Wednesday, December 24, 2008

Category: Physical Assessment - BUNCHING

Pediatric Stridor - Potential site of origin
  • Inspiration Only - More likely above the vocal folds
  • Inspiraton & Expiration - More likely involving the vocal folds
  • Expiration Only - More likely below the vocal folds

Monday, December 15, 2008

Category: Smart phone and PDA - TECHNOLOGY

In addition to ePocrates being an excellent clinical PDA program their free online resources are an excellent tool for keeping important facts at your fingertips when you have web access.

Just enter a disease or drug name and click go.

Tuesday, December 9, 2008

Category: Smart phone and PDA - TECHNOLOGY

Author Dana Oakes has published the quick reference pocket guides for over twenty-five years. Their accuracy, professionalism, and affordability have made these books the standard in portable respiratory care texts. Titles include the Clinical Practitioner’s Pocket Guide to Respiratory Care (the famous “Blue Book”) and many others. These books are now also available for smart phones and PDA (only in a Windows Mobile version) further expanding their use at the bedside and lightening up our bulging lab coat pockets.

Category: H and P - BUNCHING

Sunday, December 7, 2008

Category: Smart phone and PDA - TECHNOLOGY

Introduction -Medical calculators on smart phones and PDA save time and help prevent calculation errors. Useful physiologic calculations are more readilyused if you do not need to rely on only your less than perfect memory.
There are many options but at this time Medcalc is my go-to calculator .
MedCalc runs on Palm OS and Windows Mobile handheld devices. It is designed for rapid calculation of common medical formulas and scores used in anesthesiology, pediatrics, emergency, intensive care and internal medicine.

Features -
  • free and easy to use
  • comprehensive (>80 formulas, see complete list)
  • formulas sorted by categories
  • units available either in S.I. or local units (defaults can be set for each item)
  • most formulas come with bibliographic references and clinical tips
  • results can be saved for later retrieval (Palm OS only)
System requirements -A Palm OS compatible device running Palm OS 3.1 or later Windows Mobile 2003 or later .

Category: Physical Assessment - ACRONYM

Category: H and P - ACRONYM

Physical assessment of the lungs and thorax can help us determine & evaluate 5 primary findings.

Category: Smart phone and PDA - TECHNOLOGY

Three Free PDA (personal digital assistant) and Smart Phone Clinical References for both Palm OS or Microsoft Mobile.
If you already own a smart phone or PDA with a memory card, why not consider loading clinical references into your device. Having a clinical library in your pocket is like expanding your own memory.

ePocrates Rx
ePocrates Rx is a Peer-reviewed drug information resource. It is not quite like carrying the PDR around in your lab coat pocket but it is close. This is the free component of an extensive & comprehensive clinical suite available for the PDA. ePocrates Mobile CME and MedTools are also free resources. It is a relatively large program, but it worth the memory it eats up. It looks for updates whenever you sync your device keeping the reference up to date.

Merck Medicus
That’s right, a free Merck manual. MerckMedicus also provides an integrated set of useful medical resources for your PDA. Not as slick as some of the purchased comprehensive references and a bit heavy on memory use but definitely worth it.

MeisterMed and The Medical iSiloTM Depot
MeisterMed has a collection of freeware and commercial products that are designed for the iSilo document reader such as the AsthmaMeister. There is also an extensive collection of free medical iSilo documents on the web. The iSilo document reader trial is free and the full license is very reasonable.

Because of the enormous amount of information needed by Respiratory Care Practitioners during patient care and the increasing demand for that information at the bedside a technologic expansion of your memory can be a real asset.

Category: Sets of 3 and Memory- BUNCHING

BUNCHING - Triads/Triplets. The classic children stories: The Three Little Pigs, The Three Bears, and Three Blind Mice (and many more) have something obvious in common. The authors of these classic children’s stories knew something important about the nature of human memory. People have an easier time remembering things in sets of three. Clinical instruction in sets of 3 increases the likelihood that our already overwhelmed patients (and students) can remember and use these techniques.

Saturday, December 6, 2008

Category: Secretion Mobilization (cough) - BUNCHING

Clinical instruction in sets of 3 increases the likelihood that our already overwhelmed patients can remember and use these techniques. The System of, 3 breaths with breath-holds followed by the 3 coughs after the 3rd breath-hold will be utilized as our primary framework of instruction.
Prior to all directed cough maneuvers the patient is instructed in slow deep diaphragmatic breathing and breath hold. These slow deep breaths with sustained inspiration are used both in preparation for the maneuvers and between sets of cough instruction. These controlled breaths are directed at re-expanding lung, introducing air behind retained secretions, and helping the patient reduce dyspnea and the tendency toward convulsive cough. All 3 of these effects are more likely accomplished if the deep breaths are accompanied by a breath hold.

1) Step One - PreparationBoth of the basic directed cough maneuvers I will describe are always preceded by the same initial instruction. Coach the patient to take their first slow moderately deep breath. Say slowly and out loud for the patient, “hold it, hold it, hold it” in a fashion that results in at least at three second breath hold. (Another set of 3) Encourage the patient to exhale normally. The patient is instructed to take second somewhat deeper breath and again coached to, “hold it, hold it, hold it”, encouraging a slightly longer breath hold. Encourage the patient to exhale normally. For the 3rd and concluding breath the patient is encouraged to inhale to near maximum and couched again to, “hold it, hold it, hold it”, while preparing the patient to perform one of the secretion clearance methods below.

