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RT 9-5 ON14 R5.Indd Volume 9 Number 5 October-November 2014 The Journal of Pulmonary Technique Ad Page 2 INTRODUCING Acoustical Percussor The New Sound of Airway Clearance Therapy A Paradigm Shift in Respiratory Care Consider the Many Advantages Can you hear it? It’s the new sound of the Vibralung® of the Vibralung Acoustical Percussor Acoustical Percussor, and it’s starting a revolution in Airway ✜ Easy to operate; battery-powered, lightweight Clearance Therapy (ACT). The Vibralung Acoustical Percussor and portable, can be used almost anywhere applies vibratory sound waves over a wide range of frequencies (5 to 1,200 Hz) to vibrate the column of gas in the tracheo- ✜ Requires only minimal patient effort with bronchial tract. As a result, mucus is loosened and separated normal breathing throughout the airways to promote safe, effective and gentle ✜ No patient discomfort; no contact with the ACT like no other alternative. external chest wall ✜ Treatment times are quick and efficient The Gentler Approach to ACT ✜ The Vibralung Acoustical Percussor is Unique coupling of acoustical energy (sound a gentler form of ACT than oscillatory waves) directly to the airway gently vibrates the airway surface to loosen secretions PEP devices, or those that make contact with the external chest wall. It may be ✜ Sole therapy or adjunct to other methods/devices especially useful for airway clearance ✜ Optional simultaneous aerosol delivery therapy when other means like vests ✜ and hand-held chest percussors cannot be used. It’s the Incorporates delivery of PEP (Positive Expiratory Pressure) ideal choice whenever airway clearance is the goal and patient comfort is preferred. ✜ Works during both phases of the breathing cycle To schedule a demonstration or for more information, visit www.vibralungACT.com, or email: [email protected] © 2014 Westmed Inc. All rights reserved. 71328 Rev.01 Rev.01 Inc. All rights reserved. Westmed 71328 © 2014 Westmed, Inc. | www.westmedinc.com | 800.975.7987 ext. 1842 When Your Care Is Critical Westmed PLACED.indd 1 2014-06-27 11:52 AM Vibralung Ad-F1.indd 1 6/26/14 9:57 PM THE RIGHT RESULTAd Page AT 3 THE RIGHT TIME Blood Gas & Electrolytes on a PDA in about 30 seconds The epoc® Blood Analysis System improves patient safety, provider satisfaction, workflow and operational efficiencies by eliminating steps, making it safe and cost effective. n Wireless communication of results n Room temperature storage of Test Cards n 11 Analytes on 1 Test Card: • pH, pCO2, pO2, Na+, K+, Ca++, Glu, Hct, Lac, and now *Creatinine and *Chloride n Calculated values: • cHCO3-, cTCO2, BE(ecf), BE(b), cSO2, cHgb, *eGFR, *eGFR-a, *AGap, and *AGapK Improve the process and the outcome with the epoc® Blood Analysis System *Contact your Alere sales representative, call 1.877.441.7440 or visit alere.com © 2014 Alere. All rights reserved. The Alere Logo, Alere and epoc are trademarks of the Alere group of companies. epoc is a trademark of Epocal Inc. under license. 10001905-02 04/14 Alere AS14 PLACED.indd 1 2014-06-17 7:59 PM Volume 9 Number 5 October-November 2014 Editorial The Journal of Pulmonary Technique The Importance of Leadership Rounding Today’s respiratory care directors, educators, and even front-line coordinators are Vol. 9 No. 5 often inundated with a plethora of regulatory and institutional responsibilities and duties. Granted, in order to thrive, many of these responsibilities are critical to the October-November 2014 development and function of today’s respiratory care department. However, visible leadership is also crucial in maintaining a strong and thriving department. These administrative responsibilities and duties frequently contribute to extra office time and reduce clinician time availability. Table of Contents Usually department leadership is composed of clinical experts with a cornucopia of clinical experiences. Many of these leaders were excellent bedside clinicians with expertise in patient management, technology utilization, and problem solving. Their DEPARTMENTS expertise should not be subject to dormancy but available for staff to utilize to optimize patient outcomes. 