Tuesday, January 1, 2008

RSV (Respiratory Syncytial Virus)

Respiratory Syncytial Virus or RSV is, unfortunately, a very common illness. When an adult has RSV, most people call it the common cold. When an infant has RSV, it can lead to more serious issues as they have a less developed immune system and their lungs are very little.

--How does one "catch" RSV?

RSV is a very contagious virus which can be passed via droplet or by contact. This means when a person coughs or sneezes, a person can catch that virus from them. It also means that this RSV virus can live on surfaces like doorknobs, toys, counter tops and hands. RSV is easily spread when a person touches an object or surface contaminated with the virus. This is why it is so easily passed among children. It is estimated that most children will have had RSV at least once by the time that they are two years old.

--How is it Diagnosed?

When a child is brought into the doctor or to the hospital, they are, of course, evaluated. If RSV is suspected, they will do a test that will collect mucous or sputum from their nose or throat.

--What is the Treatment?

Because RSV is a virus, the doctor cannot prescribe antibiotics as this will not help. The best treatment for mild cases of RSV is common sense. Humidifier, Vicks, raise the head of the bed, etc... When a child requires hospitalization because of their RSV, other treatments are used. Keeping the airway clear of the excessive mucous is one of the things that is necessary. The nurse or the Respiratory Therapist will come in an suction out their little noses. They will not like this much, but they will certainly breathe better. Sometimes a doctor will order breathing treatments for a baby.
These will not help the RSV, but if there is some underlying hyperactive airway disease such as asthma, this may be necessary and help out a little bit. Like a cold, the best treatment is common sense, relief of symptoms (suctioning), and some snuggling by Mom.

How can RSV be Prevented?

Handwashing! Carry those waterless hand cleansers that will kill germs. Make sure your child washes their hands before eating and after using the bathroom. Make sure they wash their hands after playing with other children's toys. Don't become obsessive compulsive about it, but certainly know that hand washing prevents a lot of germs from making everyone ill.

RSV can be really frightening for the parent as the child will be breathing fast and hard. They will also usually have an abundance of mucous coming out of their noses. It is difficult when your little one is ill. Take Care.

Friday, December 28, 2007

ECMO (Extra Corporeal Membrane Oxygenation)

ECMO or extra corporeal membrane oxygenation is used when a child's lungs and/or heart are not able to perform their usual job. For whatever reason they are not able to do their work and the doctors caring for the child believe that ECMO can help, the ECMO machine provides support for the child allowing time for the lungs and/or heart to recover, repair, and develop for themselves. It works like a heart lung bypass machine similar to the one that is used in open heart surgery. Extra corporeal means "outside the body". The actual reality of the matter is this: it works like a heart and a lung for the child with a reversable heart or lungs disease. It can be used for a period of up to about two weeks.

A child would need ECMO for the following reasons:

1. Children with very severe lung disease not responding to the usual treatment of mechanical ventilation, medicines and extra oxygen.

These can include ARDS, pneumonia, trauma, asthma, aspiration, acute respiratory failure, auto immune disorders, oncology, sickle cell crisis or anything that can compromise the lungs.

2. Children who are waiting for heart or lung surgery and need the help of a bypass machine while they are waiting.ECMO works by circulating the unoxygenated blood from a vein in the neck into the artificial oxygenator (or artificial lung)where it gets rid of the carbon dioxide and receives oxygen. It is then put back into the body via an artery also in the neck. The child will also be on life support or a ventilator.

When a child is placed on ECMO, every effort is made to get them off as soon as possible. Each patient will be assigned a team of health care workers including Doctor, ECMO specialist, perfusionist, Respiratory Therapist, ECMO RN, and various other support people. When a child is placed on ECMO it is to save their life because nothing else has or will work. In other words, the child would die if it were not for the ECMO. A child will be placed on full support to start with. As healing begins to take place, settings will be turned down as the body is able to function better on it's own. The child's improvement is measured by blood samples, chest movement, improved chest x-rays and improved heart function. When this is seen, the ECMO flow will be gradually reduced to a stage where your child is actually taken off of ECMO for a short period of time. This time will be increased until the ECMO support is determined to no longer be needed. The child may still need full ventilator support. They may also need extra medications. Of course, all of this will be reduced as the child gets better.It is a very frightening thing to have your child placed on ECMO. As a parent, it is important to take care of yourself so that you are able to take care of your child when he or she gets better and will need you. It has been suggested that a parent keep a diary of all that goes on in order to know what questions to ask and to keep busy. This is a life and death situation. Gather your support people about you and allow yourself to use them.

ECMO-a last resort treatment that saves lives.

Tuesday, December 18, 2007

What is Empyema Thoracis?

