Standard Procedures for ER's/ Hospitals & CPAP?

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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Wulfman...
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Re: Standard Procedures for ER's/ Hospitals & CPAP?

Post by Wulfman... » Sat Oct 17, 2015 4:03 pm

chunkyfrog wrote:
sptrout wrote: . . . #1 always take your own medications with you in their original bottles . . .
---Especially prescription eye drops. When I had my mastectomy, the hospital tried to charge me
over $400 for my glaucoma meds. (One drop in each eye) Since I had brought my own, I filed a formal complaint,
and that was the end of that! They tried to tell me that the drops were scanned at the bedside,
but after an audit, that was found to be untrue.
Along this line, when I had my appendix out in 1992, the hospital tried to charge me for a pain medication drip. I told them it was never used or injected in my arm and they'd better remove that charge. They did, but it definitely pays to scrutinize your charges because of what they try to sneak in. The "standard" item charges are ridiculous enough.......aspirin, gloves, band-aids, etc.


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Re: Standard Procedures for ER's/ Hospitals & CPAP?

Post by Wulfman... » Sat Oct 17, 2015 4:17 pm

Reading through some of the posts in this thread made me contemplate what to do if I was ever hospitalized unexpectedly and didn't have a spare CPAP setup with me. Or, how to keep some instructions (list of equipment and settings) that could be discovered relatively easily by some attending emergency medical technicians or crew if I was unconscious.
Some people wear ID bracelets with some types of info on them, but I'm not much for wearing that kind of stuff......and it could get torn off under some circumstances. Could keep a sheet of instructions and prescription in my wallet, but wonder if it would actually be discovered.

I haven't quite come up with the answer yet, but I'm thinking about it.


Den

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Re: Standard Procedures for ER's/ Hospitals & CPAP?

Post by chunkyfrog » Sat Oct 17, 2015 4:21 pm

When the respiratory tech showed up with the hospital machine,
I had an image of the screen showing my settings on my phone.
He was impressed.

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Re: Standard Procedures for ER's/ Hospitals & CPAP?

Post by SleepyEyes21 » Sat Oct 17, 2015 4:24 pm

PoolQ wrote:"Question: Couldn't apnea have caused a new emergency? Stopping breathing can stop your heart from beating, right?"
Well in theory yes, BUT SA is not a fast thing and caused damage over the long run. Technically you can't experience SA unless you are asleep. From what I have heard it's not so much the stopping breathing that impacts the heart, but after you start breathing again the heart will race to move the O2 around the system and that adds stress to the heart. Something to be avoided, but it's not like having a blockage in the blood flow.

"Is it 'standard procedure' for them to monitor my O2?" here it sure is, it's just a rubber cup they put on one of your fingers and they leave it there, not like blood pressure where they wrap you up and take readings every hour. If you don't already know what this is then the chance of you paying any attention to it are slim indeed. It's typically just one more thing they do.

"if apnea is a real medical diagnosis affecting millions, why is there not a standard protocol for ER's & hospitals?" It is indeed real PERIOD, but so are many things and it is not what you are in there for and it's not really going to effect what they do for you. If your O2 drops for any reason, they will address that.

My issue is that they should have addressed your concerns and treated you like a human bean and not a lab rat. You also need to understand that while everything you have posted sounds very reasonable, there are many patients that go to the hospital that are very unreasonable. The hospital will not vary from procedure no matter what anyone says. When they talk with you they are following procedure and looking for very specific things and not really just having a conversation.

People that work in hospitals have learned a lot of very specific language, both in school and much that is used only between staff. We as patients know little to none of this language and most of the time we don't need to.

Learning some key phrases can help, but they have to be the right ones at the right time.

This last week I had an appointment with my sleep Doc and started off by saying " I tend to underreport" and his reaction was totally different. He sat still and upright, looked directly at me and listened. I started saying what I thought was important and that he had been missing, when I got to "I have problems breathing when I lay down, before I go to sleep" he turned to the computer and said he was referring me to a pulmonologist "right now" as this was no longer just sleep apnea.

