Are you kidding me???

So the er call us down to look at a home vent, to make sure it is working. The patient was biba because her husband says the vent is not functioning properly. The vt is set at 600 and is only returning 150-200. There is an audible leak around her nasty, crusty trach which he said he changed this morning. He has a washcloth taped to her like a bib because her secretions are oozing from her stoma. We mess around with it and the leak is very positional.

Dr B — who I LOVE, because he isn’t afraid to tell us he doesn’t know what to do — asks for our opinion. We decided that she had out grown the trach and we should try to change out the 6 shiley and put in an 8. He has us walk him through the process and he does it beautifully. The leak is lessend and we have to explain to the husband about SIMV and how the vt will vary and blah blah blah. He wants us to give him spare trachs in the new size.

During all of this chaos, he calls us to suction, then when we get there, he is doing it himself. I look at the chart and guess what??? No pcp and no pulmonologist. Are you kidding me??? How can you have ALS and be vented and no doctor???

So we tell him to contact her doctor to tell him the trach size was changed. He proceedes to tell us that the doctor managing her is Dr. I. Are you kidding me??? Dr. I is a familly medicine doctor. He tried to manage my sisters high risk pregnancy, when he said that he never had a case like hers before. yeah right. Now he is managing a vented patient. Don’t you think a pulmonologist would be in order here? I’m just thinkin…