Say you have a patient. It’s an old patient, with a primary Dx of pulmonary fibrosis. Sure, he has some underlying obstructive disease, but his main problem–the source of his ills–seems to be the fibrosis. He has become increasingly hypoxic, requiring a partial rebreather during the day and a BiPAP at night. The physician orders “Albuterol nebs Q4 hours.”
While giving the albuterolnebulizer to the patient, he desaturates and becomes more short of breath. SpO2 readings are in the 70s, so the RT who does not trust pulse oximetry (me) gets an ABG showing a PaO2 in the low 50’s and an O2 saturation of 83%.
Naturally, the physician is notified.
The physician, when notified that the patient feels worse after the neb and has experienced serious refractory hypoxemia correlated with the nebulizer therapy, orders Q2 treatments, which will be 100% ineffective when dealing with pulmonary fibrosis.
Logic, please? I fail to see the reasoning behind the physician’s order. Perhaps another set of eyes will be able to enlighten me as to why we are increasing the frequency of an ineffective treatment that seems to make the patient worse…has the hospital taken out life insurance on this guy?
Say you have a patient. It’s an old patient, with a primary Dx of pulmonary fibrosis. Sure, he has some underlying obstructive disease, but his main problem–the source of his ills–seems to be the fibrosis. He has become increasingly hypoxic, requiring a partial rebreather during the day and a BiPAP at night. The physician orders “Albuterol nebs Q4 hours.”
While giving the albuterolnebulizer to the patient, he desaturates and becomes more short of breath. SpO2 readings are in the 70s, so the RT who does not trust pulse oximetry (me) gets an ABG showing a PaO2 in the low 50’s and an O2 saturation of 83%.
Naturally, the physician is notified.
The physician, when notified that the patient feels worse after the neb and has experienced serious refractory hypoxemia correlated with the nebulizer therapy, orders Q2 treatments, which will be 100% ineffective when dealing with pulmonary fibrosis.
Logic, please? I fail to see the reasoning behind the physician’s order. Perhaps another set of eyes will be able to enlighten me as to why we are increasing the frequency of an ineffective treatment that seems to make the patient worse…has the hospital taken out life insurance on this guy?