When I was told by the DME that it would take 10 days to 2 weeks to get my machine, I called my insurance company and started the conversation with "I just had bypass surgery last December" and told them of the delay. I got my machine the same day, after hours.

It is difficult to know what is important and how to phrase things because we just don't talk their language or just don't know. When you say something to them AND it triggers one of their warning flags they WILL take action, if not they will just continue with their procedure.
Hey PoolQ- yes, I know what the O2 monitor is- the finger clip thing they put on your index finger usually. I'll assume it was on, and will look for the readings from it when I get all of my medical records from both admissions on Monday. Yet obviously, they didn't do anything for my likely de-sats. This is again, likely a matter of what they consider the 'standard' for the "danger zone;" as many of us have read on this forum, there are docs who don't flinch when patients de-sat below 90.

You are SO right about medical professionals having their own language and key phrases! And also, the ER focusing solely on what they think is right in front of them, almost to the exclusion of missing other things that could be related. When I was headed back to the ER for the second go around, I was thinking 'if this doctor is as cocky as the one on the first admit, I'm going to tell him to leave his credentials at the door, because I have 3 masters degrees and I don't care how many letters are behind his name. I just want him to sit down on the bed and talk to me like a human being.' Fortunately, he was a humane doctor

I hope you are doing well and continuing to recover from your bypass surgery. Thank you for all of your help!

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Re: Standard Procedures for ER's/ Hospitals & CPAP?

Post by PoolQ » Sat Oct 17, 2015 4:38 pm

I remember a nurse looking at my O2 and saying "gee you must sleep deeply" then turning my O2 up. This was before I was diagnosed with sleep apnea.
Sleeping MUCH better now

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Re: Standard Procedures for ER's/ Hospitals & CPAP?

Post by SleepyEyes21 » Sat Oct 17, 2015 4:44 pm

lindalrc wrote:Of course, with a prolonged ER admission like your first one, you are kind of stuck. But my basic rule is ALWAYS take the CPAP if going any place they might keep me. If a friend/partner is coming along (or following the ambulance), put them in charge of the CPAP and the fight to get it on you. I have taken mine to a colonoscopy and to an ER visit that turned into an admission. The idea of carrying around a mask in your purse/car/backpack/go bag is great. At least your face will be comfortable. Probably best to make sure that anyone you might call on after a hospital admission understands you, your machine, and what parts to get if/when sent to retrieve it. Hope you are doing much better now.
Lindalrc
Hi Linda - thanks so much for your ideas and advice! Reading what you and Nan wrote about being ready with backup machine and mask already packed, list of meds, and emergency contact info all packed together is terrific info that I will put into action immediately. In fact, I have my backup machine packed already from my last (planned) hospital trip; just need to add the med list and mask. My daughters are my emergency contacts, and I have trained them how to set up humidifier with water, and place mask on me. Titration is already set.
I was so sick on night of first admission I simply assumed hospital would have machine I could readily use; on second admission, I had no idea it would take so long to get set up.

I am doing much better than the first week of October, but still trying to get my strength back. Sleep/ nap when I can; and no gator wrestling for the foreseeable future

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Re: Standard Procedures for ER's/ Hospitals & CPAP?

Post by SleepyEyes21 » Sat Oct 17, 2015 4:56 pm

49er wrote:
SleepyEyes21 wrote:
PoolQ wrote:Standard Procedures: not that I have seen. Each Hospital has their own procedures and those they follow no matter what. So my guess is that the hospital you went to does not include does not have CPAP in any procedure that covered you.

The question is-should it be included in their procedure? Obvious answer is "well of course".

Not so obvious answer is "well lets look at what was going on"

When I was in the hospital I always had an O2 monitor on (procedure). Did you? If you did they knew if you were desat'ing or not and they would have done something if you were.

Did they handle it the best that could be done-of course not. they were discounting what you were saying. You had a health concern and no one explained anything.
Not a big surprise to me as they are 100% focused on executing procedure.

Hospital are not fun at all. They have one focus-fix what you came in for. Second they don't want to cause something new while you are in there. Apnea was not going to cause a new emergency. Make you uncomfortable as all get out, well yes. Make you worry when it would be easy to avoid that, well yes. Treat you like a human bean and show you some concern, well yes.

