Search for tag: "respiratory"

There have been concerns by some parents that they don't want their kids wearing masks because they believe their child will be inhaling their own carbon dioxide with prolonged mask wearing and that will cause oxygen deprivation. Some say that children will inhale up to six times the safe limit of carbon dioxide.

Let me help clear the air on this one. It's not true. Here's the science behind the truth. Carbon dioxide poisoning or hypercapnia from re-breathing the air we normally breathe out doesn't happen because carbon dioxide molecules are extremely small, even smaller than the respiratory droplets, which is what we are protecting against when we wear the masks. They cannot be trapped by cloth or medical masks or any sort of breathable fabric. Those tiny molecules just pass right through the material.

Surgeons, nurses, respiratory therapists, all of us in the medical profession, in fact, wear our masks for hours and hours during the day. Studies done by having surgeons wear oxygen monitors during their entire time in the operating rooms show that masks have no effect on the amount of oxygen they have in their bodies.

If your child is wearing their mask properly, covering their mouth and their nose and fitting snugly over their face with the ear loops or ties, then your child will be protected from the respiratory droplets we don't want going through the breathable fabric, but still letting them breathe in oxygen and exhale carbon dioxide through their masks.

The bottom line is masks work. Last year during what is usually a very busy winter season, I hardly saw any sick kids. Now we are seeing RSV and rhinovirus and all sorts of other winter viruses because people have loosened up on mask wearing and viruses are taking advantage of that. Hospitals are full with kids who are having respiratory virus complications. I've had parents of children with asthma tell me that since their kids wore masks, the last school year, they didn't get sick and didn't have any asthma flare-ups. We can do this.

The kids I've spoken to have no problem wearing their masks. They like to coordinate their masks with their outfits and get cool ones with princesses and superheroes on them. I tell them they actually are little heroes. They tell me they have no problem wearing masks all day at school either. My own kids even say that they're so used to their masks, they don't even think about them anymore. And they're in junior high and high school. So mask up. And if you have any other concerns about COVID and COVID precautions, be sure to talk to your child's pediatrician.

Interviewer: If you're a parent that has to decide between online or in-person learning this fall, how do you make that decision? Dr. Adam Hersh is an expert with pediatric infectious disease. He's also an epidemiologist who studies the spread of respiratory viral infections with children. He consults with school districts and individual schools about reopening plans, and he practices at Primary Children's Hospital. And here is his advice on how to make the decision, "In-person or online?"

Dr. Hersh: I think you have to look at what's going to go on at the school, and you also have to look at your own family circumstances. So first of all, I would recommend that families find out the details of the school reopening plan. What kinds of physical distancing will be achieved if in-person learning is going to happen in their school? Is it going to be the same as it's always been, or is the classroom size going to be reduced such that students will be able to be seated three to six feet apart? Ensuring that the school is really committed to universal face coverings. It is a statewide mandate, but just ensuring that that is, you know, the school's policy.

The other thing too is just having an understanding of your local community, what is going on with regards to the epi curve in your county, and there's quite a bit of variability statewide, because schools are reflections of the community. They're not islands. The people that attend the school are members of the community. So if disease transmission rates are going up in your community, that's going to be a factor against more in-person learning. If disease transmission rates are stable or declining, that's going to be a factor in favor of going that route.

The other thing that's really individualized is the health of your child and the health of everyone that's in that child's world, whether it's within the home environment that the child lives or just close contacts. And certainly, in circumstances where there are members of the family that live in the same household as the child or that the child is going to have frequent contact with, if certain family members are at much higher risk for a more complicated disease course, that's going to be a consideration that might, you know, in some families lead to choosing a remote learning option for the near future. In some cases it might force you to go back to the school and say, "Well, how stringent . . ." You know, maybe there's going to be an elderly person in the home and the school environment is really able to achieve a decent amount of physical distance for that child's class. That might kind of balance itself out.

But this is really an individualized set of considerations, but I would encourage people to look at, find out all the information they can about the school environment and then to look inwardly at their home environment and what their relative, individual risks are.

Interviewer: So we've looked at the aspect of safety of your student in class. That's the risk part. The benefit is there are benefits to going to in-person classes. Could you speak to that a little bit so a parent could weigh those too?

Dr. Hersh: Again, this is somewhat individualized. I mean, there are clearly some students for whom the benefits of in-person learning are much more substantial than for others. But clearly the socialization, being around peers is a crucial part of being in school. Certainly the engagement that one has by being physically present, looking peers in the eye, looking a teacher in the eye, certainly just enhances your focus and ability to participate. You know, the benefits are innumerable.