Empyema thoracis is a very terrible illness. Empyema is actually pus. Thoracis is the chest. So by definition it is pus in the chest. However, empyema thoracis actually is pus in the space between the lungs and the chest wall known as the pleural cavity. Pus accumulates in the pleural space pushing against the lungs. As more and more pus is produced, the pus begins to push against the lungs making more difficult to breathe. The infection usually originates in the lungs and then spreads to the pleural space. A person usually has an underlying disease or infection before they develop empyema thoracis including pneumonia, lung cancer, chest wound, surgery, or bone cancer.

As many of you know, I am a Respiratory Therapist. One of my patients, who has multiple sclerosis also has developed empyema thoracis. The Pulmonologist put in a chest tube. The infection was so thick, that they also put in steptokinase to try to thin out the pus to drain it.

Although empyema thoracis signs and symptoms may vary, the most common ones are the following: Fever, coughing, weight loss, shortness of breath, chest pain, and fatigue. As it becomes a larger infection, the work of breathing increases and a person will need to be hospitalized to get help with their breathing and to have this infection drained. In more serious cases, surgery is required and a lobectomy may be necessary (partial lung removal).

When empyema thoracis becomes severe, the pus abscess can spread to other parts of the body and infect other organs. This can cause multi organ failure. Empyema thoracis is very important to get treated as soon as possible. As mentioned above treatments include chest tube, thorocentesis, surgery. Additionally, a very rigorous regime of antibiotics will be given.

Anytime the lungs are effected by an illness, it can become life threatening. It is very important to seek treatment early.

Friday, December 7, 2007

Is it the Common Cold or is it ARDS?

In a common cold a person catches a virus, it lasts for about two weeks or so. It is annoying and can involve sneezing, abundant mucous, and a sore throat. A person with a cold doesn't even have to see a doctor because it is a virus. People will urge you to take some vitamin C and zinc for to boost the immune system. All in all, it is annoying, but certainly not as serious as ARDS.

ARDS (Acute Respiratory Distress Syndrome or Adult Respiratory Distress Syndrome) occurs usually because of with widespread infection in the body (sepsis) or as a result of pneumonia, trauma, shock, severe burns, aspiration of food into the lung, multiple blood transfusions, and inhalation of toxic fumes, among other things. It usually develops within 24 to 48 hours after the original illness or injury and is considered a medical emergency. It may progress to involvement of other organs. When ever this happens, it can actually become life threatening. Symptoms which show that someone is going into ARDS is that they have difficulty breathing. The lungs become very stiff. It often is necessary to put someone like this on life support.

A chest x-ray of a set of normal lungs appear black (air appears black). The Chest x-ray of someone in ARDS often appears white. The lungs absorb fluid like sponges and become very stiff and difficult to ventilate. The difficulty of ventilation requires an internal medicine Doctor or Pulmonologist who isn't afraid to try different modes of ventilation.

A person with ARDS who needs to be put on life support will spend a minimum of two weeks on the ventilator. There is no medication that will heal the lungs from ARDS, it is a matter of waiting for the lungs to heal. Supportive therapy is all that can be done. Life support, antibiotics, sedation, diuretics and wait.

Whereas a cold is just that, a cold, which can be a pain, ARDS is a life threatening illness requiring life suport. The difference is that one can be life threatening and the other is just annoying.


Contrary to popular belief, your lungs are not two balloons. They are more like a bunch of grapes. So when a person has a collapsed lung, it is usually not the whole lung, however, it can be any portion of the lung.

What is a Pneumothorax? A Pnuemothorax is air in the plural space surrounding the lung. This area should not contain air. When it does, the air pushes on the lung causing the little grapes or alveoli to collapse. This depending on the size causes the person to feel several things all at once. Shortness of breath, drop in oxygen saturation in the blood, and chest pain. Because the lung is not able to inflate like it should, oxygen cannot get into the blood stream like it should. Because of this, a pneumothorax is a potentially something that can be life threatening.

What causes a Pneumothorax? Usually, a pneumothorax is caused by some sort of injury to the chest wall. A broken rib that punctures the lung is an example. Another example is a stab wound. If a person does not have an injury to the chest wall but still somehow has a pnuemothorax, this is called a spontaneous pnuemthorax.

A spontaneous pnemothorax can be caused by several things. Tall thin people who smoke are among those who are at risk for a spontaneous pneumothorax. Also people who have lung disease such as cystic fibrosis, emphysema, asthma and pneumonia have a risk for a spontaneous pnumothorax.

How does a Pneumothorax get diagnoised? A chest x-ray is usually what is used to find the pneumothorax. Depending on the size, the pneumothorax is something that needs to be treated right away.

