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.

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.

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.

Pneumothorax?

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.

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.

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?

http://www.copdmadesimple.com


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.

http://www.copdmadesimple.com

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!

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.

What To Do When Your Child is Having Trouble Breathing

There are few things more intense or frightening as when it appears that your child is having trouble breathing. As a parent, you need to be able to do a quick assessment of the situation and take appropriate and precise action. The first thing you must do is keep your head about you. Secondly, you need to figure out why your child is having trouble breathing. Were they eating something and it went down the wrong pipe? Are they having an allergic reaction, an anaphylactic shock to something? Do they have some sort of lung disease such as asthma or cystic fibrosis? Once you figure out why, you need to go into action.

If the child is choking, are you able to remove the object that they are choking on. (if you have children, it might be a good idea to take CPR) If so, problem solved. If not, you must continue trying to dislodge the item while you are calling 911. The American Heart Association has specific guidelines on how to do this with back blows and chest blows.
If you have a teenager that is choking, you can do the Heimlich maneuver on them. However you do it, it is imperative to restore breathing to that child.

If they are having an allergic reaction and now they are having trouble breathing, you need to dial 911. If you have an epi pen, use it.
Give benedryl to them ONLY if they are able to swallow. Get them to the hospital or wait for the ambulance to arrive..but do it quickly.

Does your child have a lung disease? Asthma is the most common childhood lung illness in the United States.

My advice to pediatric asthma treatment or cystic fibrosis treatment
is that you find an outstanding Pediatric Pulmonologist. It is also important that this Pulmonologist have excellent Respiratory Therapists on staff to do teaching that your child or you can understand. It is important that a Pulmonologist be involved because of all of the new treatments and medications that have come about just in the last 20 years.

All of these are reasons to get your child to the Emergency Room as soon as possible.

Please remember that your child's breathing is a serious matter. If they complain of being short of breath or if you notice any signs and symptoms of them having any difficulty breathing, you need to get them help immediately.

The American Lung Association says, "When you can't breathe, nothing else matters..." This is very true.

MRSA, the "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. In this blog, I hope to give info regarding this and put to rest the fears that I believe are being fueled by the media.

1. 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.


2. How does one "catch" MRSA?

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

3. How do you keep from getting MRSA?

Handwashing 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.

4. Diagnosis of MRSA

The only way that MRSA can be diagnoised 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 diagnoised for sure.



5. 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.

Like any infection, if your doctor prescribes antibiotics, it is important that you take all the doses that are prescribed.

The lab will run something called a sensitivity test. This will say what antibiotics can be used to treat the infection.



I believe that the Media has stirred up undue panic about MRSA. MRSA was discovered in the 60's and really is nothing new. People are keeping kids home from school because of it. If a person takes the proper precautions they can avoid getting the "super bug". If a person gets MRSA, there are treatments.

Good Luck.

How To Control Your Asthma

You know you did everything by the book and here you are having an asthma attack. What I tell people when they tell me that they are doing everything by the book is that their asthma...well, it has never read the book. It doesn't know that it is supposed to behave a certain way. Controlling ones asthma requires following the doctor's orders and some good common sense.

1. What triggers your asthma?
-If every time you go to the store and walk down the perfume aisle, you have an attack, maybe you should avoid going down that aisle.

-If dust is your trigger then make sure that you change your furnace filter every three months and get something that cleans the air.

Other triggers can be a cold or the flu. At the first sign of these coming on, get in contact with your Pulmonologist to see what you should do to keep your asthma under control.
Irritants such as cigarette smoke, stress, and strong smelling cleaning agents are also things that trigger your asthma.

Avoid those triggers as much as is possible. If you for some reason are not able to avoid it, keep a rescue inhaler on your person at all times. Rescue inhalers can include the following: Proventil, Albuterol, Ventolin, Combivent. These are all fast acting inhalers.

2. What are your doctor's orders?

If your doctor has ordered some long lasting bronchiodilators such as Spiriva, Foradil or Serevent, Continue to take those even if you are feeling good. Likewise, if your doctor has ordered maintenance breathing medications like Advair or Asthmanex, keep taking those every day even if your breathing is fantastic.

