With apologies to the list, I would like to cross-post a message from
a Respiratory Therapist regarding a patient she currently has.
I would be interested in reading the opinions of the members of this
list on this patient's symptoms as well as treatment.
The issue is one of a deteriorating three year old male into his
fourth day of treatment. Physician does not want the child transferred.
Hello to everyone, I am fairly new to the list here and have learned much
from just lurking! I work in a small 66 bed hosp. in Minnesota.
We probably have 1 to 3 vent patients per month....Yes I said per month.
Our dept. has only 4 therapists and 1 casual pool. Mon. thru Fri. we staff
from 0700 to 2130...Sat and Sun from 0700 to 1530, with call the remaining
hours each day. Weekends we fly solo...1 therapist taking the 0700 to 1530
and the call from Fri thru Mon AM.
This is probably most of the time not too much of a problem, but this year
we (like everyone) have been hit really hard w/pneumonia and RSV. We have
had illness within our small staff, a tremendous overload of pts and
Tx's.....practically no help from the temp agency etc....we are all getting
Today was a particularly frustrating day. We got this little guy, just 3 in
on Mar. 11. He was a RML pneumonia..RSV +. When admitted we kind of all
thought that this would be a 24 hr. admission...he would occasionally desat
to 88% on RA but would cough and bounce right up to 98%. Ordered on
admission were Mist Tent w/40% O2, SVN w/ Albuterol q4, Zithromax etc..
Well to make a long story short the little guy was still there today (Mar.
14) when I came into work.
He is now in a 50% O2 MT, Is getting IV steroids, Rocephin, etc...His O2 is
only keeping his sats --tops 92....with him hanging out most of the time at
85%......When he comes out of the tent with a cannula, he goes down to
78-79% within a minute.
The pediatrician was consulted and she ordered a 2hr cont. neb. with CPT
q1/2hr x4 ....after the cont neb was done she ordered the nebs q1hr w/CPT
following. This was rather disturbing to me as we are such a small hosp.
certainly not set up with a peds intesive care. I tried to suggest that she
think of a transfer..to which she replied that he was not that sick...we
were just letting him lay too much. This is a quote.
I then explained that I was the only staff on to perform these tasks and
that I did not feel really comfortable starting the continuous neb without
more staff as back up....I could get called out for a code...and did not
feel comfortable leaving him with just the ICU staff as they were not set up
to one on one with him either.
I will finally cut to the chase and say that she told me that I needn't be
in the room the entire time...that the mother could hold the neb... and
restated the fact that she did not believe he was that ill.
I was a nervous wreck....and I did get called in on a code...but did not
leave the mom holding the neb.. :) That really would have gone WAY
beyond my comfort zone. So with the nurses nods of approval we shut him
down...and I left and came back in a half hour when done.
I really hated my job today. Something that I never thought I would say.
With his sats trending down and his pulse trending up....etc. etc. etc.
Today I was not a partner on this case....I was merely there to put
albuterol in the neb cup crank the flowmeter and right down the
numbers.....Anyone care to comment?? Thanks for letting me vent..I hope
that this hasn't been an improper use of this mailing list..If so,let me
Cross posted by
James S Cowan RRT
[log in to unmask]
For more information, send mail to [log in to unmask] with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is: