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How does dehydration make lungs sound?

Today we tackle your RT questions

Your question:  How does dehydration make the lungs sound?

My humble answer:  Usually if the patient is dry secretions may dry in the throat and this causes an audible wheeze or stridor.  This happens often with patients admitted with ETOH (alcohol abuse) and who go through detox.  They usually have that audible wheeze that's often confused with a true bronchospasm wheeze.  We had a patient this past weekend who was dehydrated secondary to multiple myelomas. In fact, the doctors overhydrated her to the point she had wheezes due to fluid overload (which would be your cardiac wheezes).  It annoys doctors and nurses and family members, so it's treated as bronchospasm with Albuterol nebulizers every 4 hours.
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Off Label

Off Label is a term used to describe use of a medicine for uses not approved by the Food and Drug Administration (FDA) and not recommended by the pharmaceutical company. It refers to any of the following:
  • Using unapproved dosing
  • Using a medicine for an unapproved conditions
  • Prescribing a medicine for an unapproved age group
Despite contrary belief, prescribing medications off label is perfectly legal in the United States.  This is a good thing because it allows doctors a right to use a medicine to its full potential and this greatly benefits patients.

A good example is a medicine we respiratory therapists use on a regular basis.  The recommendation is for Albuterol to be prescribed for use every 4-6 hours as needed for shortness of breath.  The medicine is not recommended for children under the age of two because there have been no studies using Albuterol for this age group.

To gain approval by the FDA a pharmaceutical company must perform studies and make recommendations for use of a medicine.  This is basically for liability purposes.  A doctor may prescribe the medicine for other uses and doses, yet by making such recommendations, the pharmaceutical company is not held liable for off label uses of their medication.

Most doctors know there are asthmatics and COPD patients who need to use Albuterol more often than the recommended dose.  I can tell you first hand Albuterol is very safe when used above the recommended frequency.  When I used to have hardluck asthma I used it as needed with the approval of my doctor so I didn't have to go to the ER every day.

Likewise, Albuterol is used on pediatric patients with good results.  It is also used in emergency rooms at continuous doses to help asthmatics breathe better.  Clinical studies -- and personal experience of many doctors, nurses and RTs who work in ERs -- show that Albuterol used in this off label fashion works just as well as epinephrine without the side effects.

Many cancer medicines are used off label.  Even morphine can be used off label.  Pulmicort was recently prescribed by one doctor for a patient to squirt in his nose to help with nasal inflammation.  This is an off label use of the medicine and worthy of a trial by that patient.  

I guess you can say that using a medicine off label is an option when all other options for treating a disease have been exhausted.  It's done to the benefit not just of the patient, but all other patients who may need such a medicine for an off-label indication in the future.

Off-label use of a medicine is a good method of allowing the doctor and patient decide what's best for the patient as opposed to the government. 
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Causes of Melasma

Scientists are still wondering on the exact causes of melasma. Since this is a condition rather than a disease it has been difficult for the researchers to pinpoint the causes. The views are divided among many but still there are some common grounds where the researchers have stood upon firmly.
Pregnancy, birth control pills and hormone replacement therapy, these three are the undisputed causes to which all have consented. Pregnancy is the primary cause of melasma because of the rapid and constant hormonal changes that takes place when one is expecting. Medical science says that the body of pregnant women experience three different types of hormones, namely estrogen, progesterone and melanocyte-stimulating hormone (MSH) during the second and third trimesters of pregnancy. As per medical studies, progesterone is found more responsible for pregnancy related melasma than estrogen and MSH. Similarly studies have also revealed that postmenopausal women receiving progesterone hormone replacing therapy are detected more with this condition than their estrogen counterparts.
Uncontrolled sunlight exposure is considered the major cause of melasma for those who are not pregnant and have a genetic predisposition to this condition. Sunlight is responsible for this dark pigmentation, the UV rays present in sunlight cause to release excess melanin that results in melasma. Even though these are shouted as the major causes actually the exact cause behind melasma is still not found. Scientists in their lab are working harder day and night to reveal the truths behind this condition.
A research has shown that the incidence of melasma are the highest in summer whereas in winter the numbers are lower. Also those women with a light brown complexion and living in regions with intense sun exposure are more vulnerable to this condition. This is because when the skin is exposed to sunlight, more melanin pigments are produced by the female sex hormones estrogen and progesterone. An interesting fact is that the possibility of melasma is higher in patients with thyroid disease. This condition is also prevalent among those who take high stress due to the over secretion of melanocyte stimulating hormone (MSH). Melasma is also detected rarely in cases of allergic reaction to medications and cosmetics.
There are many other secondary causes of melasma that are widely debated. These include several factors like family history of melasma, race, antiseizure medications and other medications that make the skin more susceptible to pigmentation due to the direct exposure to ultraviolet rays. Anyway the causes of melasma are certainly not limited within a periphery.
Michael has been writing articles online for 10 years. Check out his latest website Instantaneous Water Heater which help people find more about inline water heaters.