One of the biggest myths surrounding asthma is that it is not a serious illness to have. People's airways may be more reactive than other people's airways, but whenever we are speaking of an illness that has to do with breathing, it is a serious illness. The American Lung Association says, "When you cannot breathe, nothing else matters...". Anyone who has ever had to fight for their next breath knows that this is very true. Asthma, no matter how "mild", should be taken seriously.

Another myth of Asthma is that any doctor is qualified to manage one's asthma. This is an illness that requires a specialist. A Pulmonolgist is a lung specialist. They should be aware of the treatments that are new and are working better and longer than the old treatments. Your family doctor is wonderful, but when you have Asthma, you should not trust your breathing to just any doctor.

I wish you luck and good breathing.

Pediatric Asthma

My advice to pediatric asthma treatment is that you find an outstanding Pediatric Pulmonologist. It is also important that this Pulmonologist have excellent Respiratory Therapists on staff to do teaching that your child or you can understand. It is important that a Pulmologist be involved because of all of the new treatments and medications that have come about just in the last 20 years.

Things that are involved in treating pediatric asthma involve a Peak Flow Meter. It is important to know the peak flow meter zones and what each of them mean and what actions are necessary to take to help your child's breathing get better as soon as possible.

Which medicines are safe for what age group? A Pediatric Pulmonologist will know the ages or will know to look up to see which drugs should be used. As a parent, it is difficult to see a child who is having difficulty breathing. When do you call a doctor? What signs and symptoms should you look for? Here are a couple of things to look for when assessing the breathing of your child.

1. How fast are they breathing? A baby can breath around 40 times a minute normally, while an adult's normal breathing is around 15. If your baby is breathing over 50 times a minute that is cause for concern.

2. Are they making grunting noises when they breath at the end of each breath?
This is also a sign of breathing difficulties

3. Are their nostrils flaring. Are they going out when they breathe in?

4. Are they using all of their tummy muscles to breathe?

Is the baby not eating like they should? Are they less energetic than they should be?

When you see these signs in a baby, it is time to call the doctor, or just take them to the emergency room.

In an child it is different. They can tell you when they don't feel good or when their breathing is not right. However, here are some signs that their breathing is not normal.

1. Frequent coughing spells.

2. Breathing faster than normal.

3. Less active than normal.

4. Feeling short of breath. Can they say a complete sentence without having to stop and take a breath?

5. Breathing with their tummy muscles, like they have just run around the block.

All of these are signs of Asthma. All of these are reasons to get your child to the doctor as fast as possible or to the Emergency if the symptoms are serious enough.

Again, you will need to seek the advice and help of a Pediatric Pulmonolgist. The things that they will do to treat your child's asthma can include the following:

-Peak Flow monitoring
-Nebulizer Breathing Treatments with Bronchodilators and corticosteroids
-MDI (Metered Dose Inhalers) Therapy which can include the rescue inhaler, long lasting bronchodialators, and corticosteroid MDI's
-Allergy Medication

Please remember that your child's breathing is a serious matter. If they complain of being short of breath or if you notice any signs and symptoms of them having any difficulty breathing, you need to get them help immediately.

The American Lung Association says, "When you can't breathe, nothing else matters..." This is very true. I wish you and your child free and easy breathing.

How To Recognize Asthma Symptoms In Infants

How scary is it to see your little baby breathing kind of "funny"? Very scary. What is wrong? Here are some ways to recognize if the baby's abnormal breathing are symptoms of asthma or some other breathing difficulty and what to do when you see them. Most doctors say that you cannot diagnose asthma so early in infants. But when your baby is having difficulty breathing, nothing else matters.

1. High respiratory rate. The normal breathing for a baby is about 30 to 40 times a minute. If their breathing is over 50, seek medical attention. If it is greater than 70, call your doctor on the way to the Emergency Room. It is so very important to take your baby's breathing seriously. A high respiratory rate can be signs of different things, but it is certainly not normal. Fever, asthma, colds, pneumonia are just a few things than can cause an abnormally high respiratory rate.

2. Tummy Breathing. Is your baby using all of their muscles to breathe? Is their little tummy moving hard trying to help get the air in? This is a big sign that they are having difficulty breathing. Take your baby to the doctor or the emergency room whenever you see this particular sign.

3. A sudden high pitched wheezing noise. I have personally experience this with my one year old. I am thankful for my Respiratory Therapy teaching and my profession. I kept telling everyone that this was not normal and that I think he inhaled something into his lung. Well, finally after four days, I got someone to listen (our pediatrician) she sent us to a specialist who pulled the little piece of something out of his lung. When the noise happens suddenly, it usually is some foreign body that has been sucked into the lungs and needs to be removed as quickly as possible. This is a partial airway obstruction. If the baby has a complete airway obstruction, it is deadly and you need to get it out. Put their head in a down position and pound on their back to dislodge it. If you are having difficulty getting it out call 911 and continue to work on getting it out. The baby is not breathing and this can result in death. Move quickly, but keep your head about you.


[If you know that something is different about your baby that is disturbing to you, keep telling your medical professionals until someone listens to you. No one knows what is normal for your baby more than you do. Trust your parental instincts]

4. Grunting Respirations or Nasal Flaring. This is the baby working at breathing. Working hard to keep the little airways open and to get in as much air as possible. Also a sign to get medical help immediately.

5. If the baby is less active than normal and listless. Get medical help immediately.

6. Blueish tint of the fingernail beds and the lips. Call 911. This is a signal that the baby's oxygen in their blood is low and they are unable to correct it. They need supplemental oxygen immediately.

7. Poor feeding. If the baby can't breathe well, they are not going to want to eat.

These are just a few of the signs and symptoms to look for when you feel that something is not right with your baby. When the breathing is concerned, it is so very important that you take immediate action. Breathing is life. When one is having difficulty breathing...well....the American Lung Association says it best:
"When you can't breathe, nothing else matters."

How Sleep Apnea can Affect Your Brain

This is your brain! This is your brain without sleep!

Your body and brain need sleep to function normally. The body needs a good amount of deep sleep called REM sleep. This is the sleep when we dream. People with sleep apnea are waking up so often during the night without even knowing it, to gasp for a breath of air, that they never really get to fall into that deep sleep so necessary for the body to rest. Without the correct amount of rest for the brain, it becomes tired.

A person with sleep apnea might fall asleep during the day just because they are tired. Memory losses have been tied to sleep apnea.

Accidents at the job and on the road happen when a person is unable to sleep a sound sleep. Narcalepsy is where a person can be awake one moment and then zippity do dah they are asleep. This can be misdiagnosed in someone who has sleep apnea.

Mood changes can also happen when the mind is unable to rest. A person might be the nicest guy in the world....suddenly explode and hate everyone.

Depression and anxiety are also effects of sleep apnea.

The way that sleep apnea can be diagnosed is through a sleep study. The good news is that it can be treated. A person should not put this off for very long as other things might take place. Right sided heart failure, high blood pressure, heart attack and even death can be things that happen to a person who refuses treatment for their sleep apnea. When you go and see your Pulmonologist, he/she will recommend a sleep study. At the sleep study, they will hook you up to all kinds of different devices to see how you are sleeping. If indeed you do have OSA, the most common form of treatment is CPAP (continuous positive airway pressure).

This device will help keep the airways open.
If you have ever watched anyone sleep who has obstructive sleep apnea, it might seem strange for a while, then, it gets familiar, and then it turns into, "well, that is just how he sleeps." It is dangerous not to get Obstructive Sleep Apnea treated. A lot of people refuse to wear CPAP because, "it looks funny", "it feels uncomfortable", "it blows in my eyes". Whatever the reason, it is better to go ahead and wear the CPAP then to make excuses not to wear it.

