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EMERGENCY ROOM RESPIRATORY THERAPY CONSULT (RT CONSULT)Protocol Content:1. Scope: A Licensed Registered Respiratory Therapist (RRT) or Certified RespiratoryTherapist (CRT) who has successfully completed and passed all competencies related to patient assessment and protocols. Although respiratory students and assistants may perform medicated aerosol therapy, they may not adjust therapy per protocol.2. Emergency Room Aerosolized Medication ProtocolA. When a physician, physician’s assistant, RN, or RT orders RT Consult or RT toassess and treat, the RCP will be paged for a RT Consult. The RT may initiate this protocol working within the following guidelines.B. Upon receiving the order, the respiratory therapist will assess patient and selectappropriate therapy and medication.C. The following conditions are accepted indications for bronchodilator therapy:a. Bronchospasm/ wheezingb. Asthma/ reactive airway diseasec. Diminished lung soundsd. COPDe. Prolonged expiratory phasef. Obstructive defects of PFTg. Impaired mucous clearanceD. B. Medications available per protocol:a. Albuterol 0.25-0.5ccb. Duoneb 1 unit dose vialc. Atrovent 1 unit dose viale. Xoponex 0.63-1.25mgf. Albuterol MDIE. The following assessment and chart findings will be evaluated and documented asappropriate:a. Vital signs (HR, RR, BP)b. Current FiO2c. Pulse oximetryd. PEFR (if indicated)e. Patient assessment results (lung sounds, work-of-breathing, cough, secretions)F. Peak Expiratory Flow Rates (PEFR) will be done on asthmatics before and after theinitial treatment according to the patient’s tolerance to perform the maneuver, or this will be performed as soon as patient is able.
 
G. Following an initial assessment, an initial treatment will be given to patient’s whomeet the indications for therapy. If patient does not demonstrate improvement in PEFR,relief in Dyspnea or reduction in expiratory rhonchi or wheezing, the treatment may berepeated. If necessary, a third treatment may also be given.H. If there is no improvement after repeated treatments, the physician will be informedthe patient is not responding to therapy. Further therapy will be given only with physician notification.I. If respiratory therapy determines patient would benefit from a MDI bronchodilator for home use, and the patient meets the criteria for MDI use, an Albuterol MDI may beadministered to patient, and patient will be instructed on correct use of this MDI. Therecommended dose and frequency is Q4-6 hours as needed.J. Criteria for MDI use:1. Can physically perform the maneuver.2. Can follow directions.3. Is cooperative and alert.4. Can take a slow deep inspiration.5. Can hold breath for at least five seconds.6. Is able to perform a return demonstration.7. Respiratory rate <= 253. Documentation:A. Initial Assessment:1. The respiratory therapist will write the order in the patients chart includingmedication, dose and frequency per RT Consult if the ordering physiciandid not already do so.2. Initial orders written by the physician do not have to be rewritten by therespiratory therapist unless clarification or adjustments are required.3. All therapy will be documented in Meditech. B. Re-assessments:1. All patients will be assessed with every treatment to determine the patient’scurrent pulmonary status and effectiveness of the aerosol therapy.2. Adjustments of the patient’s therapy will be determined objectively by changesin the monitored parameters.
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