Article Source: http://EzineArticles.com/4837902
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What's the difference between asthma control and severity?

The following is from healthcentral.com/asthma.

"Asthma Control vs. Asthma Severity:  What You Need to Know" (originally published 6/6/11)

How severe is your asthma?  Is it under control?  Does it matter?  It seems the new recommendation is that asthma severity is out and asthma control is in.  So what does that me for me and you?

To help us decide I think a few definitions from The National Heart, Blood and Lung Institute's Asthma Guidelines are in order here:

Asthma Severity: This is basically how bad your asthma is BEFORE you are on any asthma medicines, or how bad your asthma would be if you quit taking your asthma controller medicine.

The level of severity is best assessed when you are first diagnosed with asthma, and it helps your doctor determine the future course of therapy that will work best for you. This is generally measured to initiate asthma therapy.

The levels of severity are generally classified as:
  • Intermittent
  • Mild persistent
  • Moderate persistent
  • Severe persistent
The problem most doctors have with diagnosing severity is most patients are already on asthma medicine before they are seen, so determining severity by the above definition is pretty much a guessing game.

If you're like me you'd love to know how severe your asthma is, yet you won't want to quit taking your athma controller medicine to find out.

Asthma Control:  This is basically a measure of how normal your life is compared to other people your age. It's measured once you are on asthma controller medicine and measures of how well your asthma therapy reduces asthma symptoms and impairments.

Control is generally measured to adjust your asthma regime. By measuring this at your doctor visits your doctor may tweak your medicine regime and/ or your asthma action plan, or keep things as they are.

It's measured by:
  • The degree your symptoms are minimized (short of breath, wheezing, etc.)
  • The degree your impairments are minimized (ability to exercise, walk, live a normal, active life)
  • The degree to which your goals of therapy are met (I'm able to exercise without limitations.  No school or work days missed.)
According to the Global Initiative For Asthma (GINA) asthma guidelines, the classifications of asthma control are:
  • Controlled
  • Partly controlled
  • Uncontrolled
To learn how to tell if your asthma is controlled click here, or you can click here to download a neat pocket guide created by GINA that defines controlled, partly controlled and uncontrolled asthma.

So it's neat to know how severe your asthma is, yet experts have learned that monitoring level of control is a better way of monitoring your asthma status and adjusting your asthma meds as needed.

Still, regardless of how severe your asthma is, by being asthma smart most asthmatics can obtain good asthma control.
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Healing the Generations 2012