There is surgery to remove the excess tissue of the throat. I have only seen this done twice. Once was a friend of mine. She said her throat was sore for months. It is a more drastic, invasive measure, but it is also used to correct this problem.

I say which ever way you use to help you keep breathing at night is good. Just don't ignore the problem. It will not go away and will eventually lead to you being hooked up to more invasive devices than the CPAP machine.

Breathe each and every Breath!

How Sleep Apnea can Affect your Heart

There are two types of sleep apnea. There is centralized sleep apnea in which the brain forgets to tell the body to breathe. Secondly, there is obstructive sleep apnea, the most common of the two, it is caused by a blockage of the airway, usually when the soft tissue in the back of the throat blocks the airway causing the obstruction.

What happens when someone continuously does not breathe or is unable to get oxygen into the lungs is that the oxygen level in the blood drops. When this happens, the brain tells the heart to work harder to circulate the blood in the body to get some oxygen from those lungs. What usually happens is the person wakes up and takes a breathe and goes back to sleep and continues to obstruct. This happens though out the time when the person is sleeping. The strain on the heart is very serious and several things can occur.




1. High Blood Pressure

The heart is working hard and pumping hard and not getting a lot of work done, the blood pressure goes up.

2. Right sided heart failure (cor pulmonale)

What happens when the heart tries and to get oxygen from the lungs, it becomes enlarged on the right side and begins not to be able to pump the way it should. Right sided heart failure. This can result in Pulmonary Hypertension, which is very, very difficult to treat.

3. Heart Attack

The heart is saying, "I need oxygen, I need oxygen, I need oxygen, I am dying, I need oxygen...heart attack...."

4. Stroke

Same as the above. The brain needs oxygen to work. When it doesn't get it for extended periods of time, the brain can die.

5. Cardiac Arrest

The body is not made to go with out breathing for too long at all. The oxygen in the body is quickly consumed. The carbon dioxide level continues to climb with no where to go but the blood. The pH of the blood in the body falls. If it gets low enough, the body dies. The heart dies. The brain dies. Everything stops...Cardiac Arrest.

Treatments for Obstructive Sleep Apnea are as follows:

The most common form of treatment is CPAP (continuous positive airway pressure). This device will help keep the airways open. If you have ever watched anyone sleep who has obstructive sleep apnea, it might seem strange for a while, then, it gets familiar, and then it turns into, "well, that is just how he sleeps." It is dangerous not to get Obstructive Sleep Apnea treated. A lot of people refuse to wear CPAP because, "it looks funny", "it feels uncomfortable", "it blows in my eyes". Whatever the reason, it is better to go ahead and wear the CPAP then to make excuses not to wear it.

There is surgery to remove the excess tissue of the throat. I have only seen this done twice. Once was a friend of mine. She said her throat was sore for months. It is a more drastic, invasive measure, but it is also used to correct this problem.

I say which ever way you use to help you keep breathing at night is good. Just don't ignore the problem. It will not go away and will eventually lead to you being hooked up to more invasive devices than the CPAP machine.

As far as treatment for Centralized Sleep Apnea it seems to be a little more complicated. The Doctors will need to find the cause of the problem. It can be something as obvious as paralysis or brain tumor. It can also not be easy to find the problem.

Treatments include the following:

Treatment for this rather serious issue varies from person to person. However, it can be treated with drugs that treat the underlying causes, such as Acerazlamide and Theophyllinr, which stimulate the need to breathe.

In other cases CPAP or continuous airway pressure is used. There are other drugs that are sometimes uses such as Protriptolyne and Klonopin. Still other individuals receive low dosages of oxygen throughout the night.

Breathe each and every Breath!

What Happens When a "Code Blue" is Called in a Hospital

"Code Blue Intensive Care Unit" "Code Blue Intensive Care Unit"


When these words are announced over head, my heart always skips a beat. I am one of the people who is usually on the Code Blue Team. I am a Registered Respiratory Therapist. Here is what goes on in a Code Blue situation. It may differ slightly from hospital, but in the big scheme of things, there are certain steps that are followed.


