The Calm Before the Storm

Only 2 patients tonight, one a Q4 and one a Q2, yep nice and quiet. This actually give me 2 more nebulizer treatments I have to do than the last shift I worked, of course the Q2 isn’t as bad as this person is thought to be, but no protocol is wanted on him so I kind of feel bad waking this patient up and taking loudly just to keep him awake and deep breathing. So ok he is wheezing and sats do drop without O2 so there is a need for something.

Wow ER just paged for a EKG….
Turns out nothing exciting, patient just left 10 days ago and has a Doctor appointment tomorrow oh and yep EKG was fine, doc says it’s probably musculoskeletal pain, now get out of here and go home.

There has been some lazy shifts lately for my old RT department but isn’t that how this job goes the patient load ebbs and flows like the tide. Feast or famine, you either run all night or you might sit all night and chat with the nurses or better yet blog about it.

Over my time in the profession I have noticed some trends of things where the patient load with increase or decrease and most of these have been fairly consistent, I’ll try and lay them out and explain the idea behind these times.

Things that cause patient load to INCREASE or decrease:

• Summertime causes a decrease due to it being nice outside, and who wants to be stuck in a hospital when it’s nice outside so more people come in for injuries than breathing.


• Exception to summertime is when humidity is high there is a increase, bring in the COPD’ers.


• Wintertime there is a major increase, it’s cold outside and there are more sicknesses, cold air can set off a asthma attack, RSV is back along with croup.


• The night of or day after Thanksgiving there is a increase. Why you ask? Here you will see a large amount of Congestive Heart Failure patients because of the large amount of food people eat with a large amount of SALT which cause fluid retention.


• Christmas and Easter see directly above. Same thing with the CHF.


• Holidays in general you will see a surge of Frequent Fliers. Now these are mainly nursing home frequent fliers who want attention from the family during the holidays so on comes the sickness. I have seen this and could pretty much track it, when the holiday came so did these people.


• A Full Moon. I don’t care what anyone says but a full moon always brings in more people, superstition or not. I have also read that the closer the moon is to the earth there is a larger gravitational pull on fluids which can affect fluid retainers.


• After the Super Bowl. The excitement of the game, the drinking, and the major one is the eating. Here you will get asthma attacks, CHF, and chest pains. Mainly this is evident in the ER but it’s true.

Well these are the major ones I have noticed but of course there are other trends for different places in the hospital like the ER, for example the weekend magic hour is about 02:30 am, this would be the end of bar time….let the drunks get hurt and sick. Never know whats going to happen at any given time in the world of health care but some things just seem to fall into place.

I would like to hear any other trends that people have figured out, I’m sure there are more.

Drive on RT’s

Attck Asthma Before It Attacks

Picture this scenario: One day, your child is running around happily and then he started coughing and breathing heavily by bed time. He may have trouble breathing during the night or may wake up coughing periodically. After a restless night, he may be cranky in the morning. If this ever happens, it may be signs of asthma.

Dr. Wasu Kamchaisatian, a specialist in pediatric allergy and immunology at Samitivej Srinakarin Hospital advised us that asthma is a type of allergy that occurs in the lower respiratory tracts which begin from the trachea all the way to the bronchioles. Children of all ages and gender can develop asthma, which although is not a contagious disease, can be hereditary. Furthermore, people who never had asthma can develop symptoms if they are in the wrong environment.

Asthma can be brought on by changes in the environment such as climate changes. The cold temperature in an air-conditioned room does not increase the risk of asthma, but if the air filter is not regularly cleaned, there may be spores or dusts that can provoke and asthma attack. Stimulants of asthma include house dusts, cockroaches, dandruffs from dogs and cats, pollens, or fungi from around the house. Because the lower respiratory tracts in people with asthma are susceptible to contraction when stimulated, exercise no matter how much or just a bit, can cause an onset.

Other than coughing, other signs of asthma include chest pain, trouble breathing, or wheezing. To be cautious, watch for these signs in both children and adults alike. If you notice that someone is coughing all night and has other signs of allergy, it may be that he/she is suffering from acute asthma attack. An inhaler can be used to relief the symptom. However, if a child has never used an inhaler before, he/she should be taken to the hospital immediately to avoid acute asthma attack, which may lead to lack of oxygen and respiratory failure.

Epidemiological studies in Thailand since 1985 have shown that the prevalence of asthma increased from 5% to 15% in the past 10 years, especially in the Bangkok area. Asthma and respiratory infection can be quite similar in symptom, although the pathology is different. To confirm the diagnosis of asthma, if there is no family history, a lung function test may be performed to measure the lung capacity. Another good indication is the effectiveness of an inhaler.

Dr. Wasu explained that because asthma is brought on by inflammation of the lung passages, the use of steroid-containing inhalers will help widenthese passages. If they are used properly, patients can safely use them without any side-effects and they are more effective than taking leukotrienes, which is an alternative choice for patients who cannot use inhalers.

Although asthma is a chronic disease, it can be controlled if treated properly. Untreated asthma can lead to decreased lung function and chronic bronchitis. Dr. Wasu recommended that children should get flu shots to prevent asthma attack as well.