Something the system out here in California did that has made a huge difference throughout the entire health care industry is patient experience. The state reduces MediCal payments to any provider that gets low patient experience ratings. Hospitals now have Director level staff that interfaces with patients about their experience and they have MD level patients advocates on staff. Insurance companies actually care that you are happy with their service (shocker!).

Well I think you get my drift that I think you could have been treated much better! If you had been in there longer I think you would have had CPAP going on and it looks like you did finally get CPAP. I am pretty sure that a standard procedure would have had an O2 monitor on you.

I don't think you were in any "danger", but that's my opinion which doesn't count for much.
Thanks for all of the info, PoolQ! I wish Florida insurances would start doing what CA is implementing; in fact, probably all the states need to do the same. Now- as far as the ER monitoring my O2- I really can't say for sure, as I was sleeping mostly from the time I fainted at the X-ray machine, until after surgery at 3:00 p.m. later that day. Is it 'standard procedure' for them to monitor my O2? I'm fairly certain they were monitoring my blood pressure at some point in the ER because my pressure was dropping really low.

Question: Couldn't apnea have caused a new emergency? Stopping breathing can stop your heart from beating, right?

Also - if apnea is a real medical diagnosis affecting millions, why is there not a standard protocol for ER's & hospitals?
If you were on Morphine and not monitored properly, that could be bad news due to your sleep apnea.

http://sleepdisorders.about.com/od/caus ... -Apnea.htm
Wow - thanks for the article, 49'er. Very interesting information here.

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Re: Standard Procedures for ER's/ Hospitals & CPAP?

Post by SleepyEyes21 » Sat Oct 17, 2015 5:01 pm

nanwilson wrote:This is what I have done... I have my spare machine in a clear plastic tub along with 2 masks and everything else I need...........including a list of my meds, on my spare night table on the other side of my bed. I have a LARGE notice on the top of the tub and on the side with emergency instructions to take this tub to the ER with me.
I have gone to the hospital twice via ambulance and both times the paramedics saw the tub (don't know how they could miss it ) and took it with us to the hospital. Once in the ER the attending nurses placed the tub as close to me as possible without hindering their work, it went with me to my room once I was admitted and the machine was set up and mask was on me right away. I list the phone numbers for my daughter and granddaughter for emergency purposes on my instructions too. As I said this has worked for me twice, perhaps we should ALL do something like this to at least save us from having to go through what you have just done.
If you don't have a spare cpap, then perhaps a large note placed so that it can be seen, to take your gear with you....OR if you at least listed emergency numbers to contact your family they could get your gear to you asap. What ever works...do it.
Nan
Thanks Nan! See my reply to Linda below - I will take all of your great advice, and make sure to take my backup with me in the future!
Be Well

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Re: Standard Procedures for ER's/ Hospitals & CPAP?

Post by SleepyEyes21 » Sat Oct 17, 2015 5:19 pm

sptrout wrote:I have no experience yet with CPAPs and hospitals, but the rule we follow based on other non-CPAP experience is hope for the best, but expect the worse (which will be the case). Therefore, #1 always take your own medications with you in their original bottles (hospital are very likely not to have all your medications and may try to substitute something else that is not even close - they tried this stunt on me). If you take your own medications, they have to use them if you tell them to. #2 Always, always have somebody with you at all times that can double check anything they do because they will screw-up. Hate to sound negative about hospitals, but my family has had a lot of hospital experience (in multiple states) and you really can expect to have issues come up. It is well known that one of the most dangerous place you will ever be is a patient in a hospital.
Hi sptrout- thanks for your input. I have never had a problem with a hospital not having my correct medications. I also have never had to bring in medications from home (but wouldn't hesitate if I needed to.) However, due to complications during these last two admissions, my docs were limiting the use of some of my daily meds, and slowly re-introducing other daily meds to see if I could tolerate them. I did refuse medications at times that I had not been informed of prior to them being ordered, since I didn't know what they were ordered for.
Also - there are many people that cannot and do not have people that can be with them at all times. I am fortunate to have family in the area I live in, and to have that kind of support. My oldest daughter is also a nurse and helps me a lot. For those that do not have family or social supports, check with your case manager at the hospital, and ask if the hospital offers a patient advocate service. This is usually a free service, and can help patients with any/ all aspects of patient care.