A nurse, doctor, x-ray technician, Respiratory Therapist, or whoever enters a room. When they look at the patient, they can see that he is not breathing. They go over to feel for a pulse, they cannot feel one. In every single hospital I have worked in, there is an emergency phone number to get this message out, someone is actively dying or has died. "Code Blue and the location is announced overhead several times. It also comes across the Code Team Pagers. Immediately, people and actions are set into motion.

(I would love for it to be as pretty as it is on TV where the patient comes out in better condition than what they went in. I would love if performing CPR on a patient could heal all of their illnesses. This is NEVER the case.

1. The person who found the Patient initiates CPR or cardiopulmonary resuscitation. This includes giving the patient breaths and pumping on their chest to imitate the hearts pumping action. This is done until the Code Team arrives.

2. The Code Blue Team consists of several people including but not limited to the following: Physician, 2 or 3Intensive Care Trained RN, 3 Respiratory Therapists, lab, and even Pharmacy. Also showing up are students who need the experience of dealing with CPR. Of course, there are the gawkers. Those who do nothing but think they should be there for support. That is why there is a person assigned for crowd control. The Physician is the one who is supposed to run the Code, The ICU Nurses are the ones supposed to start new IV sites and push the medications. They are also the ones that shock the patient when the patient's heart is in a rhythm that can be shocked. They also sometimes take turns with the compressions. The Respiratory Therapists are in charge of getting an airway by intubation (also can be done by physician), setting up the life support (ventilator), getting arterial blood gases, and doing chest compressions.

3. The first thing that happens to the patient in a Code Blue situation when the code team arrives is that every stitch of clothing on the person is stripped off. The person is totally naked. This enables the code team to start lines, check for pulses, locate the proper place to do chest compressions and assess breathing. The patient is quickly assessed for pulse, heart rhythm, and breathing.

The second thing that happens to the patient is that they are hooked up to monitors to determine what rhythm there heart is in. In the mean time, The doctor or the respiratory therapist is putting a tube in their mouth, down their throat, and into their lungs. When this tube is in place and it is determined that it is indeed in the lungs and not in the stomach, the Respiratory team will then start giving the patient oxygen via a bag. The most common name for this bag is Ambu bag. By this time, the cardiac monitor leads will have been placed on the patient, IV's started, labs drawn-all of this with in just a couple of minutes.

4. What is the heart doing? Is it beating wildly, but not effectively. Is it in a life threatening arrhythmia? Is it in a rhythm that can be shocked or not? If the heart is in a shockable rhythm the pads have already been applied to the patient.





The days of putting gel on these two big old hand paddles and rubbing them together are over. The thing that is not over is the yelling of the word, "CLEAR" and believe me...you want to not be touching the patient or any part of the bed. They will put electricity through the chest into the heart to try to get it to (believe it or not) calm down. They have the option to shock at different electrical strengths to get the job done.




If the heart is not in a shockable rhythm, is it in a rhythm that is fixable? Can we give fluids to help. Can we give drugs that will speed up the heart, slow down the heart, stop the heart for a brief shinning moment?

Is the patient asystole? There is no heart rhythm at all....only a flat line.
This is probably the most ominous rhythm that there is. It means that there is no life in this patient. More than likely, their soul has left the body.

During all of the above things that are going on, someone is right up on top of that patient pushing hard on their chest, doing chest compressions. Someone is breathing for that patient, someone is putting a tube in the patients nose and down to their stomach to keep too much air from going into the stomach causing the patient to vomit, someone is putting a Foley catheter into the patient's bladder, and someone is probably praying for the patient.

More than likely, the patient has had a bowel movement all over themselves and they have blood coming from different orifices because everything is done in an emergent situation.
If we get the patient back...if we get their heart beating, they are immediately taken to a Critical Care Unit where they are placed on life support. Most patients do not "come back". A lot of patient's who do come back, insist on dying a little bit later. Some actually get well and go home.
Do I sound discouraging. I don't mean to, it is just that on TV so many things are made to be nice and easy...and getting a person back from death's door is not easy at all. Some people no matter what you do will insist on dying. Some people should be allowed to die without the indignity of being put through a code blue situation.

