MRI naps

The subject today is MRI. I have a few problems with MRIs.

1. Why does it take so damn long?
I guess I just got used to instant results. I love being able to run my own ABGs. I love seeing the change in peak pressure when I put someone in PRVC. I love the sound a patient makes when I do a sternal rub. I'm a instant results kind of guy. I do not love setting in a wheelchair for over an hour trying to find a dance-able beat to the loud MRI machine. Don't get me wrong. I am glad that Downhill Medical Center has the facilities to give the MD exactly the picture they want, I just wish that I didn't have to set in there while it is happening. My ADHD does not approve of me staying in one place for that long. Hell, my ADHD barely allows me to sleep. TGFB!

2. Why is it so damn loud?
I drive a economy car. It gets 35 mpg. It cost $7,500 slightly used about a year ago. It has a muffler. By contrast, according to Wikipedia (it must be true!) "New 1.5 Tesla scanners often cost between $1,000,000 USD and $1,500,000 USD. New 3.0 Tesla scanners often cost between $2,000,000 and $2,300,000 USD." So what? Can't they put an muffler on it. Come to think of it the tech looked like Vin Diesel. Maybe he put one of those "fast and furious" exhaust systems on it. Which brings us back to # 1. Seriously, my ADHD was screaming.

3. Why do I always lose my pen?
When I empty my pockets some shit-bird always steals my pen. At least they leave my wallet.

On to more important things. I've been trying to come up with interesting ways to squeeze the bag during the MRI. I've tried the right handed and left handed power pump and the amazing two handed human ventilator. After my hands tired I did the funky chicken with the bag under each arm. When my wings gave out I tried the official Suzanne Somers thigh master technique. I was just getting bored enough to start the stomp the ambu bag when the door swung open and Vin told me I didn't have to go to ICU but I couldn't stay there.

It could have been worse. There's nothing like a good MRI nap. One hour where you don't have to do anything but breathe for one patient. Your mind tends to wander and you find yourself coming up with stupid names for your bagging technique.

I take it all back, I love MRIs.

RT

Protocols

Who's got them? I know that as a fledgling therapist I have come into the business at a time when the protocols are already written. The old-schoolers have fought for the respect needed to allow us to change Granny's nebs to while awake so we don't have to wake up a sleeping COPDer. They bravely stood up to the docs and said,"We can be trusted not to mess it up too badly!" So what have us kids done?

What I mean is this. I work in a hospital with world class protocols. I can order or change any respiratory med. Unless the doc opts out I can change orders for CPT. If I get called to a patient's room I can can stick them for a ABG, start a neb, order a chest X-ray, interpret the film and blood and call the doc with my recommendations. Many times my recommendations are for lasix, narcan or ativan.

Where is the push to open up our protocols further? Respiratory therapists are able to give these and many other meds. We are able to decompress tension pneumos and insert emergency cricothyrotomies. In fact RTs in my state working in transport can do some pretty amazing things including intraosseous placement and ej placement. They advance the practice of respiratory care.

This is your call to arms. What can you do to advance the practice of respiratory care? How can you prove to the docs that we can't screw it up too bad. If for no other reason do it to piss off that really lazy guy in your department. He'll get called that much more often.

Back by popular demand

Well...one person mentioned me briefly. I promise to try for at least a weekly post in the future.

I've been settling into my job at Downhill Medical Center and Resort for the Undead. It's been a transition that I wasn't ready for.

Don't get me wrong, I love the autonomy that we have here. My problem is that we have a large university medical center down the road from us. So while they get all of the stabbings, shootings, MVAs, ecmo babies, blunt force trauma, general trauma, heart transplants and "Hey ya'll, watch this" stunts we get the leftovers. I would say that octogenerians, ODs and belly surgeries gone horribly arwy makes up 80% of our vent business. In fact, it's so bad we have a long-term care facility within our hospital so they don't have to take a long bumpy ambulance ride to the vent farm.

I am by no means complaining. I love my job and wouldn't trade it. However there are times when I would love to see a good trauma roll in the door. You don't know what you will miss until you give it up.

Respiratory Terrorist

People love me here, even though I can be an asshole.

Hard to sleep

I promise this is mostly related to the practice of respiratory care, and here's how.

Respiratory care also encompasses sleep medicine.

A diagnosis that may be arrived at during a sleep study is Restless Leg Syndrome.

RLS may be treated by Mirapex .

Mirapex may cause uncontrollable urges to gamble and have sex.

So I was delivering quality respiratory care the other night when a commercial for Mirapex came on. I was checking my vent and only half paying attention to what was on the TV. My attention was caught by a voice saying something to the effect of "... talk to your doctor if you have uncontrollable urges to gamble or have intercourse..."

