply@blogger.com (Djanvk) — Mon, 30 Jun 2008 09:32:00 +0000

We are currently very low in our census of respiratory patients but we still have some interesting ones come in and out of my place here. Tonight I had a patient come into my ER who was very tachycardic to the tune of 170's and higher along with a respiratory rate of 40's and sweating very profusely.

What does that sound like? If you said a pulmonary embolism you would be correct. Now this really is nothing very new to most RT's but what really struck me about this one is the mortality of this person that was brought up to me. I had previously done a EKG on this patient when he first came into the ER and was called back to do another one about a half hour later. What I noticed was his rate had increased along with his heart rate and the patient just being very anxious, but he was very alert and awake.

When I finished I went out and talked with the doctor, I asked him if this patient had some sort of bad infection also because of a high fever according the the nurse. The doc said no, he has a bad PE and he was pretty sure this person was going to die.

Right there is was struck me, "pretty sure this person was going to die". Does this patient know that, are we looking at a dead man walking type of issue, somehow he can tell that this person who is alert and awake has a clock that is ready to stop. Well the doc was right, he got to the point that he needed intubated and not more than 2 minutes after the intubation his HR went from 170's to the 30's and a code was started.

After all was said and done this patient didn't make it, but between when I talked to the doctor until the code was stopped, I couldn't help but think that I was this alert person that we knew that his time was up and it was just a matter of time. I was talking to this person knowing that the doctor could be right and I could be the last person he talks to. We watched this person just fade away, did all we could to save him but in some sense we all knew there was not much hope at all.

This all started me thinking about what we see as RT's compared to other people in the world. If you think about it how many people actually get the chance to actually watch someone take their last breath? How many people get to see a person who is injured beyond recognition from a car accident? Really I don't think many people get the chance to experience the things we sometimes do and a daily basis. Yes most people will probably see a dead body after the fact at a funeral but really how many are able to see life just slip away from a person or see us as caregivers struggle to resuscitate a person and get their heart started again?

Honestly do people in our lives, friends and family really understand what we see and deal with at our job? Do you think they have a good idea of what our job involves? Unless you are around our job you can never really know what we see or do. In my 12 years as a RT I couldn't even guess how many people I have seen die, and really I feel I have been desensitized to the reality of death and dying. I often wonder that if, God forbide, one of my parents would pass away that I wouldn't be able to show much emotion but I do know I would be sad. It is possible that I am so used to seeing people die that I might not even be able to cry for my loved ones.

All in all as a RT I really think that we see more death that a lot of RN's in the hospital. Think about it, as the RT we are required to respond to all codes, not all RN's are. There is the possibility of a code happening in the floor that the RN works at, but we as RT's are responsible to respond to ALL codes in the hospital. So are we around it more, I think so. This fact I can see in the eyes of some RN's who I see in codes, it's in their eyes they just seem a little out of sorts. We on the other hand usually have been though many of codes and are a rock in the sea of turmoil called a code. Don't get me wrong there are a lot of RN's in the position to see a lot of this also, namely ER nurses, they probably see a bit more than us. They are also a special breed.

There are many jobs out there that see things that most people would not want to but that's what separates the people who are able to do these types of jobs. It's not for everyone, you have to have a certain toughness and mindset to do this type of work. We have that mindset, and it is needed to not only do you job but to be a calm face in a stressful situation.

Friends and family might know what a RT is, but will never understand really what we see and deal with as a RT. Sometimes it can get to you when you think about it.

Drive on RT's.

Small Town Patient Privileges

noreply@blogger.com (Djanvk) — Sun, 22 Jun 2008 09:45:00 +0000

Patients in a small town hospital like the one I work happen to be a totally different animal than the ones in the bigger cities. This idea I'm pretty sure Freadom over a Respiratory Therapy Cave and agree with me about because it seems that he is in this same small town hospital category.

