RespiratoryRespiratory

Since We Draw ABG’s From Since We Draw ABG’s From an Artery…an Artery…

We Must Hold the Site We Must Hold the Site for Five Full Minutesfor Five Full Minutes

If the Patient is on Blood If the Patient is on Blood Thinners, Add 15 minutesThinners, Add 15 minutes

Hold forHold for 2020 minutes!minutes!

Since Heparin Works the Since Heparin Works the Fastest, it is Often Fastest, it is Often

Ordered FirstOrdered First

However, it is Common However, it is Common to Start the Patient on to Start the Patient on Coumadin (warfarin) at Coumadin (warfarin) at

the Same Time.the Same Time.

This is Done BecauseThis is Done Because

Warfarin takes three to four Warfarin takes three to four days to achieve therapeutic days to achieve therapeutic anticoagulant effect. anticoagulant effect. Therefore, heparin is Therefore, heparin is continued until the Warfarin continued until the Warfarin can take overcan take over..

Your Patient Asks, “Why Your Patient Asks, “Why Are You Giving Me Rat Are You Giving Me Rat

Poison?” Poison?”

You Could Respond You Could Respond With…With…

A better question, is why are A better question, is why are we giving perfectly good we giving perfectly good human medication to lowly human medication to lowly little rats?little rats?

Rodents are difficult to kill with Rodents are difficult to kill with poisons because they will eat a poisons because they will eat a small bit of something and wait, small bit of something and wait, and if they don't get sick, they and if they don't get sick, they continue. An effective rodenticide continue. An effective rodenticide must be tasteless and odorless in must be tasteless and odorless in lethal concentrations, and have a lethal concentrations, and have a delayed effect.delayed effect.

The main benefit The main benefit of anticoagulants of anticoagulants over other poisons over other poisons is that the time is that the time taken for the taken for the poison to induce poison to induce death means that death means that the rats do not the rats do not associate the associate the damage with their damage with their feeding habits.feeding habits.

Back to Patients….Back to Patients….

If a Cannula Comes Out of a If a Cannula Comes Out of a NEW Trach (72 hours or NEW Trach (72 hours or

less)less)•The site has not matured yetThe site has not matured yet•This is a medical emergencyThis is a medical emergency•Call for helpCall for help•Replacement may be difficultReplacement may be difficult

The First Medication Often The First Medication Often Given in an Asthma Attack Given in an Asthma Attack

isisAlbuterol (Proventil) via inhaler or Albuterol (Proventil) via inhaler or

nebulizer treatment. These are in nebulizer treatment. These are in the drug class called Beta Agonists.the drug class called Beta Agonists.

Beta AgonistsBeta Agonists

Beta-agonists are medications that Beta-agonists are medications that mainly affect the muscles around the mainly affect the muscles around the airways (bronchi and bronchioles). Such airways (bronchi and bronchioles). Such as:as:

ProventilProventil XopenexXopenex

VentolinVentolin BrethineBrethine

IsuprelIsuprel

AlupentAlupent

In Respiratory Difficulty, In Respiratory Difficulty, Many Feel That Morphine is Many Feel That Morphine is a Good Medication a Good Medication Because:Because:

Morphine dilates veins Morphine dilates veins and decreases blood and decreases blood returning to the heart returning to the heart and lungs.and lungs.

With Good Hydration…With Good Hydration…Children With Sickle Cell Children With Sickle Cell Anemia are Often Anemia are Often Healthy Much of the Healthy Much of the Time.Time.

When a Patient is When a Patient is Recovering From a Recovering From a Thrombophlebitis in the Thrombophlebitis in the Calf of Their Leg, it is Not Calf of Their Leg, it is Not Unusual to Measure the Unusual to Measure the Diameter of Their Calves Diameter of Their Calves Every Day.Every Day.

Although A Venous Although A Venous Doppler May be Used Doppler May be Used Instead.Instead.

Comparisons Are Made Comparisons Are Made Between Their Right and Between Their Right and

Left CalfLeft Calf

The Primary Function of The Primary Function of the Tonsils is to Filter the Tonsils is to Filter and Protect Against and Protect Against Invading Pathogens.Invading Pathogens.

Tonsils

In the Post Tonsilectomy In the Post Tonsilectomy Diet, Red Liquid and Diet, Red Liquid and Milk are Initially Milk are Initially Avoided.Avoided.

Things to Remember Things to Remember About Children With About Children With

Cystic FibrosisCystic Fibrosis* * ClubbingClubbing of fingers but not barrel- of fingers but not barrel-chestedchested

* * CongestedCongested but not generally but not generally wheezingwheezing

* * ThickThick sticky sticky mucousmucous that blocks that blocks pancreatic pancreatic enzymeenzyme

* * Immune compromisedImmune compromised child… child… should receive all vacines.should receive all vacines.

* Benefit from * Benefit from postural drainagepostural drainage

The Faces of Cystic The Faces of Cystic FibrosisFibrosis

Drug of Choice for Bee Drug of Choice for Bee Sting Allergic Reaction:Sting Allergic Reaction:

Epinephrine which helps with swelling Epinephrine which helps with swelling AND dilates the bronchial tubes. Two AND dilates the bronchial tubes. Two actions in one medication.actions in one medication.

Common Tuberculosis Common Tuberculosis MedsMeds

* * EthambutolEthambutol

* INH* INH

* Rifampin * Rifampin

When TB Patients Do When TB Patients Do Not Respond to Meds in Not Respond to Meds in

Six Weeks…Six Weeks…

They can expect to stay on They can expect to stay on meds for six months to one meds for six months to one year.year.

When Do We Check PPD When Do We Check PPD Intradermal Skin Test?Intradermal Skin Test?

In 48 to 72 In 48 to 72 hourshours

Positive PpdPositive Ppd

Negative PpdNegative Ppd