With that said, I think I would be remiss if I didn't acknowledge that there is a subset of students for whom remote learning may be, especially in this moment, to the extent that that's offered from their school, may be a better fit. And again, you know, these decisions ultimately are individualized.

Interviewer: Protecting yourself and others against COVID-19. It seems like the further and further we get into the pandemic, the more ideas and more things people are doing to protect themselves.

But Dr. Richard Orlandi from University of Utah Health says, actually, some of the best things you can do to protect yourself and others just come right back to basics. Can you give us an idea of what the hierarchy of things are that we really should focus on that we know protect ourselves and other people?

Dr. Orlandi: Staying physically distant from one another. People have called this social distancing, and I prefer the term physical distancing, because we still want to interact with one another. But the idea of staying six feet apart so that if I cough or sneeze, that's not going to hit you, or if you cough and sneeze, it's not going to affect me. We know that that's how this virus is spread is either through respiratory droplets being sprayed out or if I touch my eye, my nose, my mouth, get those respiratory droplets on my hand, I touch your computer and then you type and then you touch your eye. And so that's how those things are happening. So that physical distancing is really important.

When we're not able to be physically distant, masking is important. Now, a couple of weeks, you and I talked about how masks were not as important because we were thinking of them in terms of I'm going to put a mask on so you don't get me infected. But we're changing the way we're looking at that, and really I'm going to put a mask on so I don't infect you, even if I don't have any symptoms, because we now are understanding that people may be able to transmit this virus the day before or a couple of days before they really have that fever, muscle aches, shortness of breath, coughing type of flu-like symptoms. That's going to help so that when I go to the store, I'm not spreading it to everybody else. Now, if all of us do that, we're keeping one another safe, and that's a great way that we can show our citizenship, our care for one another.

Interviewer: So it comes down to droplets, keeping your droplets away from other people, keeping other people's droplets away from you. And you do that by physically distancing yourself and also remembering not to touch your hands to your eyes, your nose, or your mouth. But Dr. Orlandi says this time of year, in particular, that can be really challenging.

Dr. Orlandi: Doggone it. In allergy season, what happens? Your nose itches. Your eyes itch. Try to avoid doing that. Or if you do it, if you rub your eye and you rub your nose, just hand sanitize afterwards. Hand washing is so important. Sanitizing the surfaces around you. If you work in an office where a lot of people are still coming to work, get those wipes out and wipe down your work area. Wipe down the doorknobs and things like that where we're all commonly touching.

Interviewer: And if we all keep it up and do it really, really well, it will make a difference.

Dr. Orlandi: Literally, what people are doing here in Utah, it's saving lives. And I would say stay physically distant but socially close. Check on your neighbors, check on your family and stay connected, but do it in different ways. Do it through video platforms. Do it through the phone. Go for a walk. Stay six feet away from one another. If there are things that we can do to slow down the spread of that virus, that's probably the best thing we can do for our healthcare systems and for our society and to get our economy back up and running as fast as we can.

This information was accurate at the time of publication. Due to the changing nature of the COVID-19 pandemic, some information may have changed since the original publication date.

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Health is more than just diet and nutrition and how you look in the mirror. In order to live your best life, taking care of your mental health is crucial. Your mental state allows you to feel good about yourself, be confident to live the life you want to, and have positive, enriching relationships.

Kevin Curtis is a licensed clinical social worker with University Neuropsychiatric Institute. He suggests asking yourself three questions to assess the state of your mental health:

• Are you having thoughts that are useful to you?
• Are you having thoughts that impact your ability to function?
• Is your emotional state supporting or hindering achieving your goals?

Kevin is joined on this episode by his friend Ben. Ben works at the University of Utah and considers himself a regular guy who has been working with professionals to improve his mental health over the past decade.

Ben admits that he's not the paragon of mental health, but feels tons better than he was 10 years ago. He's learned a few tools and techniques that have helped improve his mental health over the past 10 years. He shares the three tools he feels were the most helpful for him.

1. Box Breathing/Tactical Breathing
   The way you feel during an emotion is ultimately a physical response. The increase in heart rate when anxious. The flush of blood to the face when angry. These physical changes can start a feedback loop with your emotional state that can lead to an overwhelming response.