Some of the differences I have noticed are the types of reasons that people come in for are pretty simple compared to larger hospitals but there are exceptions also to this. There are the injuries that can be more local to the type of hospital you work in. For example where I work is a large farming community, we have had rolled over tractors, getting kicked by horses, falling off of barns, and my favorite the guy who him and a couple of buddies were drinking out in the cow barn and had a little to much and passed out and coded right in the middle of cows, down in the hay and manure. The EMT's said they were worried that the cows would kick them while they were working on the patient. This guy smelled awful and had cow manure and hay all over him, unfortunately he didn't make it and the ER room smelled and had hay all over the place. Then there was the Ethenol Toxicity patient who decided to drink some straight ethenol from the ethenol plant, yep not smart it's 200 proof!!!! He was quite red.

Tonight I had another one of my small town patient who received a privilege that I have not come across so far in my 12 years as a RT.

I was on my way to do a breathing treatment with a older patient at around 8 pm and when I got to her room there was no one there. Fine I thought she must be walking around the unit, we do encourage our patients to get up and walk. I see her nurse and ask if she is out walking and I'm told no she isn't, she is - get ready for this -

Ok here is the dialog:

Me: Hey Nurse Betty do you know where Mrs. Bing is at, she is due for her treatment?
Nurse Betty: No she isn't here right now, she's out.
Me: Out, not here, is she at a test?
Nurse Betty: Uhhh nope, she is at a Wedding.
Me: She is what??? (confused look on my face)
Nurse Betty: Yep you heard me right she is actually at a wedding, she left about 1 pm.
Me: Really, is she coming back?
Nurse Betty: Yea the doctor said she had to be back by 9:30 pm.
Me: So she is gone to a wedding and has a curfew. She is really sick isn't she. (dumbfounded)
Nurse Betty: (sarcasm) Oh yea she is so totally sick.
Me: Did she wear a dress? Get all dolled up?
Nurse Betty: No Idea I just go here at 7 pm.

Ok this I found interesting as she must not be very sick at all, send her home and have her follow up with a doc at the clinic. Your wasting our time.

So about Midnight I have to go assess her for respiratory status and she is there finally and I can give her the treatment also now.

Me: So I hear you went to a wedding today?
Mrs. Bing: Oh yes I sure did.
Me: Was it a good wedding?
Mrs. Bing: Yes very pretty and the reception was a lot of fun to.
Me: So what time did you get back?
Mrs. Bing: A little before 10pm, the doctor gave me a curfew. Can you believe it, I'm 86 years old and I was given a curfew. I really don't remember ever getting a curfew.
Me: Yea that is pretty funny, well glad you had fun and made it back before the doctor grounded you. Alright here's your neb.

I just really found this interesting that a inpatient is released to go to a wedding or really anything while they are sick. Granted we cannot hold someone against their will but why not just discharge this person, they seem to be okay. Oh well I thought it was funny.

Then tonight there is this younger 20 something in the ER who I had to do a EKG on. The police were here for this one because he was a bit unruly. Seem like he had a couple to many drinks or drugs of some sort. So anyways I'm in there and he threatens to spit on people so the conversation proceeds:

Big Dork: Get away or I will spit on you and give you the SARS I have!!!!
Me: I don't really think you have SARS.
Big Dork: Yes I do get away.
Me: How did you get SARS?
Big Dork: I don't know, how can you get SARS?
Me: It's not in the United States, have you traveled overseas recently?
Big Dork: Yes I've traveled overseas recently.
Me: Where to, because there are not to many places that have SARS?
Big Dork: What places have SARS?
Me: Japan, China, over in that area.
Big Dork: Well yeah exactly, that's were I went to Japan.
Me: Yea Okay, if you spit on me SARS or not I will let that cop beat on you.
Big Dork: I'm not really going to spit on you.
Me: Ok hold still so I can run this EKG, thanks all done and good luck with your SARS.
Big Dork: Thanks, can I have a glass of water.
Me: Let me ask you nurse, cya.

That was just plain funny, I like funny drunk/high people you can mess with then and they will never even really notice you messing with them.

