Great Commentary on “Normal” iPad use

The iPad Does Not Need Be Complex 

Terrific perspective on keeping the iPad “manageable” for the normal user.

Rene Ritchie on YouTube  Ruining the iPad

A click-bait title, but from one of the Webs best technology commentators.

Great to keep in mind when implementing IOS clincal tools.

 COPD Management Guidelines Summary 

The AARC in partnership with Boehringer-Ingelheim have introduced 2 new resources to assist the practitioner in the management of COPD

 

The 1st PDF highlights the GOLD and ATS guidelines. 

Real-world examples are used to highlight key considerations as to why following these evidence-based guidelines results in better patient outcomes.

The next PDF is a Huddle Card Checklist which may be an integral report tool during the patient’s hospital admission. 

AARC.org > Recourses > COPD Resources

https://www.aarc.org/resources/clinical-resources/copd-resource-materials/?utm_source=informz&utm_medium=email&utm_campaign=aarc-protech&_zs=PNxKN1&_zl=k3Qo6

Entering the Room

 The 3 I’s of entering a patients room.

 The Feynman Technique

Step 1: What do you want to learn about?

• Identify a topic and start with a blank document. (A blank sheet, either paper or electronic). Write out everything you know about the subject as if you were teaching it to a child.
• As you learn more about the topic, add it to your sheet. 
• Use your organization tools of choice (colors, bullet points, outlines) so you can see your knowledge develop.

Step 2: Explain it to a 12-year-old

• Now that you think you understand a topic, explain it to a 12-year-old.
• Use your document as a reference to remove unnecessary jargon and complexity. Only use words a 12 year old would understand.

• Anyone can make a subject complicated but only someone who understands it can make it simple.

Step 3: Reflect, Refine, and Simplify

• Review your notes to make sure you didn’t mistakenly gloss over anything or insert unnecessary jargon.
• Read it out loud. If the explanation isn’t simple enough or sounds confusing, reflect and refine.
• Go back to the source material, reviewing the parts you don’t understand. Repeat until you have a simple explanation.

Step 4: Organize and Review

• Test your understanding in the real world, by teaching it to someone. 
• How effective was your explanation? What questions were asked? What parts caused confusion?
• Reflect, Refine, and Simply

Optimizing Therapeutic Cough

Shaping the Patient’s Therapeutic Cough

Shaping a patient’s therapeutic cough plays an integral part in every patent encounter.  Whether the primary therapy visit is for bronchial hygiene, hyperinflation, inhaled medication, peri-operative care or patient education, cough evaluation and instruction is a vital component of every visit. 

 
The scope of this discussion does not include or address the diagnosis or treatment of “chronic cough” although some of the techniques addressed can be helpful in addressing that specific clinical challenge. 

By optimizing the therapeutic cough you can assist the patient in the following:
1) Decreasing the tendency toward uncontrolled, spasmodic ineffective couch. 
2) Assist in opening collapsed lung and mobilizing secretions. 
3) Decrease the shortness of breath associated with uncontrolled cough.

The framework of primary cough instruction outlined below is divided into, 3 sustained deep breaths with a 3 count breath-holds followed by a set of 3 controlled coughs.

Optimizing those 3 steps will be explored in a later post.

Breaking down clinical instruction into sets of 3, increases the likelihood that our already overwhelmed patients can remember and use techniques effectively. The pattern of, 3 breaths with breath-holds followed by the 3 controlled 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 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.

Step One – Coach the patient to take their first slow moderately deep breath.

Step Two - 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) 

Step Three - Encourage the patient to exhale slowly to resting exhalation . 

Step One Repeat - The patient is instructed to take second somewhat deeper breath. 

Step Two Repeat – And, again coached to, “hold it, hold it, hold it”, encouraging a slightly longer breath hold.  

Step Three Repeat - Encourage the patient to exhale slowly to resting exhalation . 

Step Three Concluding - For the 3rd and concluding breath the patient is encouraged to inhale to near maximum. 

Step Two Concluding- and couched again to, “hold it, hold it, hold it”, while preparing the patient to perform a controlled cough from the near maximal .

Step Three Concluding - 

* Instruct the patient produce 3 moderate controlled coughs from the same deep held 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 held breath. 

* And finally, encourage the patient one final time to inhale maximally and to, “hold it, hold it, hold it”, and then encourage 3 slightly more vigorous coughs from the held breath. 

* Return the patient to normal breathing and reassess. 

C.O.P.D. Includes What Diseases?

 Chronic Obstructive Pulmonary Disease (COPD):

Includes the the following under its clinical umbrella or has significant clinical overlap.  

The acronym - B.A.B.E.

