Resp Care
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The recent introduction of the hand-held computer has provided an important new tool for the medical team. The device is inexpensive, portable, and operator-programmable in BASIC. We describe software for a spirometry program with computer-generated interpretation as an example of numerical calculation and logical decision making.
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The esophageal obturator airway (EOA) was introduced for clinical use in 1973. There have been few controlled studies on its effectiveness or safety; those published had differing results--one showed no clinically significant difference in PaO2 and PaCO2 between EOA and tracheal tube, while two others reported slightly increased PaCO2. Subsequent modifications include the esophageal pharyngeal airway, esophageal gastric tube airway, and Vermont, or Pilcher, model. ⋯ It is contra-indicated in the conscious or semiconscious patient, in children, for more than 1-2 hours, and in known cases of esophageal trauma or pathology. The most commonly reported hazard is esophageal perforation; others include tracheal intubation (which is actually the most common hazard), failure to seal mask, failure to pass tube, incorrect assembly of mask and tube, the tube's becoming an intragastric foreign body, and obstruction to intubation. While the tube is not the hazard-free device it was once thought to be, it has a place in emergency airway management in preventing insufflation of air into the stomach as well as aspiration of gastric contents.
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Comparative Study
The effect of home respiratory therapy on hospital readmission rates of patients with chronic obstructive pulmonary disease.
The South Hills Health System Home Health Agency, Homestead, Pennsylvania, studied the effect of home respiratory therapy on hospital readmission rates in 418 patients with chronic obstructive pulmonary disease (COPD). Respiratory therapists evaluated and followed referred patients in their homes. Oxygen, breathing equipment, and supplies were provided, and patients were educated in use, cleaning, and maintenance of equipment. ⋯ These results indicate that home care provided by respiratory therapists can significantly reduce the rehospitalization of COPD patients. Prevention of rehospitalization in the study group resulted in estimated average hospital costs of savings of $2,625 per per patient for the year. As a result of this study, two large local industrial employers, the Federal Black Lung program, and Blue Cross of Western Pennsylvania have added respiratory therapy to their home health benefits.