It is a really difficult situation and decision that has to be made. Ideally, the decision should have been made long before it is needed, and family members should have been made aware of the Patient's wishes. This is what should happen. However, death is sometimes hard to speak of, but it is one of those necessary things that needs to be done.

People who should be allowed to die with dignity without having to go through a code blue situation:

1. People who do not wish to be placed on life support
2. People who are elderly who do not wish to be placed on life support
3. People with cancer who do not wish to be placed on life support
4. People who have illnesses that they are never going to recover from and do not wish to be placed on life support.

So you see, it is my opinion that people, families, care givers and loved ones need to sit down and talk about end of life issues. Do they want to go through everything that I just explained up there.

We had a woman in the hospital. She was not brain dead but she had very little brain function left in her. She had already been placed on life support. The family wanted everything done. What I was finally able to get across to the family was this: What they see is what they were going to get. If we do all of the work on her and save her life, her brain is still not going to function. She will never breath again on her own, she will never speak to them again. When we were able to impress upon the family that their loved one, the person that they knew and loved was gone, we were able to move on ... and more importantly, so was that family. They all said their loving good byes and we let her go on to heaven.

It is my hope that someone who reads this will learn just a few things from it and with this information be able to make a good, educated, and loving decision when these end of life issues come about.

Chantix: The New Quit Smoking Drug--Does it Really Work?

Can I have a Whoooooo hooooo? A drug that actually will work for those who want to quit smoking.

I work in the health care field. As a matter of fact, I am a Respiratory Therapist. Now you would think that amongst those who deal with people who cannot breathe because they have smoked, you would think that they would be able to quit. Well, I hate to tell you, heath care professionals can get addicted too.

One day my friend told me that in a few months her daughter was going to have a baby. My friend, a chain smoker, who loved smoking was going to be a grandmama. I told her that she had to quit smoking. Her daughter encouraged me in trying to get her to work on her smoking addiction. Soon after that, she came into work and told me that she honestly had quit smoking and the way she had done it was with Chantix. One of the RN's that I know has quit and two other Respiratory Therapists have quit.

Here is my disclaimer: Nothing will work for a person who does not wish to quit smoking. Some people enjoy smoking and they absolutely do not want to quit. Guess what, Chantix will not work for them...nothing will work for them short of dying from suffocation from not being able to breathe.

Go to a Pulmonologist or an internal medicine doctor who is very familiar with the new drug. Sometimes they will start a person on Welbutrin and Chantix. It all depends on the doctor. I recommend Pulmonologist, because the lungs are their specialty.

If you want to quit smoking, give Chantix a try. I hope that it will work for you.

Is Smoking Around Children Child Abuse?

This is a very difficult subject, yet one that I feel very strongly about. I cannot emphasize to my readers and to my patients on how dangerous smoking is for their own health. Studies have shown that it is even more dangerous to smoke around others. For those who cannot fight back, our children, I feel the need to speak out. There are many times when I ask one of my patients who is having difficulty breathing if they still smoke. (Smokers lungs have a definite way that they sound) When they tell me that they have never smoked, I am surprised, then I am appalled when they tell me that their parents smoked or their spouse smoked.
The damage that smoking causes to the lungs is irrefutable. The damage that a smoker can cause to their children's lungs is absolutely terrible. If we could see the damage on the outside that the smoking is causing on the inside, I believe that parents all over would either quit smoking, or be arrested for child abuse charges.

One of my good friend's husband used to smoke around his daughter...she has cystic fibrosis. I told her many times to call the police for child endangerment. She finally divorced him, one of the reasons being, that he loved his cigarettes more than he loved his children. I couldn't agree more.

There is a new drug out called Chantix. Several of my chain smoking friends who are RN's and RRT's have quit smoking with this drug. To quit smoking, the number one thing is that you have to want to quit smoking.