Well hope this was as entertaining to you as it was to me tonight as it did make the night more interesting because I actually had no patient that were due anything overnight. Easy night

Drive on RT's

What do Cord Gas values mean?

noreply@blogger.com (Djanvk) — Tue, 17 Jun 2008 05:51:00 +0000

In the different hospitals I have worked at over the years where the respiratory therapists either draw or run the umbilical cord gases I have often wondered about what the normal values of a cord gas was. Just from running a lot of cord gases I have came to my own conclusion of what a cord gas value should probably be but have never really looked into what the real normal values are and what a value out of the norm would mean.

I have done some research online to see what I could find out. Here are some fact about umbilical cord gases and the normal values:

The umbilical cord blood is studied for the status of the fetal acid base. Cord gases are obtained to detect the presence or absence of acidosis and to decide whether the cause of the acidosis is respiratory or metabolic. Establishing the source and type of acidosis make it easier to a.) plan resuscitation b.) treat complications.
Umbilical cord blood pH and acid-base balance is most useful in association with the delivery of an infant with a low APGAR score.
Only newborns who have a persistent APGAR score of 0-3 for 5 minutes or longer and an umbilical artery blood pH of less than 7.00 are at risk of manifesting anoxic brain injuries.
Premature infants are at higher risk for intracranial hemorrhage and subsequent neurological dysfunction, such as cerebral palsy. Without umbilical cord blood gas analysis, these neurological complications could be incorrectly attributed to intrapartum or birth asphyxia, especially if the latter is solely based on APGAR scores. Normal umbilical cord blood values in the premature infant virtually eliminate the diagnosis of significant intrapartum hypoxia or birth asphyxia.

The information I used above was found from different sources who are all basically saying the same thing. Now how about those normal values and the values the show a respiratory or metabolic acidosis.

As a reminder the umbilical cord is backwards as the Venous side carries the oxygenated blood and the Arterial side the unoxygenated blood. Doctors prefer to use the Venous cord blood but can assess PH with he arterial side also. Also these values are not set in stone, they are just a reference point, I have came across values the differ but very slightly.

After BirthNormal Fetal cord blood pH and gas values:


	VEIN	ARTERY
pH	7.25 - 7.35	7.28
p02	28 - 32 mmHg.	16 - 20 mmHg.
pC02	40 - 50 mmHg.	40 - 50 mmHg.
Base Excess	+/- 0 - 5 mEq/Liter	+/- 0 - 10 mEq/Liter

Abnormal Venous cord blood pH and gas values

	Respiratory Acidosis	Metabolic Acidosis
pH	<>	< 7.25
P02	Variable	< 20 mmHg
pC02	> 50 mmHg	45 - 55 mmHg.
Base Deficit	< 10mEq/liter	> 10mEq/liter

	Respiratory Acidosis	Metabolic Acidosis
	Low pH	Low pH
	High pC02	Normal to high pC02
	Normal Base Excess	High base excess

As always I hope you have learned or been refreshed on this topic, I know just researching for this information I have learned a bit of information.

Thanks for reading.

Drive on RT's

Some are more sensitive than others.

noreply@blogger.com (Djanvk) — Mon, 16 Jun 2008 09:23:00 +0000

Over the years of being a Respiratory Therapist I have learned a few different schools of though on the use of oxygen and how effective it is at different levels.

It has varied from:

100% Nonrebreather to in reality a 70-80% nonrebreather. A lot of nurses actually believe it is really 100% oxygen the NRB is giving.
OWL protocol, or Oxygen With Love. This actually really seemed to work and what it was used for was to decrease the occurrences of retinal detachment in babies in the NICU. The protol was to keep the SPO2 level between 88-92%. We all know that high levels of oxygen can cause retinal detachment in infants, well this protocol actually worked, it decreased the amount of infant that needed eye surgery due retinal detachment from around 60% down to below 20% at the hospital I worked at. So did it work, I think so.
You need a bubbler with oxygen. No you don't, not always. I do give them our for levels over 4 lpm on the nasal cannula IF they are at that level for awhile, or they are getting bloody or burning nares.
All Post-Op patient need 2lpm of O2 for 12hrs after surgery. I think not.
Anything under 2 lpm with a Nasal Cannula is a worthless on a adult.