I had the privilege of attending the Healing the Generations conference at Foxwoods this past Thursday and Friday. As usual, Alice Forrester and her Clifford Beers team put together a highly informative and restorative conference, with great organization and good food. The theme of this year’s conference was Trauma and the Brain.
What struck me the most was the fact that many different researchers and practioners, all coming from difference disciplines, focus and research methods all reach the same basic conclusions. These seem to be…
Relationships matter. There is so much evidence now of neglect and abuse impacting brain development, and of the possibility for healing within relationships.
Childhood stress impacts brain development in many areas, and thus has great implications for both education and physical health.
Healing cannot be maximized with just verbal interventions. Treatment that includes body based activities has the most potential. These include EMDR, yoga and meditation, but also include walking, rocking, tossing a ball back and forth, etc.
Music has tremendous power to organize, heal and sooth the brain.
I also learned about several promising treatment programs that were showing results with both children and parents. One interesting approach presented by Phil Fisher, PhD. From Harvard videotaped parents’ interactions with their children and then edited out clips of the parents doing good things, like attending and responding to their child. They played these clips back to the parents and said, do more of this. I liked the building-on-strengths approach.
Another intervention called RULER was described by Marc Brackett, PhD. It was a method for teaching emotional intelligence within schools. Dr. Brackett stressed the importance of teaching the method to “everyone with a face” including administration, cafeteria staff, teachers, etc. It sounded very promising.
I presented on Using the New Brain Science to Do More Effective Treatment…and Have more Fun at Work. I got a lot of compliments on my presentation.
One of the most moving workshops I attended was a dramatic skit about vicarious traumatization by the Post Traumatic Stress Center in New Haven. Through a play they demonstrated the feelings of vicarious trauma that are part of our work. It generated a lively discussion among the audience.
Over all, a very worthwhile experience.




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It's time to slow down

When you face a personal crisis, one of the first pieces of advice of any personal health expert will be to tell you that you need to is slow down. You need to simplify things. The best way to organize, or re-organize, your life is to simply slow down.

That kind of wisdom goes back thousands of years. It usually take either an expert or a person who is experienced to see that the best way to solve a problem is to slow down, to analyze the problem, and then to tackle it slowly. This allows one to think better. This allows one to see the whole picture.

A great example of this is landing an airplane, or so I hear.. If you are landing a plane and meet resistance, or a draft, what happens next is determined by the action of the pilot. A natural instinct of an amateur is to speed up. They think that by going faster this will allow them to get through the problem.

Yet what happens is he meets more resistance. The ride gets very bumpy. The problem gets worse.

The expert pilot, or the pilot with experience, will know that the best way to respond to a situation like this is to slow down. You slow down and you glide right in and the solution is easy. You land and end of story.

When you or I start to feel a financial pinch, we slow down. We spend less. We try to get our finances under control. This is what we must do or we will fail. We will have to file for bankruptcy.  When our lives get stressful, we don't tack on more tasks:  we slow down. If we speed up we go bonkers.  

Those in Washington are another good example. Washington in recent years is run by amateurs. Most are career politicians.  Most have never worked in the private sector. They see a problem and they want to solve it by spending more and creating more programs. They don't get it.

They don't see that by speeding up in this way they are just creating more friction. They are making the problem worse. In the late 1800s Grover Cleveland was asked to speed up during a recession, and instead he refused. He said something like, "When times are tough we must slow down, not speed up.'

Yet Cleveland was a wise man of the working class before he became President. He understood how to solve problems. He understood the importance of slowing down. Within a year the economy had improved. He stood on the sidelines, did nothing, slowed down, and that was it. Problem solved.

That's how resistance was treated on the national level back in the 1800s. Washington slowed down in the face of adversity. While there were many recessions and depressions in the 19th century, they were only 1-3 years max.

Yet now that our leaders are career politicians instead of working class people who understand how to solve problems by slowing down, they don't know how to lead. A good example here is FDR and Hoover. Instead of slowing down in the face of adversity they sped up. They spent and they created and the Great Depression went on and on and on.

The same is happening today. Instead of George Bush and Obama slowing down, they sped up. The problems of this nation did not get better. The recession lingers on. They do not understand the importance of slowing down; of getting out of the way; of looking at the big picture.

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RT Shaking

My boss asked me why I was shaking so much when I came in to work this morning, and I simply held out my hands, noticed I certainly was shaking, and I said, "That's because I dread coming into work when it's like this."

"Like what?"

"When it's busy like this for no reason."  I showed her the clipboard and pointed to the diagnosis next to the 20 names:  pneumonia.  "I have to medicate myself up so I can cope with it."

"What!!!  You take drugs?"

"Yes," I said with a smile. "It's called a couple extra puffs of ventolin and two whopping large cups of coffee."

"Oh," she said.

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