2) Step Two - The Three Step CoughAfter the 3rd deep breath and breath-hold instruct the patient produce 3 small coughs from the same deep inspiration. Immediately have the patient inhale again to near maximal inspiration and coach them one again to, “hold it, hold it, hold it”, and then encourage 3 slightly more vigorous coughs from the same held breath. And finally, encourage the patient one final time to inhale maximally and to, “hold it, hold it, hold it”, and produce 3 final vigorous coughs from the final breath-hold. The patient is then encouraged to return to slow moderately deep diaphragmatic breathing with a periodic breath hold. Additional instruction, performance and return demonstration can be repeated as appropriate. As compared a traditional single step cough, this system increases the patient’s control of their cough and decreases incisional pain. This technique would be most suitable for patient’s you do not suspect of airway collapse associated with cough and with minimal suspicion of mucus plugging.

If any time during the directed cough the patient begins to lose control of their cough immediately instruct the patient to take a somewhat deep breath (not maximal) and help them control the breath by instructing them to “hold it, hold it, hold it”. A primary trigger of paroxysmal coughing is an uncontrolled coughing to full exhalation. Avoiding this full cough exhalation by encouraging a moderately deep inspiration and breath hold can help many patients control the paroxysmal cough tendency.

As always, as mentioned above, return the patient to slow deep diaphragmatic breathing and breath hold between sets of cough maneuvers.

3) Step Three – The Alternative of Three Step HuffingThis alternative technique is potentially most useful in patients where you may be concerned with airway closure during cough. The identical preparation and sequence is used but the typical closed glottis cough is replaced buy the open glottis forced expiratory technique. Rather than the 3 sets of increasing vigorous 3 step coughs, the patient is instructed in the performance of 3 sets of increasing vigorous 3 step “huffs”. The huff technique is performed nearly identically to the above mentioned three-step cough with an open glottis “Huff” replacing the typical closed glottis cough.

Huff maneuvers (forced expiratory technique) have been traditionally considered a method of mobilizing secretions without generation high expiratory flows and its accompanying airway collapse with patients with less patent airways.
Coaching of directed cough by the practitioner must still be aimed at optimizing the individual components of airway clearance as discussed in the related training but it must always be reinforced in such a manner as to not overwhelm the patient.

Thursday, December 4, 2008

Category: H and P - ACRONYM

Category: Quiting Smoking - ACRONYM

Prepare a strategy based on your 4 “W”s and R.A.C.E.
  • R emove yourself from situations that trigger your need to smoke.
  • A lter your schedule and environment to not center around smoking.
  • C ontain the urge. Remember the urge to smoke “just that one” will pass whether you smoke or not.
  • E mploy techniques that reduce the urge. e.g. Take a deep breath and hold it, suck on a mint, stretch or take a quick walk, visualize the poisonous effects of smoking on your body.

Category: Quiting Smoking - ACRONYM

Become conscious of your habit – Plan ahead
As a smoker:
  • When did you smoke? e.g. Morning, Meals, Breaks.
  • Where did you smoke? e.g. Home, Car, Work.
  • Who did you smoke with? e.g. Alone, Friends, Co-worker.
  • Why did you smoke? e.g. Nervous, Relaxation, Habit.
  • What were your 3 most notable daily cigarettes?
Be ready to change your behavior or avoid your smoking triggers.

Wednesday, December 3, 2008

Category: H and P - ACRONYM

Memory tools for Respiratory K.I.S.S. in this Blog:

  • BUNCHING or CHUNKING - To make it easier to remember a long list of almost anything, break the list into small and manageable groups, or "chunks." (Often in sets of 3, Triads/ Triplets)
  • ACRONYMS - You form acronyms by using each first letter from a group of words to form a new word. This is particularly useful when remembering words in a specified order. Acronyms are very common in ordinary language and in many fields.
  • SENTENCES/ACROSTICS - Like acronyms, you use the first letter of each word you are trying to remember. Instead of making a new word, though, you use the letters to make a sentence.
  • RHYMES & SONGS - Rhythm, repetition, melody, and rhyme can all aid memory.
  • TABLES & ALGORITHMS - Tables and algorrithms attempt to place information in organized grids and and flowcharts to assist with organization of information and decision making.
  • TECHNOLOGY - Smart phones and PDAs. Keeping a mobile library in your pocket and easy web resources.
DISCLAIMER - The information contained in this website is not medical advice. While a licensed respiratory therapist presents the content, the author is not a physician. Questions relative to your health, the health of a friend or family and/or patient care concerns should be directed to a qualified physician.

Sunday, November 30, 2008

Respiratory Care K.I.S.S.

Keeping it short and simpler for Respiratory Therapy. (K.I.S.S.)
We would like to believe that patients and students remember the majority of the instruction we provide. But as bedside practitioners, we must be honest with ourselves and appreciate the opposite is actually true. Our students and overwhelmed patients remember very little of what we teach. It is within this reality that I would like to discuss and introduce relatively “simplified” methods that can help our patients and our students remember important clinical information and technique.