8 Editorial 10 News Currently the majority of respiratory care practitioners at the bedside are often new graduates or those who have limited clinical expertise or diverse experiences. Spotlight On Spirometry 15 The proficiency of care and knowledge of technology administration of department 15 Spotlight On Bloodgas leaders can enhance and facilitate the learning processes of the “greenhorn” staff. As well as demonstrate the worth of the respiratory department in tough or unique 16 Sleep Roundtables clinical situations. ARTICLES Other benefits from rounding with the clinical staff is it shows that the leaders understand the staff’s working environment, what they are subject to and/or managing as well as the staff’s responsibilities. This is vital for “seasoned” staff Heliox Therapy in Bronchiolitis 18 who often feel neglected. Rounding allows for the “teachable moment” which can 20 CPAP Use in the Post-Operative be invaluable in the growth and learning of unseasoned clinicians. These bedside Environment situations can strengthen the leader to staff relationships and help foster future communications. Leaders should incorporate daily rounding into their daily 23 Benefits of Using a Portable Ventilator schedules, not just to collect QA data, but to engage and support their bedside staff. 24 Biphasic Cuirass Ventilation Daily rounding should be a goal for all department leaders. Being prisoners to their Approaches offices will get assignments completed but a valuable part of being a leader will be 29 Postoperative Respiratory squandered. The staff depends on leadership’s expertise and knowledge, keeping it held captive in their offices, will prevent the department from reaching its highest Compromise summit of success. 31 High-frequency Chest Wall Oscillation 36 Oxygen Therapy and Congestive Heart Failure Kenny Miller 41 Clinical Experience Using Inhaled Kenneth Miller MEd, RRT-NPS, AE-C Educational Coordinator Epoprostenol Dean of Wellness 43 Application of the Breathe NIOV Respiratory Care Services LVHN Device 45 Vibralung Acoustical Percussor: A New Paradigm 48 Effects of Exhaled Nitric Oxide on Adolescents 4 Respiratory Therapy Vol. 9 No. 5 n October-November 2014 Do you see it? Look again. Ad Page 5 It might be bronchiectasis. Bronchiectasis is a condition where the lungs’ airways are abnormally stretched and scarred resulting in mucus retention. Sometimes when you see COPD, chronic bronchitis, pneumonia, asthma or cystic brosis, you might also be seeing bronchiectasis. Scan and look again. A high-resolution CT scan can help determine a diagnosis of bronchiectasis. Early diagnosis and intervention is the key to slowing the disease progression and helping your patients Breathe a Little Easier.™ The Vest® Airway Clearance System is one therapy option for patients with bronchiectasis. Learn more by calling 800-426-4224 option 3 or visiting www.thevest.com The Vest® and Breathe a Little Easier™ are trademarks or registered trademarks of Hill-Rom Services PTE Ltd. Enhancing Outcomes for Patients and Their Caregivers is a registered trademark of Hill-Rom Services, Inc. The Vest System is o ered in the home by Advanced Respiratory, Inc, a Hill-Rom company. Hill-Rom reserves the right to make changes without notice in design, speci cations and models. The only warranty Hill-Rom makes is the express written warranty extended on sale or rental of its products. © 2014 Hill-Rom Services PTE Ltd. ALL RIGHTS RESERVED. ORDER NUMBER 186921 rev 2 07-JUL-2014 ENG – US Editorial Advisory Board Mohammed Al Ahmari, PhD, MSc, RRT Dr. Miguel Goncalves Kenneth Miller, MEd, RRT-NPS, AE-C ISSN 2152-355X AARC Intl Fellow Pulmonology Department and ICU and Clinical Educator, Dean of Wellness, Published six times each year by Director, Respiratory Care Program Emergency Department Respiratory Care Services Goldstein and Associates, Inc. King Fahd Military Medical Complex & University Hospital of S. João School Lehigh Valley Health Network 10940 Wilshire Blvd., Suite 600 Prince Sultan College of Health Faculty of Medicine Allentown, PA Sciences University of Porto, Portugal Nawal M. Mofarreh Los Angeles, CA 90024 USA Al-Khobar, Saudi Arabia Joshua F. Gonzales, MHA, RRT-NPS, MBBS, Arab Board-Internal Tel: 310-443-4109 · Fax: 310-443-4110 Prof. Nicolino Ambrosino, Head, RRT-SDS, RCP Medicine I, Cardiac Center- E-mail: [email protected] Pulmonary Unit, Cardio-Thoracic Associate Professor Al-Thawra General Modern Hospital, Website: www.respiratorytherapy.ca Department Department of Respiratory Care CPR Instructor & Co-Ordinator University Hospital, Pisa; Head, Texas State University Saudi Heart Association in affiliation Publisher/Editor in Chief Pulmonary Rehabilitation and San Marcos, TX with American Heart Association, CPR Steve Goldstein Weaning Unit Rik Goselink, PT, PhD Center, Al-Thawra Hospital Auxilium Vitae, Volterra, Italy Professor, Rehabilitation Sciences Sana’a-Yemen Managing Editor Christopher Hiscox Muhammad Aslam, MD Dean, Faculty of Kinesiology and Richard J. Morishige, MS, RRT, RCP, Senior Editor Chris Campbell Associate Professor of Pediatrics Rehabilitation Sciences RAC News Editor Vincent Terrier University of California Irvine Universitaire Ziekenhuizen Leuven/ Director, Clinical Affairs Associate Editor Jordana Hammeke Neonatologist Katholieke Uniersiteit Leuven, Belgium Breathe Technologies, Inc., Associate Editor Susan Goldstein UCI Medical Center Charles J.
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