It is my belief that smoking around children hurts them. Therefore, it is my belief that smoking around children is indeed child abuse.

Obstructive Sleep Apnea

Wake up! Wake up! Take a breath"

Has your spouse ever woke you up with those words? Sometimes it can be frightening and sometimes, it can be annoying. The fact of the matter is this: if you have OSA, you are already waking up many, many times a night because your body is telling you that it needs some air. You just don't realize that it is happening. However, when you wake up the next day, you are not rested, you fall asleep when you are not intending to, it is all very frustrating.

Obstructive Sleep Apnea happens when the airway closes with an obstruction and the person can no longer take a breath in. They will make the effort to breathe yet they will not be able to get any air in. The heart rate slows, the oxygen level in the body drops and the body fights to breathe. It is something like drowning or suffocation. Because the oxygen level in the body drops, there are serious consequences to not dealing with ones Obstructive Sleep Apnea. The following are things that can possible happen with someone who ignores their OSA:

1. Never Rested, irritable, stress increases
2. Right sided heart failure (cor pulmonale)
3. Pulmonary Hypertension
4. Death

When you go and see your Pulmonologist, he/she will recommend a sleep study. At the sleep study, they will hook you up to all kinds of different devices to see how you are sleeping. If indeed you do have OSA, the most common form of treatment is CPAP (continuous positive airway pressure).

This device will help keep the airways open.
If you have ever watched anyone sleep who has obstructive sleep apnea, it might seem strange for a while, then, it gets familiar, and then it turns into, "well, that is just how he sleeps." It is dangerous not to get Obstructive Sleep Apnea treated. A lot of people refuse to wear CPAP because, "it looks funny", "it feels uncomfortable", "it blows in my eyes". Whatever the reason, it is better to go ahead and wear the CPAP then to make excuses not to wear it.



There is surgery to remove the excess tissue of the throat. I have only seen this done twice. Once was a friend of mine. She said her throat was sore for months. It is a more drastic, invasive measure, but it is also used to correct this problem.

I say which ever way you use to help you keep breathing at night is good. Just don't ignore the problem. It will not go away and will eventually lead to you being hooked up to more invasive devices than the CPAP machine.

Breathe each and every Breath!

Bronchiectasis - - Explained As Simple As Possible

Bronchiectasis is an abnormal widening of the large airways causing them to loose their elasticity. A person may be born with it (congenital bronchiectasis) or may acquire it later in life as a result of another disorder (including cystic fibrosis). Bronchiectasis is often caused by recurring inflammation or infection of the airways. It may be present at birth, but most often begins in childhood as a complication from infection or inhaling a foreign object.

About 50% of all bronchiectasis patients are cystic fibrosis patients. Other occurrences of bronchiectasis are when the patient repeatedly has pneumonia, tuberculosis, fungal infections, pnemocystic carini. Patients who aspirate on a regular basis also can develop bronchiectasis.

Here are some symptoms of bronchiectasis. This is by no means a complete list:

1. A chronic cough with large amounts of mucous perhaps mixed with blood.

2. Shortness of breath made worse by activity.

3. Weight loss

4. Tiredness

5. Wheezing

6. Clubbing of the fingers


Testing for Bronchiectasis:

When you go and see your doctor, hopefully a Pulmonologist (lung specialist) he/she will want to do a whole bunch of tests on you, and I do mean a whole bunch. Here are a few that they will want the results of to determine if you do have bronchiectasis and the severity of the disease. These tests include, but are not limited to, chest x-rays, chest CT, sputum culture x 3, blood tests, TB test, and even a sweat test (cystic fibrosis testing).

Now that they have put you through all of this testing, how in the world are they going to make you feel better. What kinds of treatments are required for this illness. Your doctor will be able to order several treatments.

1. Chest Physical Therapy and Postural Drainage. This is a speciality of mine since I am a Respiratory Therapist. But to do it at home will require some training of you and your family. I recently had a delightful patient with bronchiectasis and her Pulmologist decided to try the pneumatic vest on her. It worked beautifully. She was coughing up some very uckky stuff in no time at all. She said she was able to breathe better and I was doing the happy dance.