   To help keep your mind calm when feeling stressed, Ben focuses on his breathing. He will breathe in for a count of four. Hold that breath for a count of four. Breath out for a count of four. Pause for a count of four. Repeat as necessary. This is called "box breathing."

   This breathing technique allows you to shift your mind to a physical response rather than an emotional one. It changes the way your body feels, and in turn is able to help make the emotion feel less overwhelming.

   Tactical breathing uses the same four-second breathing technique but removes the pauses between breaths. This alternative will provide the same benefit, but is best used in a situation when you need to be able to breathe regularly.

2. Check fo BLAST(H) Conditions
   We've all had a friend, partner, or child in our lives that make poor decisions or are particularly irritable because something more physical is going on. It's sometimes easy to see exactly why another person is stressed, but hard to recognize it in yourself. As such, Ben's second technique takes a personal inventory of the following if you are feeling overwhelmed:

   B: Bored
   L: Lonely
   A: Angry
   S: Stressed
   T: Tired
   H: Hungry

   If these "BLAST" conditions are present, recognize they may be having an impact on your emotional state.

   A good step to improve your mental health is to adopt strategies and daily habits that will keep you out of these conditions as often as possible.

3. The Reach Out
   While professional help can be an integral part of your mental health strategy, it's also important to build a network of support and "emotional scaffolding" with people in your life and network.

   "The Reach Out" is a technique that aims to build and strengthen your connection with others. If you are feeling down, or upset about a situation, reach out to two people you trust. These people can be friends, family, coworkers. Take the opportunity to tell them what is going on in your life and how you feel about it. Explain that you are not seeking solutions to your problems, but rather you are merely reaching out to let them know what you are experiencing.

   By expressing vulnerability without setting an expectation, you are inviting these people to join a network of support without placing pressure on them. Additionally, by reaching out and getting personal, you are inviting the possibility of sharing a meaningful interaction that can deepen the bonds you have together.

In times of stress, be sure to take care of your mental health. These tips may help maintain and improve your day to day mental resiliency. However, if you are experiencing overwhelming feelings of depression or contemplating self-harm or suicide, reach out to a professional.

For people in Utah consider the Crisis Intervention Services at University of Utah Health. Talk to Us

If you have any questions, comments, or thoughts, email us at hello@thescoperadio.com.

Interviewer: What role will physician assistants play in the evolution of healthcare? We'll talk about that next on The Scope.

Announcer: Health tips, medical news, research and more, for a happier healthier life, from University of University of Utah Health Sciences. This is The Scope.

Interviewer: The physician assistant profession is 50 years old this year. And today we're going to talk a little bit about the history, and also how they're going to be playing a greater role in healthcare in the future. Odds are if you're not using a physician assistant now, in the future, you very well may be. Jennifer Coombs is an Associate Professor of physician assistant studies at University of Utah and is also a physician assistant herself. In order to better understand where the profession will be going, tell me how physician assistants came to be because I think it's a fascinating story that grew out of a need.

Jennifer: Correct. Well, we like to say that the origin of our profession was the Vietnam War. There were returning military corps men and a physician at Duke University had the idea to train relatively rapidly providers that can work relatively independently but in collaboration with physicians.

What happened at Duke University was Dr. Stead, who was the founder of our profession, he found that he had a need to have someone in the office that can really help him, deeply help him, prescribe medications, see patients, come to him if there were any issues. And this is the stroke of genius that he had this idea, that he had when he saw how well trained these Vietnam veterans were and they came with so much experience.

Then, he had this idea to start training people. And it quickly moved from being Vietnam veterans and corps men to all sorts of other people who had amazing experience. We had, quickly, nurses. Nurses would go to nurse practitioner school. Nurses could also go to physician assistant school. We had respiratory therapists. We had physical therapists. We had paramedics, all sorts of experiences and backgrounds.

Interviewer: People already in the healthcare industry in one way, shape, or form.

Jennifer: Correct. And then they would be trained, and then they could go back and work with physicians and do everything, really, that their supervising physician did.

Interviewer: Right. So the physician was able then to see more patients because they had somebody that could prescribe or do a lot of the things that other staff of the hospital or doctor's office couldn't?

Jennifer: Right. Physicians then could see sicker patients, could see the more complex patients. And then everyone could be seen because, really, no one can do it all. I mean, this whole idea that physicians are going to be the managers of everything is absurd. And they need help.

Interviewer: What was the need that they needed to fulfill by creating this new role in health?