What is the treatment for a Pneumothorax? The doctor will put in a chest tube which will suck out the air in the pleural space allowing the lung to reinflate. This is almost immediate relief for a person having difficulting breathing. If the pneumothorax is a small one, the doctor will usually allow for it to resolve on it's own. However, this person will require observation to make sure that it doesn't worsen. Removal of the chest tube takes place when the xray shows healing and the chest tube is not draining so much.

A pneumothorax is a very serious matter and should never be taken lightly. When a person is short of breath and having chest pain, no matter the cause, they should be taken to ER for a chest xray.

Tuesday, November 20, 2007

How does a "Super Bug" like MRSA Develop?

MRSA has been in the news a lot lately. It is unfortunate that the media has caused a small panic over a bacteria that has been around for at least four decades.

What is MRSA? How does a bacteria become a resistant "super bug"?

MRSA stands for methicillin-resistant Staphylococcus aureus, a type of staph infection that is resistant to methicillin and other commonly used antibiotics in the same class, including penicillin, amoxicillin, and oxacillin.

Recently, there was a teenager who was said to have died from MRSA. This is a terrible tragedy especially since it can be treated. I hope to give info regarding this and put to rest the fears that I believe are being fueled by the media.

I. What is MRSA?

Staphylococcus aureus is a species of bacterium commonly found on the skin and/or in the noses of healthy people. Although it is usually harmless at these sites, it may occasionally get into the body through breaks in the skin such as abrasions, cuts, wounds, surgery sites and cause infections. These infections may be mild like pimples or boils or serious when it gets into the blood stream.

It is the staph infection that a lot of antibiotics are useless to treat. However, there are antibiotics that can treat it. For instance, the drug of choice to treat MRSA is Vancomyicin.

- How does one "catch" MRSA?

MRSA is a contact infection. You must touch it to catch it.

-How do you keep from getting MRSA?

Hand washing is the number one way to keep from getting an infection. Whether that infection be the common cold or MRSA. A kindergarten teacher says that a person should wash their hands as long as it takes to sing the ABC song.

If you get a cut or a scratch, wash the site with antibacterial soap, keep it clean, and cover it with a band aid.

Avoid touching other people's personal items. For instance, in Gym class don't use someone elses towel or razor.

- Diagnosis of MRSA

The only way that MRSA can be diagnosed is if your doctor orders a culture to be taken from the area that is suspected of the infection. This is a simple painless test. They take a cotton swab and run it over the area and send it to lab.

Only then, can MRSA be diagnosed for sure.

- Treatment for MRSA

Depending on the location of the MRSA infection, the doctor will prescribe antibiotics. The doctor may have to drain the wound or open it to let it drain naturally. Whatever and which ever, your doctor needs to be involved.

II. How Does a Super Bug like MRSA come about?

-The way that a bacteria becomes resistant to antibiotic treatment and then becomes a "super bug" is actually very simple. Bacteria is very smart. When person is sick and they go to the doctor and the doctor prescribes antibiotics, a person needs to take those antibiotics until they are all gone. If we take antibiotics only until we feel better, some of the bacteria is left in our system. It looks at the antibiotic, sees how it kills the bacteria and it mutates. The way that the antibiotic used to kill that particular bacteria is no longer useful. That bacteria is now resistant to that antibiotic. Every time an antibiotic is given and taken and that bacteria is not wiped out, that bacteria becomes smart and resistant to that antibiotic. You get enough of a mutated bacteria and you get MRSA, the super bug. Fortunately, there are antibiotics to treat MRSA, so it is really not that super.

The hospital which I am employed has a grant to look into people that come into the hospital already infected with MRSA as opposed to those who catch it at the hospital. It is amazing how many people are colonized with MRSA and they have no idea, no symptoms...nothing.

Education is the key to understanding MRSA. Media induced panic is not.

Sunday, November 18, 2007

Asthma: When to go to the Doctor

"If I just take one more puff on my inhaler, and if I just sit here, I will feel better...". or "I don't have time for this..."

People don't realize or they don't want to believe that asthma can be a life threatening illness. I have had people come into our Emergency Room in total denial of how serious their condition is at that moment. They have put off coming to the doctor because it really is a bother. Please remember that if you stop breathing, you will not survive.

It is important to educate yourself on asthma if you or your child have asthma. There is a lot of education online, at hospitals, at clinics about asthma. One of the tools that a person can use to see if they need to go to the doctor is their Peak Flow Meter. Every asthmatic should have one. A Peak Flow meter has three levels: A green level...breathing good. A Yellow level...breathing not so good CALL DOCTOR. A Red level...go to the hospital Emergency Room...NOW. I believe that education is key in knowing when to go to the doctor.

One of my favorite e-books is "Asthma Made Simple". It explains asthma in such a simple language so that a person with Asthma can understand exactly what is going on in their lungs. How asthma works, what is that "tight" feeling in the chest? What is wheezing and why do I wheeze during an asthma attack?