2. Antibiotics. A very heavy duty regime of antibiotics as you do not want the bugs to take up residence in your lungs.

3. Bronchodilators--MDI's or Nebulizer treatments.

4. Bronchoscopy - The doctor can go down into your lungs and suction them out and take pictures of your lungs.

Your doctor may even have more ammunition in his arsenal for fighting bronchiectasis.

What you can expect for your life or the Prognosis. Depending the extent of your illness and the length of time you have had it, you can lead a normal life, or you may need a lung transplant. Again, this is something that you will need to discuss with your Pulmonologist.

I wish you good breathing and clean lungs.

Cystic Fibrosis - - 65 Roses

Children who cannot pronouce Cystic Fibrosis sometimes call it by a much sweeter name, "65 Roses." This disease is anything but sweet.

Cystic Fibrosis. What can be said about this terrible disease? It is a heriditary disease affecting the lungs, sweat glands, and digestive system. People who have cystic fibrosis have to take medications to help breath and digestive enzymes to aid in digestion. When a child is born and it is suspect that they have cystic fibrosis, they do what is called a sweat test on the baby. If it comes back positive, some other test are conducted to confirm it. Some of the symptoms of cystic fibrosis are the following (this is in no way a complete list):

Thick mucous affecting mostly the lungs making it rather difficult to breathe. In people with CF, water and salt can not move through the tiny cells easily which makes it dry. The body then produces thick, mucus. Because of the thick mucous, many different bacteria like to make a home in the lungs causing further inflamation and mucous production. Some of the technical names are allergic bronchopulmonary aspergillosis, pseudomonus. The person with CF will be put on a regime of antibiotics and drugs that thin the mucous.

Growth issues. Most of the time CF people will not grow to be very tall and due to digestive and pancreatic issues, they are usually underweight.

Clubbing of the fingers and toes. This happens over years of low oxygen supply to the body.

Treatmenst Include:

CPT or Chest Physical Therapy. This is done usually by the parent and the Respiratory Therapist. There is always the pneumatic vest. It does wonders to help get the secretions moving.

Bronchodilators: Albuterol, Levealbuterol, ipatroprium bromide, tiatroprium bromide, to name a few of the more well known ones. These help open the lungs to aid in the coughing up of the mucous.

Antibiotics: Whether they be IV or nebulized antibiotics they help fight off the diseases that like to camp out in the mucous.

Lung Transplant: One of the respiratory therapists that I used to work with (she had to quit. Her doctor felt she was exposing herself to too many germs), she and her brother have cystic fibrosis. Both of them have now received lung transplants and are doing amazing.

To get on a lung transplant list, one has to be sick enough to be very ill, but well enough to be able to take on new organs. One of my dear friend's daughter has CF and that kind of brings the illness right home. When I went to see her, I would hear her daughter cough that deep, uckky cough and I would want to do something to make her better.

Maybe some day there will be a cure for cystic fibrosis....to learn more about this disease, please go to www.cff.org that is the cystic fibrosis foundation home.

Go Bears!! Does Watching Sports Help Breathing?

It might seem a bit ludicrous, but yes, being vocal at sports games, whether at home or at the game, breathing deep is good for you. That is why laughter is so good for you. For one thing, it releases endorphins, and the next thing is that it helps a person take deep breaths. Breathing deep helps in healing the body. It allows more oxygen into the system for your hemoglobin to circulate in the body. Good circulation and good oxygenation assist in healing. That is why when someone has surgery, shortly after surgery the Respiratory Therapist shows up with that Incentive Spirometer to make you take deep breaths. I helps prevent pneumonia and promotes healing. Breathing deeply also relieves stress. If you have ever heard anyone tell someone, "Calm down and take a deep breath". That is actually medically correct.





So cheering at those football games...yelling at the TV....you can now tell everyone that you are doing it for good health and better breathing!!

Life is good. Breathe Deep!!