Jennifer: It is interesting because it continues to this day and I think the role is access and quality care. And that is provided on teams. We know that teams provide the best care. And teams aren't really a new idea. But PAs have really taken off, and they've bridged a gap that was needed. So if you have a child that has a fever in the middle of the night, you go to a quick clinic or an InstaCare, you might see a physician assistant, and that person is going to get you treated. It's going to get you excellent quality care and get you out of the door. And that just has been our thing, and we've done it well, and we just keep having more and more demand for our services.

Interviewer: Yeah. So the bottom line is to treat a lot of the things you or I might go to the doctor's office for, you don't need all the education that a doctor has. So how much training does a physician assistant have?

Jennifer: We are a two-year program, and you get a master's degree. Of course, people come with a tremendous amount of experience. People are usually a little older when they go to physician assistant school. And they come with an undergraduate degree. And then they go through the two-year program.

Interviewer: So the history kind of, maybe, sets us up for what the future is going to look like. We have a profession of medical professionals that don't need as much training, that can handle a lot of things that a regular physician could, that allow the physician then to focus on those more complicated cases as you said. So going forward, how will a physician assistant play a role in healthcare? How is healthcare evolving? How is it changing, that it's going to require good physician assistants?

Jennifer: I think one thing that is important in healthcare today is providing very, very quality safe care at a good value. And we talk about value a lot at the University of Utah. Physician assistants can provide very high-quality care. And we provide that service at a good value for the institution, a good value for the community. Physician assistants isn't as expensive to train as physicians. And so I think that's one thing that has been our bailiwick is quality care at a good value.

Interviewer: And correct me if I'm wrong, but I understand in healthcare there is going to become a shortage of primary care physicians. And we hear a lot in healthcare about how in the future, your primary care physician is going to be your kind of point of contact for care, but there is going to be fewer of them, which causes a problem because we've got a generation . . . a big population of people that are going to need more and more care. How are physician assistants going to fill the role?

Jennifer: Physician assistants are really well trained for primary care. They can take care of a variety of problems, but you're going to see PAs in all aspects of medicine. There are shortages of care in every specialty of care. And if you have a child that has epilepsy, it might be a physician assistant you can be seen over at Primary's initially, get in the door, then you might be referred. You might see a physician assistant over at the University of Utah Health Care, in neurology. And so they're everywhere. They're everywhere. They're in hospitalists, they're in surgery. They really just coming in and providing that care that's needed and opening up that access.

Interviewer: And in the future, as we move more to team-based care, what will the physician assistant role be in that team-based care?

Jennifer: Often, the physician assistant is a little bit of leader on that team so the physician may not come in the room. The physician might be only called in to help out if needed. I know that in rural areas, we have physician assistants that do everything and that are the leader of the teams. You're going to see PAs everywhere on every team.

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Interviewer: Our emergency room physicians use vital signs to diagnose you. That's next on The Scope.

Announcer: This is from The Front Lines with emergency room physician Dr. Troy Madsen on The Scope.

Interviewer: One of the first things that will happen when you go to the emergency room as you will have your vital signs taken and what exactly does that do? I want to get a little insight from emergency room physician as to what that information can help with. Dr. Madsen, when you see somebody, do you see their vital signs before you actually ever see them?

Dr. Madsen: I do very often. And it's funny because vital signs, you hear that it sounds incredibly boring but in vital signs, they are vital.

Interviewer: Sure. Vital. How many vital signs are there?

Dr. Madsen: So there are four vital signs we use, blood pressure, heart rate, respiratory rate, so how fast you're breathing, and temperature. And those are the things I look at and 99% of the time, I see those before even walking to the room. A person comes to the ER, they go to the triage area, they check vital signs, and that's a big part of triage.

Someone comes in with a heart rate of 140, they're going to go back to a room a lot faster than someone who has completely normal vital signs. So it's a big part of what we do in the ER, it's a big part of my decision-making process of saying who do I need to see first versus okay, I've got five patients I need to see right now, who can wait?

Interviewer: Yeah. What's the worst case scenario of vital signs situation?

Dr. Madsen: Worst case?

Interviewer: Yeah. Like you look at the chart and you see this, you're like, "Bam, first on the list."

Dr. Madsen: The worst case scenario would be certainly no vital signs.

Interviewer: That is okay.

Dr. Madsen: That would be cardiac arrest.

Interviewer: Fair enough.