If you are having tightness in your chest that is not relieved by your rescue inhalers, If you are coughing and wheezing and nothing seems to help, not even your Prednisone, it is time to call the doctor. Do not wait to see if another breathing treatment will help. Do not wait until it gets worse. Do not keep sitting there hoping that you will be able to take the next breathe. The American Lung Association says that when you can't breathe, nothing else matters...believe that.

Know when your inhalers will run out. Educate yourself on which medications you are taking and how each one works in your lungs. If you are using your inhalers more often than what your doctor ordered, you need to call your doctor to let them know this.

If you have asthma, please get yourself a Pulmonologist...a lung doctor. They will be up to date on the newest treatments. They know the lungs and how they work intimately.

In review on when to go to the doctor with your asthma:

1. When your Peak Flow Meter is in the Yellow
2. You are taking your inhalers more often than ordered by your doctor
3. The tightness and the wheezing is not relieved by your medication

Why & How to educate yourself about Asthma:

1. Know your illness
2. Know why you have asthma attacks and what will make them better.
3. Learn online. Find someone who explains it so that you understand it. Find someone who is not out to impress you with their medical terms. Again the e-book about asthma made simple is a good one.


4. Ask your Respiratory Therapist if they have a Certified Asthma Educator at their hospital.

It is imperative that we take Asthma seriously. I have seen a teenager die from an asthma attack because he had the wrong inhaler with him. When they got him to the hospital, we were unable to open up his lungs they were so shut down. Please believe that this is a very serious illness.

Call your doctor, educate yourself, take control of your asthma. You can do it!

Thursday, November 15, 2007

More On Congestive Heart Failure

I heard a Doctor explain Congestive Heart Failure to a patient like this: "It is not that the heart fails to pump, it is just that it has been working so hard to pump that it has become thick and unable to deal with the volume of fluid coming to it..."

In CHF the blood moves through the body at a rate that is slower than what the body function needs. So here is all this fluid moving through the body like a line at an escalator. People are waiting to go somewhere, but they just can't get on the escalator just yet...so a line forms. Just like the line forming, the blood backs up into the system and where does it back up to? The lungs. This is why people who have CHF have a difficult time breathing. They have so much fluid backing up into their lungs, that the air can't get through to ventilate the person. Next thing you know, you are rushing that person to the hospital because they cannt breathe.

Causes of CHF include the following:

1. Coronary Artery Disease--Disease of the vessels that provide blood and oxygen to the heart. When they become diseased and clogged, the heart does not get enough oxygen and cannot pump as effectively as it should.

2. Heart Attack -- If a person has a heart attack, part of the heart muscle can become damaged and again, it cannot pump like it should.

3. Hypertension - High Blood Pressure - One of the reasons that it is dangerous to have high blood pressure is that it can damage the veins and the arteries

4. Heart Defect - - This is usually something that a person is born with.

I realize that this is not a complete list, but at least it can give you an idea that any sort of disease that taxes the hearts function can eventually cause CHF.

SYMPTOMS & TREATMENTS of Congestive Heart Failure

1. Irregular Heart Beats. Sometimes a person will say, my heart feels like it is racing or my heart feels like it is jumping in my chest. This rhythm will cause fluid to back up. When you go to the hospital, they will put you on a monitor and do an EKG. This will tell them what your heart is doing. Sometimes they will feel it necessary to change your hearts rhythm. They can give you a medicine that will suddenly stop your heart and then let it beat again in a normal rhythm. Something else they can do is called a cardioversion. They will shock your heart into a lower and more stable heart rhythm.

2. You may feel tired or lightheaded or even experience some weakness.

3. Difficulty breathing. The fluid backs up into the lungs. You come into the hospital, they will give you medication to help you potty out the extra fluid. In some cases they will call for Respiratory Therapy to put a device on you that pushes positive pressure into the lungs.
BiPap causes the positive pressure in the lungs to help push the fluid back into the vascular system where it belongs...and then with the lasix (potty medication) your body will get rid of the extra fluid. Some people require to be put on life support when they also have other conditions such as COPD.

Your Doctor will want to know the extensiveness of your heart failure. In order to do this, he/she will order some tests to be done.

An Echo-cardiogram is an ultrasound of the heart. It will tell the doctor what your ejection fraction (EF) is. That is how well your heart is pumping. This comes in a percentage. For example your EF = 45%.

Your doctor may order some blood tests, and EKG to determine how serious your heart failure might be.

All in all, CHF can be controlled by you and your doctor. Do not try to fix this yourself. Find yourself a fabulous cardiologist who is willing to take the time to explain everything to you so that you can understand it.

I wish you luck and good breathing.

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