* Bronchitis, Chronic

* Asthma COPD Overlap

* Bronchiectasis,  Bronchiectasis Nontuberculous Mycobacterial 

* Emphysema

Medical Calculators

Respiratory Calculators

Medscape and Epocrates give you access to an astounding array of integrated medical formulas. They include detailed links and bibliographic references for each formula. The categories let you filter down to more specific respiratory calculations or to the topics that you are searching.  This is a free resource with the basic services.

https://www.epocrates.com/

https://www.medscape.com/public/medscapeapp

Shop and Give Back to the COPD Foundation

Every penny counts! 

Your online purchases through Amazon can go the extra mile and help support the nonprofit COPD Foundation. 

When you designate the Foundation as your charity of choice, Amazon contributes to the Foundation following your purchase(s). 

https://smile.amazon.com/?ref_=smi_ge_rl_rd_gw

COPD Teaching and Reference

The COPD 101 Library 

The COPD Foundation has created the COPD 101 Library which is an excellent overview of key clinical concepts for COPD & Genetic COPD, including risk factors, epidemiology, screening and diagnostics, and treatment strategies. This presentation can be a starting point for anyone new to COPD or seeking to improve overall care. Patient education materials, created specifically to assist clear communication of disease management concepts, are also included to help optimize therapy plans.

COPD 101 is available on the site below and is in Basic PDF, Enhanced PDF (including speaker notes), and Full PowerPoint (presentation-ready) formats.  Presentations on inhaled medication delivery have also come online mid-2022.

https://www.copdfoundation.org/Learn-More/I-am-a-Healthcare-Provider/The-101-Library.aspx

3 x 3 Steps to Decrease the Vocal Impact of Inhaled Corticosteroids (ICS)

1-2-3 to decrease the impact on voice of inhaled steroids.

1) Three teaching points - Reinstruct in optimal technique, including:

    a) Upright posture with chin up. 

    b) Active oral rinse & spit after dose(s).

    c) Correct inspiratory flow for the delivery device.

2) Three device options to consider*

    a) Add a valved holding chamber to the pMDI if appropriate. 

    b) Consider a SMI (Soft Mist Inhaler, Respimat).

    c) Replace a DPI with a pMDI/holding chamber or SMI or neb.

3) Three alternative ICS options*

    a) Alvesco pMDI

    b) QVAR pMDI

    c) Pulmicort & quality nebulizer

*  Contact the ordering provider as appropriate.  

ICS = Inhaled Corticosteroids

pMDI = Pressurized Metered Dose Inhaler

DPI = Dry Powder Inhaler

SMI = Soft Mist Inhaler

Adventitious Lung Sounds 3 x 3

 3 Primary Parenchymal Adventitious Sounds -  3 Descriptions

Oakes Respiratory Care Pocket Guide

Oakes Respiratory Care Pocket Guide (2021-10th Edition)

The classic "blue book" of respiratory therapy has come out with its 10th edition. 
I agree with the publisher and this is the best edition to date. 

The accuracy, professionalism, and affordability have made these pocket reference guides the standard in portable respiratory care texts for decades.

 https://respiratorybooks.com/collections/respiratory-pocket-guides/products/oakes-respiratory-care-pocket-guide-2021-10th-edition

A.D.A.P.T. & Physical Assessments of the Lungs

A.D.A.P.T.

5 primary findings can be determined by the physical assessment of the lungs and thorax:

1) Airway patency

2) Density of underlying tissue

3) Adventitious lung sounds

4) Presence or absence of lung

5) Tracheal shift

Perfect Hand-held Applications

Best Hand-Held Application 

There is only one best hand-held app in any category. 

It’s the one that will be consistently updated and that you are willing to invest the time to learn so deeply that it becomes second nature.  

You’ll never find perfect. Only the perfect application for you.

Characteristics of a Trache Tube

Describing Clinical Characteristics of a Tracheostomy Tube

Recall Using: A B C D E & 123

Airway lumens

1) Single lumen
2) Dual lumen
3) Connecting adaptor (15mmOD) removed with inner cannula?

Brand & Composition

1) Company of manufacture
2) Metal – stainless steel, silver
3) Plastic – PVC, silicone, other

Cuff

1) Cuffed or uncuffed
2) Inflated or deflated
3) Cuff characteristics, High/low press, High/low vol, shape

Diameter and Dimensions of tube

1) Inner diameter (I.D.)
2) Outer diameter (O.D.)
3) Length of tube (standard, short or long length)

fEnestration

1) Fenestration present?
2) Fenestration open / closed
3) Position and construction of fenestration

Cough - Common Causes

Some Common Causes of Cough

Consider: G. A. S. P.

* G.E.R.D.

* Asthma, ACE Inhibitor, Allergy

* Smoking, Chronic Bronchitis, Sinusitis

* Post Infection

Localize Physical Assessment of the Lung and Thorax

Localize pulmonary assessment by answering 3 questions:

1) Right or Left lung?

2) Upper, middle or lower lung field?

3) Anterior, posterior or lateral lung field?

3 Steps to Keep Planning Simple

(While taking advantage of Apple's 3 primary system applications)

1)  Do NOT rely on your brain as your repository for ideas and commitments.