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Re: Standard Procedures for ER's/ Hospitals & CPAP?

Post by SleepyEyes21 » Sat Oct 17, 2015 5:25 pm

chunkyfrog wrote:
sptrout wrote: . . . #1 always take your own medications with you in their original bottles . . .
---Especially prescription eye drops. When I had my mastectomy, the hospital tried to charge me
over $400 for my glaucoma meds. (One drop in each eye) Since I had brought my own, I filed a formal complaint,
and that was the end of that! They tried to tell me that the drops were scanned at the bedside,
but after an audit, that was found to be untrue.
That's outrageous!! I bet if the insurances fined the hospitals more often for their "mistakes," these hiccups would diminish drastically

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Re: Standard Procedures for ER's/ Hospitals & CPAP?

Post by SleepyEyes21 » Sat Oct 17, 2015 5:39 pm

Wulfman... wrote:
chunkyfrog wrote:
sptrout wrote: . . . #1 always take your own medications with you in their original bottles . . .
---Especially prescription eye drops. When I had my mastectomy, the hospital tried to charge me
over $400 for my glaucoma meds. (One drop in each eye) Since I had brought my own, I filed a formal complaint,
and that was the end of that! They tried to tell me that the drops were scanned at the bedside,
but after an audit, that was found to be untrue.
Along this line, when I had my appendix out in 1992, the hospital tried to charge me for a pain medication drip. I told them it was never used or injected in my arm and they'd better remove that charge. They did, but it definitely pays to scrutinize your charges because of what they try to sneak in. The "standard" item charges are ridiculous enough.......aspirin, gloves, band-aids, etc.


Den

.
Hi Den - your post reminded me of a charge for an extra pillow back in 1982 when my first daughter was born. I was scrutinizing the bill, and read $24.00 for 'extra pillow' and I almost came unglued Although I had asked for an extra pillow, it wasn't like I got to take it home or anything, and it definitely wasn't from Bloomingdale's or Macy's finest linens departments 5 zillion count and up! What a racket

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Re: Standard Procedures for ER's/ Hospitals & CPAP?

Post by SleepyEyes21 » Sat Oct 17, 2015 6:23 pm

Wulfman... wrote:Reading through some of the posts in this thread made me contemplate what to do if I was ever hospitalized unexpectedly and didn't have a spare CPAP setup with me. Or, how to keep some instructions (list of equipment and settings) that could be discovered relatively easily by some attending emergency medical technicians or crew if I was unconscious.
Some people wear ID bracelets with some types of info on them, but I'm not much for wearing that kind of stuff......and it could get torn off under some circumstances. Could keep a sheet of instructions and prescription in my wallet, but wonder if it would actually be discovered.

I haven't quite come up with the answer yet, but I'm thinking about it.


Den

.
Hey Den - this is an interesting thing to contemplate and there is a definite need for it. I'd say there is a market for this type of thing. My dad (now deceased) had A-Fib for 22 years and would not wear a medical bracelet no matter how much his adult kids begged him to. Yet, when I was being treated for a pulmonary embolism for 6 months, I had no problem wearing a medical bracelet stating I was on a blood thinner. Now, if we could get hospitals to pay attention to the fact that we need our cpap to breathe right, then maybe a medical bracelet would be the answer for some. Better yet, whoever can invent the portable CPAP that fits in a glove compartment (mask and all), and one that can withstand extreme temperature changes- will be a millionaire without a doubt!

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Re: Standard Procedures for ER's/ Hospitals & CPAP?

Post by SleepyEyes21 » Sat Oct 17, 2015 6:41 pm

PoolQ wrote:I remember a nurse looking at my O2 and saying "gee you must sleep deeply" then turning my O2 up. This was before I was diagnosed with sleep apnea.
LOL As if deep sleepers don't breathe well- what a twit!