Dr. Madsen: But if I see someone who comes in, let's say they have a temperature of 104, heart rate of 120, blood pressure of 80/40, I'm thinking to myself, "This person is in sepsis. They have a severe infection. I need to get into that room right now. We need to get two IVs started, start fluids going, antibiotics going." We're jumping on it immediately. So it's a huge part of my decision-making processes as to where I'm going next as an ER doctor.

Interviewer: Give me a couple of other scenarios there, what the vital signs might tell you before you even see the patient.

Dr. Madsen: So another vital sign we might see, so let's just say I see a heart rate of 160, blood pressure again, 80/40, maybe they're not febrile, I'm thinking to myself, "This person is in an abnormal heart rhythm. They could have a supraventricular tachycardia or atrial fibrillation." Again, that's someone I'm going in the room immediately. It could be someone where we have to administer medication or shock their heart to get it back into a normal rhythm.

Interviewer: Got it. What about just a high fever? Everything else looks kind of okay.

Dr. Madsen: Okay. Yeah, and that's not an uncommon thing especially during flu season. Again, it's someone, I'm going to want to get in the room but I probably I'm paying more attention in that situation to their heart rate and blood pressure. It's someone where, again, if I had someone who had a low blood pressure versus the person with a temperature of 104, I'm going to be in the room with the blood pressure first.

Interviewer: Got it. So vital signs definitely are vital for what you do.

Dr. Madsen: They really are.

Interviewer: And then after you get in the room and you find out what happened, are there scenarios where you would combine all that information in a way that the average person wouldn't necessarily?

Dr. Madsen: Yeah. So I'm then going to combine that with the lab results so you've got to take the whole picture into account looking for infections. I'm going to look at vital signs or if are they febrile, what was their heart rate, I'm going to look at their white blood cell count. Those are all things I'm considering.

It also is a big decision part in terms of where they go from the ER. So if someone has abnormal vital signs, they may not go to a standard medical bed once they're admitted. They may go to the medical intensive care unit because they need closer monitoring. Those vital signs are telling me there's something wrong here that needs to be addressed and they can't just go to, again, a standard four bed where they may not get the attention they get in the intensive care unit.

Interviewer: So definitely vital signs is very important for you to do your job to try to figure out what's wrong with somebody but there's a lot of ways now that the common person can figure out their blood pressure at home, you've got home cuffs, we wear things on our wrists now that can tell us our pulse. Is that something we should be monitoring ourselves on a daily basis?

Dr. Madsen: So that's a great question because there is the flipside of this where I think sometimes we can pay so much attention to our own vital signs and it can become distracting. Occasionally, we'll see someone who has a home blood pressure monitor and they say, "Well, my blood pressure is usually 120. Today it was 140." There are always going to be just natural variations in blood pressure and heart rate. So I think you sometimes you can get a little overly concerned about blood pressure, or you can have heart rate monitors that maybe you're seeing your heart rate up around 100 at one point where normally it's 80.

Again, always going to be variations depending on stress level, just how you're feeling, exercise or not. All those things are going to affect your blood pressure or heart rate. But I wouldn't get overly concerned about things. But certainly, keep in mind that a significant variation there is something that raises concern for me.

Interviewer: When it comes to vital signs, what are the thresholds that you kind of look at? Like so say, for example, I maybe have a heart rate monitor, I feel my heart rate is starting to race all of a sudden and I'm just sitting there, right? I take my pulse or I look at my monitor, how do you know when it starts getting into abnormal?

Dr. Madsen: It depends what you're doing but I think for a person who's just sitting there, who's not exercising, if they have a heart rate greater than 100, that for me is concerning. And again, I just want to answer my mind, are they anxious, are they in pain, that's going to raise your heart rate or is there something else going on, an abnormal heart rhythm. That would prompt me to get an EKG, something to look at the electrical activity in their heart to make sure it's in a normal rhythm, that there's not something abnormal that's causing that.

For blood pressure, once you get that top number, the systolic number less than 90, that raises concern for me. Sometimes, you may have someone who just exercises a lot, who maybe their blood pressure is usually 95 and it drops to 85, that's not so concerning. But the average person, when it gets less than 90, that's also something for me that makes me a little more concerned.

Interviewer: And I think most of us can tell if we're breathing rapidly or . . .

Dr. Madsen: Yeah, breathing rapidly. A standard fever would be something greater than about 100.5 degrees, something getting up into the 100s there. Some people say, "Well, you know, my temperature runs a little cooler. My temperature is 99 now." Again, I usually don't get too concerned about that till it gets into the 100s.

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