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Spirometry: Where Patient Co-operation is Essential

Posted Nov 09 2008 10:06pm

Now for some reason or another despite being in clinical rotation for over 2 months I still had not done a spirometry. Whenever they were ordered and I went with my preceptor to perform them they would be cancelled. This cycle of spirometries continued until one day last week when I was in spirometry hell. I was in ER where we were called to do 2 spirometries. I go introduce myself and explain the spirometry test to a cute old man. Now the handheld machine that we use is pretty idiot proof, it coaches what to do next and will only “accept” quality tests, and will even tell you once you have completed three reproducible tests..

So I first I thought okay this guy is going to be a breeze, well turns out all that forceful exhalation made him cough and in turn desat. Needless to say it took a long time to complete three pre and post reproducible trials. While completing his spirometry we were paged to do another, this lady was slightly better however she seemed more interested in telling us about her trip rather than the spirometry. The third lady we were paged for was by far the worst. I walk in and introduce myself and she just laughs at the test. Fantastic we are off to a great start. As soon as we begin, she has a poor effort and pushes the machine back into my face. I explain to her why we need the test and what it shows. All she did was complain and give us poor efforts. She complained how she was short of breath, how she had no slept, how she hated this test. I wanted to be in the room even less than she did and on top of it she reeked like smoke.

After 3 terrible spirometries in a row, I was ready to be done with them when there was another page for guess what another spirometry. Luckily, the patient we went to see had asthma and probably had done a half a dozen spirometries in her life. She was fantastic. She did 3 reproducible efforts all in a row with little coaching. She restored my faith in performing spirometry.

Also I would like to thank the frozen rt for introducing me to Surgical ICU rounds with Dr Jeffrey Guy.
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