That last one is a area that I'm dealing with right now. All of the other hospitals that I have worked for we were in the school of thought that under 2 lpm, you might as well just take them off because it doesn't do anything for that patient.

For some reason that has been true so far for me and my patients, until I started here at my current hospital. I recently had 3 different patient who I just couldn't wean off of oxygen. They were a 15 month old, a 60 year old and a 83 year old and they were all on the under 2 lpm levels of oxygen, which seemed to be the kicker.

Now that 15 month old I do understand that pediatric patients do respond to lower levels of oxygen flow, which is why they make a low flow oxygen flowmeter which goes from 0.1 to 1 lpm. This patient had a possible pneumonia but great sounding lung sounds after a day, but we could not get this child off of the 0.1-0.2 lpm of oxygen. She would drop to the mid to low 80's without it and as soon as I put it back on, poof back up to the high 90's.

Then the 60 year old I had. This person was a long term smoker, probably had COPD also so I would assume that this person lived in the low 90s to the high 80s. But what was interesting is that on RA this patient would drop down to 80% so we would put 0.5 lpm O2 on and the sats would jump back up to 97% right away. Seriously 1/2 lpm and the spo2 would jump that high. I was amazed. I had always learned that under 2 lpm was a waste of oxygen and equipment.

Now the last patient, my 83 year old was the same way. I was doing my oxygen rounds and I checked her spo2 on 1 lpm and she was 99% on the 1 liter. Great I though, I can take her off the oxygen, which I did. I then came back in a hour just to make sure that the sats were fine and wow was I shocked. 78% on RA!!!! I'm thinking, "Really no kidding, that 1 liter made that much difference with her!!!". Well it did, I put her back on the 1 liter of O2 and BoooYahhh, it shot right up to 97%. Amazing.

This was in the same night, all three of them had their oxygen issues. This night right here disapproved the idea to me that anything under 2 liters per minute of oxygen is worthless in adults, I was a skeptic but now I think I might be a believer. Even most of the books say a nasal cannula is set between 2-6 lpm and 24-36%. Now 1/2 lpm is 23% according to the formula:

21% + (oxygen liters per minute *3) = fio2.

That there is under the book definition of the nasal cannula, but it seems to do some good. Oh well as long as they are not dying on me and it's that 1 lpm that is keeping them from doing so, I will keep using the lower levels now as needed.

if anyone has any information or web sites about the lower levels of oxygen on adults I would be very interesting in that information, because like I said I have always heard it worthless under 2 lpm, but apparently some patients are more sensitive than others.

Drive on RT's and thanks for reading.

Diagnosing my Grandfather

noreply@blogger.com (Djanvk) — Mon, 16 Jun 2008 07:49:00 +0000

My Grandfather was in the hospital again this last week for a couple of days because of shortness of breath and he has a doctor that seems to just beat around the bush by not giving my grandparents a definite diagnosis. He was told that he did have a blood clot behind that knee that is taking Lovenox for at home, yep my Grandmother is giving his shots in the stomach. I saw her do it today, she does a good job.

The problem my grandparents are having is that this doctor has never given a good distinct diagnosis of what is causing his breathing issues that he has been into the hospital for two times this year and has also been in before, so as a good RT I am going to lay out the facts and give my diagnosis. Maybe a good case study here.

He is 86 years old
Has had 2 heart attacks both with CABG surgery
He smoked for over 50 years, quit about 15-20 years ago
He does a lot of woodwork with lots of sawdust
He gets very SOB when it is hot and humid
Has a productive cough
When SOB he sleeps better sitting up
Breathing treatments do help him
He gets bronchitis fairly often
He is diabetic
He is very active, does woodworking, walks to mow lawn, plays with grand kids

Ok from what I have here I really think that he has a good case for COPD. I understand that there could be some heart issues here, but I would rule out COPD and would like for him to have a PFT test done. There is a good possibility that a corticosteroid would do some good for him and a rescue inhaler.

