rtNOW incoming call at 04:47PM from RN at Small Community Medical Center for patient ***** ****** DOB 01/1/1939 MRN *****. Patient admitted for right sided pneumonia. Patient is currently on 2L O2 via nasal cannula and wears at base line with saturations in lower 90s and respiratory rate is on higher side at 36. Patient is currently doing Duoneb QID and Albuterol PRN. rtNOW recommends to continue scheduled nebs along with aerobika and if patient is having secretions to add 3% saline neb QID to help loosen secretions. rtNOW also suggested using BIPAP for work of breathing to see if we could help slow down respiratory rate. I would start at 14/8 and 40% and if doesn’t tolerate pressure, decrease to 12/6 and 40% and follow-up check with blood gas. Patient does wear PAP at night for OSA but machine is not at facility, family will bring in. RN stated she will talk with physician and call back if they are willing to initiate BIPAP. Otherwise nothing else was needed. rtNOW call ended at 05:01PM.
rtNOW follow up call at 1758 to Small Community Medical Center regarding patient ***** ******, MRN: *****, DOB: 1/1/1939 MRN: *****. This RT spoke with RN regarding care of ***** ******. Follow up from a previous call with another rtNOW RT who suggested using BiPAP due to increased RR and R sided PNA. Per RN they chose not to use BiPAP but instead remain on 2LNC and place patient on CPAP per home regimen. If the patient continues to decline the facility will initiate HFNC per physician. Patient will continue to receive scheduled nebulizer treatments. RN had no questions at this time. rtNOW call ended at 1801.
rtNOW incoming call at 1922 from RN at Small Community Medical Hospital regarding pt ***** ****** DOB: 1/1/1939 MRN: *****. RN wanted to discuss the patient’s increased WOB/O2 bleed in for home CPAP. Patient was breathing in the 30s SpO2 94% HR 101 on 2LNC. Patient appeared to have mild retractions. RN stated patient WOB has gotten worse in the last hour and attempted to put home CPAP on but patient SpO2 declined. This RT assisted with describing the different types of O2 adapters that their facility might have and where to put the O2 bleed-in adapter in-line with the patient’s home CPAP. RN asked about HFNC and RT stated that due to the patient’s increased WOB and PNA that PAP would be the most beneficial. Blood gas is recommended. RN acknowledged, and stated that they will be finding the adapter and initiating O2 with the patient’s home CPAP. All questions answered and RN had no further questions. rtNOW call ended at 1930.
rtNOW incoming call at 8:37pm from RN at Small Community Medical Center med surge on ***** ******, DOB 1/1/1939, MRN *****. Called to place patient on Bipap. Patient was tried on home cpap with assistance from rtNOW around 7:30 this evening. Patient is still SOB, and the staff felt it was time to switch to bipap with no improvement from the cpap. The patient was placed on Bipap V/60, 15/7, 50% Fio2, 1.0 I.time. Patient had a RR of 28, VT around 400ml, VE of 12.7 VE, pip 17, leak of 28L, and oxygen sat of 96%. The staff in the room verbalized the patient looked much more comfortable on Bipap at this time. Blood gas recommended. Please call back with any other questions. rtNOW call ended at 8:47pm
rtNOW follow-up call to check on ***** ******, DOB 1/1/1939, MRN *****, Patient is sleeping comfortably on Bipap v/60 settings at 15/7 iT=1.0, backup rate-12. RN was able to wean Oxygen down to 25%, patient Spo2 was 93% at this time. No other changes needed at this time.