I normally have a low blood pressure, and anytime I am sedated in any way, my BP drops even lower. Years ago, I had an endoscopy and what woke me up in recovery was 2-3 nurses slapping my arms and legs and calling my name rather loudly. As I was coming to, I'm thinking 'WTH??' Turns out, my BP was really low due to the sedation, and the nurses apparently thought I was close to dying. What a great resuscitation - it was like being reborn

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Re: Standard Procedures for ER's/ Hospitals & CPAP?

Post by curems » Sat Oct 17, 2015 7:00 pm

Wulfman... wrote:Reading through some of the posts in this thread made me contemplate what to do if I was ever hospitalized unexpectedly and didn't have a spare CPAP setup with me. Or, how to keep some instructions (list of equipment and settings) that could be discovered relatively easily by some attending emergency medical technicians or crew if I was unconscious.
Some people wear ID bracelets with some types of info on them, but I'm not much for wearing that kind of stuff......and it could get torn off under some circumstances. Could keep a sheet of instructions and prescription in my wallet, but wonder if it would actually be discovered.

I haven't quite come up with the answer yet, but I'm thinking about it.


Den

.
Not 100% effective but I do have apps on my phone that show my emergency contact on the lock screen and allow emergency access to my medical ID even while locked. The medical ID includes diagnoses, allergies, meds, emergency contact and the fact that I'm an organ donor. I've added my cpap Rx to my meds so that there's access to my settings.

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Re: Standard Procedures for ER's/ Hospitals & CPAP?

Post by sptrout » Sun Oct 18, 2015 10:29 am

SleepyEyes21 wrote:
sptrout wrote:I have no experience yet with CPAPs and hospitals, but the rule we follow based on other non-CPAP experience is hope for the best, but expect the worse (which will be the case). Therefore, #1 always take your own medications with you in their original bottles (hospital are very likely not to have all your medications and may try to substitute something else that is not even close - they tried this stunt on me). If you take your own medications, they have to use them if you tell them to. #2 Always, always have somebody with you at all times that can double check anything they do because they will screw-up. Hate to sound negative about hospitals, but my family has had a lot of hospital experience (in multiple states) and you really can expect to have issues come up. It is well known that one of the most dangerous place you will ever be is a patient in a hospital.
Hi sptrout- thanks for your input. I have never had a problem with a hospital not having my correct medications. I also have never had to bring in medications from home (but wouldn't hesitate if I needed to.) However, due to complications during these last two admissions, my docs were limiting the use of some of my daily meds, and slowly re-introducing other daily meds to see if I could tolerate them. I did refuse medications at times that I had not been informed of prior to them being ordered, since I didn't know what they were ordered for.
Also - there are many people that cannot and do not have people that can be with them at all times. I am fortunate to have family in the area I live in, and to have that kind of support. My oldest daughter is also a nurse and helps me a lot. For those that do not have family or social supports, check with your case manager at the hospital, and ask if the hospital offers a patient advocate service. This is usually a free service, and can help patients with any/ all aspects of patient care.
Hello SleepyEyes21,

I agree that any medications that you bring/use should not interfere with anything new that the hospital doctors may add. I was mainly referring to maintenance drugs that are taken every day, and the person being dependent (not addicted) on them. I found out that hospitals did not carry two of my extended release drugs (which is apparently not unusual), which are standard generic types. For example, I take one drug that is a 1mg, 24 hour release, drug. The nurse had no idea that she could just not give me a 1mg instant release drug. I had to send my wife back home at night to get the correct medications. On that general subject, do not believe for a second that the RN in charge of your care has a clue. We have found many that could not even take a temperature or blood pressure correctly.

I agree that many people do not have anyone that can stay with them 24x7. This is sad, but probably very typical, plus many people do not know how important it is to have someone with them. One of the worse problems, besides the previously mentioned medications issues, is that there is no way to know when your doctor(s) is going to suddenly appear in your room to check on you. If you are asleep, or just "out of it", then without an able body person in the room with you, you will be clueless as to what the doctor has planned for you. Based on my wife's experience dealing with her mom & brother's 10 year nursing home and hospital ordeal, the doctors would show-up anytime 24x7. She was afraid to even leave the room for a quick meal.

The medical situation in the US is much worse than anyone who has not experienced it first hand can even image.

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