This particular doctor will not say what this could be. He has said there could be a touch of emphysema, and that the cough is "chronic in nature", but he will not send him for the proper tests to check to see if the lungs have problems. This is driving me nuts. How hard is it to order a PFT testing to be done? Why not send him home with some MDI's. He did send him home with a antibiotic called Avelox that after reading is supposed to be good for upper respiratory infections. This med only takes 4 pills to kick bacterias butt, pretty cool and powerful.

This is added as a late entry, but this doctor also stated to my grandparents that the Sawdust from his hobby has no effect on his lungs as the particle size is to large to get into his lung. Huhh. Yep he said it's gets stuck in the upper airway and that's why there is sawdust in his sputum when he coughs because it is filtered out by the nose and upper airway. Yea ok quack.

Well that's the deal, I really hate this cannot make up my mind mentality of this particular doctor and I'm glad he is not from my hospital.

Let me know what you think.

Cover your workers, don't set them up for failure.

noreply@blogger.com (Djanvk) — Wed, 11 Jun 2008 07:31:00 +0000

My wife as I have said before is a ER nurse at another hospital and she came home the other night just a little bit distraught about something that happened at work where a couple good points or we can say lessons came out that can come into play for all medical professions.

I was night shift and she had a patient who was a child and a very overbearing mother to go along with the child. An I.V. was placed in the patient and it took about 6 nurses and tech's to hold this 8 year old child down who was biting and kicking to get the I.V. done. I.V was finished and blood was drawn.

My wife grabbed the labels off the chart the tech had put on there and labeled the blood tubes and send then to lab. 1o minutes later the lab calls and said they were the wrong labels they were for another patient.

Not good but can be fixed, the patient has a I.V. so we can just draw more. Now lab comes down to draw more blood from the patient and is told to wait a moment so we can get the labels together. Lab does not hold on and goes ahead and throws her fellow workers in front of a truck. This young lab tech goes into the patients room and proceeds to tell the patients mother that the Nurse screwed up the blood and didn't put the correct labels on the tubes.

Good job young lab tech, not mom is irate and comes out of the room into another patients room and starts yelling and dropping the F bomb all over the place to my wife right in front of another patient. Calling her the worst nurse ever, this hospital sucks, I'm taking my child outta here (go ahead), among other colorful things.

Now how could this of been avoided? Of course double checking the labels, yes that is a lesson learned. Also though this lab tech could of easily told the mother that they needed more blood for another test, or that the blood in a tube clotted, anything but YOUR NURSE SCREWED UP, and this could of all be avoided. The patient had a I.V. so there would not be another needle stick at all. Easy fix.

The security was called for a irate parent, the nurse supervisor called the young lab tech and chewed her out and the doctor said nothing was wrong with the patient anyways, plus my wife was upset and said some things to the parent.

What did we learn from this besides checking your labels:

1. Cover the integrity of your fellow employers and the reputation of the hospital if it is possible.
2. Do not set people up for failure, help each other out and things run smoother for everyone.

It's easy, just use you brain and common sense.

Thanks for reading, Drive on RT's.

The PediaRTritian is born

noreply@blogger.com (Djanvk) — Wed, 11 Jun 2008 06:00:00 +0000

Pediatrics are an interesting bunch, sometimes they receive treatments like adults and others times they are treated totally differently. Either way we all know pediatric patients do cause some nervousness with certain people.

I like to think that I have quite a bit of experience with pediatric patients. Lets see I worked in a level 3 NICU which I was also on the neonatal transport team where a RN and RT would fly or drive babies born with problems, normally respiratory problems. I have also worked in a Pediatric ICU along with different peds units. On top of all of that I also have 4, yes I said 4 kids at home. I've been around the peds population a bit.

So you ask where am I going with this? Well it has to do with the small town hospital I work at currently. Now this is a small town hospital that really doesn't get a lot of pediatric patients at all.