• Get it out of your brain and and into a system.  (Brain-dump)
• Let your brain be the creative engine. 
• If you use an iPad consider using the Pencil if the act of writing is an asset to your workflow.

2)  Plan the day (week) before.

• Apple Notes: 
• Ideas/thoughts,
• Records/scans, 
• Cognitive off-loading. (Brain dump)
• Apple  Reminders: 
• Projects, 
• Plans, 
• Goals
• Apple Calendars: 
• Appointments, 
• Commitments, 
• Things that must be done.

3) If it must be done, give it a place on your calendar. 

• Everything you do takes place in the context of time.
• Your calendar is where the rubber meets the road.
• Project lists (Apple Reminders) are where you put your goals, your calendar is where you put your work.

COPD Pocket Consultant Guide

COPD Pocket Consultant Guide App - from the COPD Foundation

This IOS (& Android) application is designed to support the treatment and management of COPD. The latest version contains an updated therapy flow-chart, the latest medications, inhaler instruction videos, depression and anxiety screeners, a new pulmonary referral checklist and much more.

In addition, users can toggle between tracks specifically designed for patients and caregivers by clicking “Change View” in the upper right of the main menu screen. The patient and caregiver track has features, including an interactive "My COPD Action Plan" and tracking calendar; inhaler and exercise videos; activity tracking; a wallet health information card; "For My Next Visit" prompts and more.

https://www.copdfoundation.org/Learn-More/The-COPD-Pocket-Consultant-Guide/Healthcare-Provider-Track.aspx

Inhaled Corticosteroid (ICS) - generic name, clinical suffixes

End in ide or end in one:
Always an inhaled steroid.

* budesonide

* ciclesonide

* flunisolide

* beclomethasone

* fluticasone

* triamcinolone

Beta-Agonist (SABA & LABA) - generic name, clinical suffixes

End in ol:
Always a Beta-Agonist bronchodilator.

albuterol (SABA)

formoterol (LABA)

levalbuterol (SABA)

olodaterol (LABA

salmeterol (LABA)

vilanterol (LABA)

SABA = short acting bronchodilator aerosol

LABA = long acting bronchodilator aerosol

DISCLAIMER, Restatement - 

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 your physician or primary care provider. 

If you are having chronic, difficult and unresolved respiratory problems, consider speaking to your primary care provider about a referral to a pulmonologist.  

3 Rules for Your Clinical "Smartphone"

 Don't let your Device be an Information or Infection Vector!

1) Protect your employer.

    * Follow your organization's policy on smartphone (handheld tech) use.

2) Protect your patient.

    *H.I.P.P.A., H.I.P.P.A., H.I.P.P.A.!

        * Protected health information (PHI):

            * cannot be on an unsecured smartphone.

                * Including photographs.

            * Don’t let your smart device become an unsecured PHI vector.     

        * Keep your handheld tech clean.

            *   Don’t let your smart device become an infection vector. 

3) Protect yourself

    * If you use handheld tech with a patient or family, let them know that you are using the device for them.  (e.g. checking drug compatibility, performing a calculation)

Epocrates - Hand-held Knowledge Extension

Epocrates

Even in its free non-subscription form, Epocrates offers a comprehensive portable drug reference for the respiratory therapist and other health care practitioners.

Drug Reference:

    • Adult and pediatric dosing

    • Black box warnings 

    • Contraindications, adverse reactions, and drug interactions

    • Pharmacology

    • Manufacturer and approximate retail price.

It also includes:

    • Interaction checking

    • Pill ID

    • Clinical guidelines

    • Clinical calculators

The robust search and category structure enables efficient use of Epocrates regardless of your healthcare focus.

https://www.epocrates.com/

Medscape - Handheld knowledge extension

Medscape - Comprehensive portable resource

https://www.medscape.com/public/medscapeapp

Medscape is a leading comprehensive portable resource for healthcare professionals, it offers essential point-of-care drug and disease information; the latest medical and pulmonary focused news and relevant professional education.

Medscape membership is free and gives you unlimited access to the entire network of sites and services.

Simplify - Practicing what I preach.

 Simplifying the Blogs Format

I am going to try to practice what I preach and make some changes as I move forward. 

* Streamline and simplify posts whenever possible and practical.

* Remove illustration "fluff" unless it is directly pertinent.

* Remove distracting backgrounds. 

* Repost, update and simplify old post.

* Mark out of date posts.

Respiratory Care a Profession For You?

Is Respiratory Care the Right Profession For You?

* Do you want to help people every day of your working life?

* Do you like working with technology?

* Do you want the ability to work in a variety of places with patients of all ages?

If this sounds like you, respiratory therapy could be a career for you!

Job stability is excellent and demand for respiratory therapists has never been higher. 

The opportunity to help people and make a meaningful difference in the lives of others means you’ll get much more out of your career than just a paycheck.

https://be-an-rt.org/