HUH? I asked my patient, "Did that say what I think it said?"

Damn Diprivan.

So two days later I'm setting on the couch with my lovely wife speaking of things of great consequence. On pops the Mirapex commercial. I quickly hush her (bad idea) and intently watch the commercial. There it is! They actually said that this drug may cause increased urges for sex. Now, having just hushed my wife (and knowing I could look forward to a dry spell) I was wondering how I could make this information work for me.

Upon further research, I found that there is a class action lawsuit (big surprise) to benefit the people who have been hurt by Mirapex. I also found that this medication could cause sleeplessness. I guess so. If you're up all night tending to your pleasure/reward-seeking activities there is little time for sleep. Obsessive eating, gambling, shopping, and scrogging are not condusive to a restful night's sleep. I feel that I personally have been caused emotional distress by them and would be happy to settle out of court for free samples. I wonder if they will dissolve in my wife's next cocktail? Bwhahahaha.

RT

Bodies

So Body Works is in my town and I really want to go see it. I really think it would be interesting to see the human body in this way. My wife on the other hand thinks it's morbid and defiantly something she can miss. Now, in the course of my short professional life I've seen most of the important internal organs right up close. Why would I want to see more dead people? It's like a CPA going home and doing their taxes. What do you think doing these jobs do to us. Does it desensitize us to the point where we can say, "It's just another dead body?" What does that say for humans, or individuals? Sorry I'm being like this, I almost got in a fight today and that always makes me wax philosophical.

http://www.bodyworlds.com/en.html

RT

Rare gas

I must have worked at a small hospital too long. Tonight we have a patient on Heliox. It is so sweet. I've really enjoyed doing a couple of his checks because I like hearing him talk like Donald Duck. I know, It doesn't take much to get me excited. Otherwise it's a pretty slow night. I'm enjoying it because I know that soon we will have a multitude of sick people and not enough employees. If anyone wants a job let me know.

RT

My own personal Jesus

So I was attending a code the other night and had to run a ABG to the blood gas lab because the tube system was down. Of course I was on the 43rd floor (OK...a slight exaggeration) and had to walk 3 miles to the lab (not an exaggeration). I, being new, chose the worst possible route to my destination. As I walked through the front lobby I was accosted by two young men in ties. With a maniacal look in their eyes they asked if I had accepted Jesus as my own personal savior.

With Depeche Mode running through my head I told them I was in a little bit of a hurry and would have to get back to them with my answer. Still barring my way they proceeded to tell me that there was nothing more important than my everlasting soul. Smiling, I told them that there is a dead person whom I am trying to help resurrect who may wish to respectfully disagree. Further, I added, unless they had a personal invite to pass out their pretty little phamplets I suggested they leave. For as soon as I could tear myself from them I would be calling security. They parted like the Red Sea and I proceeded to the lab, ran the blood, and called the results. I then went through the lobby to see if I would need to make good to call the people with the badges and mace. Thankfully, they had made like the Ark of the Covenant and disappeared.

Now, what I don't understand is why these young men had been sent to the hospital. We have clinical clergy who are more than capable of handling the spiritual needs of our patients. If they need something that cannot be provided the people's own religious leader is welcome at the hospital. I find it hard to believe that anyone in their right mind would have their young people go out into a medical center and hand out propaganda at 9:30pm. The only thing my cynical mind can come up with is either these kids had their religions mixed up and thought they were racking up virgins, or they came from a poor church that was trying to bring in some tithes to pad their coffers.

At different times of the day there are different types of visitors in the hospital. During the day there are the elderly who come to visit their friends and bogart the coffee. There are the kids who are dragged there to Aunt Jane one last time. There are the adult children who haven't visited their parents in the nursing home for six months and then charge into the hospital demanding the moon. However, as the clock comes closer to straight up in the dark the people become desperate. Lack of sleep coupled with a very sick loved one makes people unable to cope with even the most basic decisions. I've seen visitors turn circles over and over trying to decided if they want vanilla or chocolate pudding in the cafe. The last thing they need is someone giving them a little piece of paper that tells them that unless they recite a silly little prayer right now they are in real danger of going to hell.

I guess my past life has made me consider these people predatory. I've never been a big fan of organized religion and this is why. If these people want to do some good why don't they go to a skilled nursing facility to minister to the elderly who would love to have visitors who had something uplifting to say. I'll tell you why. Their god is all about the Benjamens.

RT

P.S. OK...I'm just pissed that I had to listen to "Personal Jesus" in my head all night. Damn, I think I'll be listening to it again tonight.