Since at least the 1960s pulmonary physicians were preaching not to give high flow 02 to COPD patients because they would "hypoventilate" and maybe even hypoventilate to a respiratory rate of zero. Campbell and other emphasized that important therapeutic principle
We talked about elevated carbon dioxide levels suppressing the brainstem systems to drive breathing so that it was only the hypoxia drive that was left and that would be to varying degrees taken away by being given excessive oxygen. In that era it was not uncommon for ambulance drivers ( there were no EMTs in the old days)to give COPD patients 4-6 liter flow O2 only to arrive at the hospital with the patient barely breathing.Those days thankfully are long gone.
This article from Emergency Medic Blog give a good summary review of this topic
H/T to Dr Robert Donnell and his blog for his continuing impressive effort to "keep up" with medical stuff while still practicing medicine as a hospitalist.
Wednesday, February 24, 2016
Tuesday, February 09, 2016
Bring an advocate if you have to go to hospital
Bring an advocate with you if you have to go to the hospital,if possible a physician.My two recent times in the hospital made it clear how valuable that can be.
My first stay was for a pace maker implantation which though considered as outpatient procedure actually takes place in the hospital and typically involves an overnight observation stay.
My advocate was my wife, an also retired hematologist.She was first helpful in trying to help the person who pushed in a large portable computer apparatus and attempted to take a medical history which was made laughable by her almost complete lack of knowledge of medical terms and then trying to spelling them for entry into the computer. It took her 3-4 minutes to finally enter the fact that I had an allergy to ceftin ( cefuroxime) She was the first of 4 or 5 folks who asked me if I had any allergies who then dutifully recorded that in the electronic medical record , but for the good it did a handwritten note later thrown in the trash would have been as effective.See below.
Once I was wheeled into the cath lab for the procedure, I was on my own. I saw someone ( nurse, tech, nursing assistant ?) hanging up an IV bag and asked what it was.I was told it was Ceftin!. That is right, after telling 4-5 people I had an allergy to that medication, that it exactly what they planned to give me.,the last of which was not more than 5 minutes before when I was in the waiting area for the cath lab.She consulted with the cardiologist and she said vancomycin was substituted. A few minutes later one of nurses set up a barrier over my face to protect the operative field.Had that been set up earlier I would have not inquired about the contents of the IV bag.
Interestingly, I noticed on my hospital bill that I was charged for a dose of IV Ceftin as well as the vancomycin.Maybe you get charged if they get the medication from the pharmacy,whether or not it is used.
More drama with vancomycin when I was preparing to be discharged the following morning. The resident had seen me and was writing the discharge orders. Apparently he made a comment to himself or perhaps to whomever was in ear shot that they had used vancomycin rather than the routine ceftin. Somehow the nurse interpreted whatever he said to mean that I was to receive another dose of vancomycin before discharge and was in the process of making that happen when my advocate-wife-physician asked why she was doing. After a few minutes of arguing my wife cornered the resident and confirmed that he was discharging me on minocycline orally and there was no order written or given verbally for the vancomycin.
My first stay was for a pace maker implantation which though considered as outpatient procedure actually takes place in the hospital and typically involves an overnight observation stay.
My advocate was my wife, an also retired hematologist.She was first helpful in trying to help the person who pushed in a large portable computer apparatus and attempted to take a medical history which was made laughable by her almost complete lack of knowledge of medical terms and then trying to spelling them for entry into the computer. It took her 3-4 minutes to finally enter the fact that I had an allergy to ceftin ( cefuroxime) She was the first of 4 or 5 folks who asked me if I had any allergies who then dutifully recorded that in the electronic medical record , but for the good it did a handwritten note later thrown in the trash would have been as effective.See below.
Once I was wheeled into the cath lab for the procedure, I was on my own. I saw someone ( nurse, tech, nursing assistant ?) hanging up an IV bag and asked what it was.I was told it was Ceftin!. That is right, after telling 4-5 people I had an allergy to that medication, that it exactly what they planned to give me.,the last of which was not more than 5 minutes before when I was in the waiting area for the cath lab.She consulted with the cardiologist and she said vancomycin was substituted. A few minutes later one of nurses set up a barrier over my face to protect the operative field.Had that been set up earlier I would have not inquired about the contents of the IV bag.
Interestingly, I noticed on my hospital bill that I was charged for a dose of IV Ceftin as well as the vancomycin.Maybe you get charged if they get the medication from the pharmacy,whether or not it is used.
More drama with vancomycin when I was preparing to be discharged the following morning. The resident had seen me and was writing the discharge orders. Apparently he made a comment to himself or perhaps to whomever was in ear shot that they had used vancomycin rather than the routine ceftin. Somehow the nurse interpreted whatever he said to mean that I was to receive another dose of vancomycin before discharge and was in the process of making that happen when my advocate-wife-physician asked why she was doing. After a few minutes of arguing my wife cornered the resident and confirmed that he was discharging me on minocycline orally and there was no order written or given verbally for the vancomycin.
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