It is that time of the year for evaluations and I was called into the supervisor's office to do a little evaluating of me for the past year which I had just started working at this hospital. So I'm going through the Blah Blah Blah, your doing fine, Blah Blah Blah, what can you improve on, etc etc and this comes out.

Supervisor - "A RN wrote you up some months ago about not feeling comfortable with you as the RT of a peds patient, but was comfortable with your other night shift cohort."

Look on my face: WTF? I do remember this patient.

Me - "How so, I took great care of this patient."

Super - "Well this was a new nurse and she said that you didn't help her very much."

Me - "Help her with what, I did my RT stuff and the patient was in no distress."

Super - "She was just new and nervous and wished that your were more around to help her be comfortable with a respiratory peds patient."

Me - "Really? But isn't she a nurse who went through school? I'm not sure I understand what she was getting at, but I guess where I come from there are nurses who are pediatric nurses."

OK so after chatting a little while it basically came down to the supervisor, who is also the floor's supervisor, letting me know she want's us more involved in the care of peds patients with respiratory problems. Just help our more because the RN's don't get a lot of peds patients and get a little nervous around them.

Correct me if I'm wrong but do we not get the same amount of respiratory peds patients as the RN's do as inpatients? Granted I probably have more experience that most of the nurses on that floor with peds but still, what more can I do besides educate those RN's who are not comfortable with respiratory issues, I will not sit there and hold their hand. I guess I just don't quite get it.

Once again another added responsibility of what the RT can do is added to the list, the PediaRTritian is born. Tonight it also just so happens that there is a peds patient on the floor for us to see and besides just doing my nebs and RT stuff, I am stopping down about every 2 hours to check with the RN to see how she thinks the baby is doing, what else can I do. This just frustrated me a bit that I was told that a nurse wasn't comfortable with me and now we are wanted to be MORE involved with peds patients, but I am not going out of my scope of practice.

Now that RN who wrote me up, well she quit soon after that because that peds patient stressed her out to much and took a job at a clinic where she doesn't deal with peds patient. Now was it me or just a new RN freaking out a little to much and not being comfortable with her own training. I've also been informed that there are RN's here who flat our refuse to take peds patients even to the point of calling off work if there is that possiblity. Amazing.

Pretty soon RT's will run the hospitals.

Keep it up RT's and drive on.

Kids Site about the Human Body

noreply@blogger.com (Djanvk) — Mon, 02 Jun 2008 08:07:00 +0000

The picture on my last post came from this site:

http://www.thehumanbody.ecsd.net/

It's a site made from a 2nd grade class and here's is what it says it's about:

The Human Body

A Telecollaborative Project for St. Mary's Grade 2 Class with Mrs. Vaage and Mrs. Nugent

I though it was a pretty neat site, there is a gallery of pictures of the human body drawn by the kids and in there are little articles about the different body parts written by the kids.

Fun little site I thought I would share.

Nebulizers or MDI's inline with a Ventilator?

noreply@blogger.com (Djanvk) — Mon, 02 Jun 2008 06:40:00 +0000

Here at my hospital we seem to go through streaks of how we give medication to patients on ventilators. For a couple of months we might use MDI's and then we might just switch over to Nebulizers inline for a couple of months, and it is normally the same doctor who will oversee these patients on vents, it would be our pulmonologist who does it.

Tonight I just came back from being off for 2 days and we now have 3 ventilators running and all three of them are getting nebulized medications. One of the vent patients used to be getting MDI treatments but has now been switched over to nebulizer treatments. So I got to thinking which is better? Could this just be because he has Xopenex ordered as one of the medications along with Atrovent? Shouldn't be the reason we carry these by MDI also I have heard, even though I have yet to see a Xopenex MDI here at this hospital.

Doing some reading online and my own personal experience I have found different pro's and con's of using either a nebulizer or MDI with a ventilated patient, this is what I'm going to try and share with everyone, and I am looking forward to any opinions you might have for either side.

Metered Dose Inhalers Inline with a Ventilator

MDI's have to be perfectly timed with a vent cycle
MDI's give better deposition
You need more puffs from the MDI to get a regular dose to a patient due to the moisture in the ETT that will cause the medication to stick to the ETT or inspiratory limb of the vent circuit. I have seen anywhere from 4 to 24 puffs given at any one time.
MDI's treatments are faster than nebs.
Need to give a pause after the breath otherwise the majority of the medication could possible go out the exhalation limb.
You have to push the MDI right after the inhalation cycle starts or if your to early a lot of the medication goes out the exhalation side, you can actually watch this.

Nebulized medications Inline with a Ventilator

Becomes a vapor like the humidification
Do Not have to time with the ventilation cycle
Same dose as you would use with a non ventilated patient
Does take longer
Does increase measured exhaled tidal volume and minute volume
decreases the trigger sensitivity of the pressure supported breaths due to higher flow making a bigger negative pressure necessary, increasing he work of breathing in the patient
may cause problems with the internal ventilator components due to the medication sticking to the components
should possibly use a extra expiratory filter and maybe a inspiratory filter to protect the ventilator

Those are just some quick little notes of interest I have come across in my researching information for this article along with information I have learned as my time of being a RT.

Some more information I have learned about the placement of the nebulizer and MDI's when you give the treatments I have found and some I have known or used in the past.

When giving a MDI through a ventilator you should put the MDI inline as close to the wye as possible and up to 6 inches behind the wye. Always give the puff timed with a inhalation cycle or it will go down the exhalation side and not to the patient.

With the nebulizer inline I was really curious about the best way to place the nebulizer inline as to get the best treatment and from what I found which was the consensus was to put the nebulizer as far back from the wye on the inspiratory side as possible. Some even will put it behind the humidifier as they found that the aerosol of the nebulizer will mix with the humidified water aerosol, which are basically both the same. The reason it is said to place it farther back is so the inspiratory limb on exhalation will fill up with the nebulized medication aerosol and on inhalation there is a larger concentration of medication given to the patient. There is also the old law that says a gas will go towards the area with the least resistance, so if its closer to the wye the exhalation flow will be the area of least resistance due to the flow and there is a entrainment aspect to that side of the tubing also. Which makes sense to me.

I now after reading am more partial towards the use of nebulizers inline with a vent than MDI's at this time. I also will be moving my nebulizers farther back from the wye, which I will do here in about a hour's time. I lot of my questions were answered by doing some research and I hope I might of given you some more information that you never really knew.

One more thing, DON'T Forget to remove the HME before you give a treatment!!!

Drive on RT's

Pixie Dust...What can it do for us?

noreply@blogger.com (Djanvk) — Thu, 29 May 2008 09:33:00 +0000

There is a article at CNN.com about some stuff coined "Pixie Dust" which is being experimented with on soldiers who have a amputated body part like fingers, arms, legs or toes but not heads. This is being trialed at Brooke Army Medical Center (BAMC) in San Antonio Texas where I took my Respiratory Training.

You can read the article here: Pixie Dust

This pixie dust is supposed to give the body a salamander effect and trick the body into regenerating the missing body part. The powder forms a microscopic "scaffold" that attracts stem cells and convinces them to grow into the tissue that used to be there.

"If it is next to the skin, it will start making skin. If it's next to a tendon, it will start making a tendon, and so that's the hope, at least in this particular project, that we can grow a finger," Wolf said.

This is pretty interesting, how could this help our profession? Could this "pixie dust" help regenerate lungs destroyed by smoking, improving quality of life for COPD patients? Could it help people exposed to substances cause them to get fibrosis?

Interesting to say the least and I will keep a look out in for how it turns our for humans and for the soldier in the article. Hope it works.

Protocols Do Work.

noreply@blogger.com (Djanvk) — Thu, 29 May 2008 07:55:00 +0000

Today I had to come into work early due to the requirement of the monthly Staff Meeting. Ohh what fun, but I did actually gain some information this time that I thought was pretty interesting.

If you have read one of my earliest posts I talked about a Therapist Driven protocol that we had implemented at my little hospital about 7 months ago. This protocol had to do with us the RT's assessing patient and then being able to adjust nebulizer, MDI and Oxygen therapy's as we deemed needed. Well we are now done with the testing phase of the implementation of our therapist driven protocol and a letter from our director is out to the doctors with surveys to see if we continue with this type of therapy.

There are some statistics that we pretty interesting that were compared from this 6 months of the protocols being in use and the 6 months prior to the protocols being in use. These stats were pretty interesting and pointed in favor of using these protocols and making them law. The only areas of care that were talked about were patients with Pneumonia and COPD issues.

Hospital staylLengths for Pneumonia and COPD decreased by 1 day in both areas. So we were able to adjust treatments for the patients and decrease their length of time in the hospital.

Now here is what I though was pretty amazing in the financial aspect.

In patients with a Pneumonia the cost of Respiratory Therapy given to the patient was DECREASED by 23% with the protocol in use. We saved the hospital 23% per patient on average if they had pneumonia.

And

Patients in with a COPD issue the cost of Respiratory Therapy given to the patient was DECREASED a whopping 36% with the protocol in use. Here we saved the hospital 36% per patient on average if they were in for COPD.

These facts speak strongly for the use of Therapist driven protocols and that we might actually know what we are doing.

During this meeting I did get into a disagreement with the director and supervisor about how we should for the first 24 hours do the treatment exactly how the doctor ordered it due out of respect to the doctor so they don't think we are just saying they don't know what they are doing.

Whats the point of doing the protocol assessments in the first 24 hours if we are not going to change anything? The doctors signed off on the protocols, so we have a right to use them as needed, otherwise you need to change what the protocol says.

I think I stunned the director when I said "So basically you two want us to suck up to the doctor's so they don't feel bad?" They said no it's a teamwork thing.

I don't know I feel as though if we don't use the protocol as written the doctor's might get the impression that we are skeptical on our abilities as therapist to assess our patients and choose the right treatments.

Fortunately I have a couple of other therapist who agreed with me and backed me up in my thoughts. Good to know I wasn't alone in my thoughts. So this was to be a unwritten rule that I'm not so sure people will follow. I for one will keep doing it as I have been and that's by the book on how the protocol was written up. Can't get into trouble for that.

Statistics show that we must be doing something right, and there are no complaint's about how we have done our assessments so far. Hopefully the doctors do really see it that way and the surveys come back in good shape, then we can make this law and continue on.

Drive on RT's

Stop and put you hand on that person.

noreply@blogger.com (Djanvk) — Sun, 25 May 2008 10:21:00 +0000

I'm coming up on my re certification of my CPR card very soon and I was looking around on the guidelines at the American Heart Association to see if there are any new changes, and wow did I see something different:

Hands Only CPR.

There are only 2 Steps to save a person's life:

1) Call 911
2) Push hard and fast in the center of the chest.

So I started looking around a little bit and from what I understand is that this simplifies the process for the standard layperson. Just make a phone call and press that chest.

This is just for a adult who was witnessed collapsing not someone who possibly has been down for awhile or a drowning victim. So basically if you see someone collapse just start pressing that chest. Easy right.

One of the big things I see this helping is the though of most people that they don't want to put their mouth on a strangers mouth for fear of disease, this is understandable and this technique removes that problem. Also this is a very simple process so the person who is going to do CPR doesn't have to worry about not remembering the proper steps to do CPR. These 2 factors could possibly help a person faster than before because now maybe people will be quicker to react and not hesitate because fear of doing this wrong or getting their mouth on a strangers mouth, unless of course it is some Hot person you would want to put your mouth on.

Back to the topic at hand. Of course is this is the full standard now there would really be no need for a CPR class because it would take like 2 minutes to teach, so no this isn't all there is anymore you still need to learn the regular way for if you find someone down and not sure how long they were down. This also isn't for the pediatric population only for Adults witnessed collapsing.

Hopefully this isn't old news to everyone but I found it interesting, now to sign up for my CPR class and get this over with.

Drive on RT's.