18:33 - Arrived in parking garage and begin walking briskly toward the hospital.
18:42 - Clocked in at first available time-clock.
18:46 - Walked into the 5 minute team-meeting announcing new practices and mistakes to avoid.
18:55 - Arrived in the NICU respiratory office, dropped off backpack and begin taking SBAR report on all 70 patients.
19:15 - Signoff/report is interrupted several times for various reasons.
19:30 - Report is finished and the 70 patient assignment is split between two respiratory therapists using ventilators as major acuity guides.
19:30 - I am called stat to initiate a high frequency oscillator and inhaled nitric oxide on a patient.
19:45 - I am notified of 2 patients going to MRI on ventilators
19:47 - I call house supervisor to have coverage for the transport.
20:00 - I am called stat to patients room to change ventilator from high-frequency oscillator (HFV-A) to high-frequency jet (HFV-P).
20:10 - Transfer complete to HFV-P.
22:20 - I am called stat to bedside. Upon arrival discover patient arresting, code called entire medical team works to revive patient.
23:10 - Code is stopped.
23:20 - I am called to patient bedside for loose endo-tracheal tube. Retaped tube without incident.
00:00 - Called stat to OR-2 for twin c-section
01:25 - Called stat to Labor and Delivery 9 for meconium
02:00 - Lab machine goes into self-calibration setup, so all gases are tubed to another unit to be run.
03:00 - Still waiting on machine to come into service, been cleaning up the lab with no calls.
04:00 - Lab machines are still down, check all ventilators with no discrepancies, no issues.
05:00 - Lab machines come back up, just in time for 5am gases. Draw and subsequently run 35 capillary gases.
06:00 - Prepare signoff report to oncoming Respiratory Therapists
06:50 - 4 Relieving RRTs arrive to take SBAR report.
07:36 - Clock out and head out to the parking garage.
A blog about Respiratory Care by a Respiratory Therapist
Showing posts with label Respiratory Therapy. Show all posts
Showing posts with label Respiratory Therapy. Show all posts
Spanish Phrases for Respiratory Therapists
Spanish Phrases for Respiratory Therapists
Quick and dirty spanish thats easy to remember
Are you in pain?
Tiene algún dolor (or just "Tiene dolor?")
Pronounced: Tee-in-ae Al-goon Doh-lor
Pronounced: Tee-in-ae Al-goon Doh-lor
Take a deep breath
Respira profundo
Pronounced: Res-pida pro-foondo
Take a deep breath and cough
Respira profundo y la tos
Pronounced: Res-pida pro-foondo ee la tos-ae
This medicine helps make breathing easier.
Esta medicina ayuda a respirar menos trabajo.
Pronounced: Es-tah med-icin-a ae-you-dah a res-pidar (or just say res-pida) men-ohs tra-bah-ho
Do you need anything?
Necesitas algo?
Pronounced: Ness-a-seetas al-go
If yes, and you can't understand what they want, it might be something complex, so call for a translator.
Do you have any questions? If yes, call for a translator.
Tiene preguntas?
Pronounced: Tee-in-ae pre-goon-tas
For help press this red button for help. (while pointing at the nurse call button)
Por ayuda pulsar el botón rojo.
Poor ae-you-dah pul-sar boo-tun roe-hoe
My name is _____________
Mi nombre es ____________, or mi llamo es ____________
I am a respiratory therapist
Yo soy terapeutas respiratorio.
Yo soy tera-peu-tas respir-a-torio
On-call?
I did my first on-call shift yesterday and I got called in. Usually the on-call therapist is what is considered a "resource therapist" but they gave me a full assignment, 3 cystic fibrosis patients. I was beyond exhausted when I finished my shift. That does mean though that my next scheduled day which is Friday, I will get 8 hours of overtime, yay, sortof :-)
Last night in the PICU
Respiratory therapists where I am are behind the bed for all major procedures; procedures like bed-side-surgery, or anything requiring conscious sedation. That is where I was at the beginning of this story, just hanging out behind a bed, every so often saying aloud something about peak pressures on the vent and cerebral oximetry readings if they began dropping. After almost two hours of this, its over and everything went amazingly clean and smoothe, the surgeons were joking the whole time and everything was great.
Then I walk out with the surgical team just in time to hear "RT ROOM 99 STAT" on my phone. So I jog over, room 99 is three rooms from where I was and the surgeon is right behind me.
The attending is shouting orders and this baby is very clearly unconscious, not breathing and more cyanotic than I have ever seen in my life, and I have seen many many deaths (by cardiac arrest secondary to respiratory arrest) in this line of work. There are two fellows changing out on compressions, another RT that got there before me is bagging and I am setting up all the stuff to intubate.
I have never been so amazed at what I saw next, because I was now at the head of the bed setting everything up for intubation I got a stage-to-audiance point of view and at this point there are over 20 residents, fellows and medical students watching. The attending takes the scope from me and intubates the baby himself, which I am fine with. He loves intubating. The amazing part is still yet to come; remember I had just walked out of a bed-side surgery. The attending looks up from the baby and mid-command of epinephrine he yells an order for heparin and then yells "Call ECMO stat!" and then its repeated "ECMO has been called stat!" and then the surgeon, that I had just been working with comes into the room, says "Surgery is here" and in less than 1 minute, and I am not exaggerating the scrub-techs had the surgeon in sterile gear with a tool in the first 10 seconds and he was cutting, in the next 50 seconds as if they had done this exact impromptu surgery every day for the last 50 years, had every single box they needed opened in the order the surgeon would need it in the next 50 seconds they had the entire room sterile-fielded, and they even put gear on people that were involved in holding the baby and I watched them dress out the RT while she sat there bagging unable to stop.
It was like a scene from fantasia, no scrub-tech attempted to grab the same thing as another one; everything got done in probably the most efficient manner ever to exist.
Then the trouble starts, the surgeon is ready, ECMO has arrived and another surgeon shows up and the other surgeon says "whats up, do you need me?" and the primary surgeon is really upset and says "I dont know what the fuck happened Dan, this is one of my norwoods from last week that was doing fine. He is struggling to get everything on lock down and yells "Son of a bitch, is ECMO here yet".. "ECMO is here doctor" to which he replies "Fucking say something then, I cannot see you, you have to talk to me, tell me everything because I'm waiting on you."
at this point I am an observer, my the other RT cannot move because they did not tape the tube because they could not confirm past an end-tidal that it was in the right place so she was holding the tube in place while the anesthesiologist maintained ventilation.
I leave and I take her phone from her pocket and have assumed her patients at this point. I start getting calls on both of my phones now, change the ETT here, advance ETT there, withdraw ETT over there. "RT TO ROOM 1 for extubation" comes over my phone. I jog over there and there is a Swahili family with their 3 year old daughter who is trying to shred her ETT out of her throat, 4 nurses are holding her down and the doctor is talking to another doctor at the door. I come in, and say "are we ready?" and I'm given a big yes so I grab the yawnker, I suction her mouth out, and its full of blood, I drop the cuff and in-line suction. I announce I'm extubating and its out. She has an audible stridor that seems to be actually going away and she sounds course, with full-body retractions so I say "she had a leak greater than 20, with obvious issues should we give racemic or what?" The doctor says "lets goto vapotherm and wean her fast" and I said "ok" so then I hook up the vapotherm at 10L, 30% FiO2 and she improves, a little.
I leave and go to check on the other people and to make sure all the therapy is done for my patients and the other RT's patients. I get a call to "setup oxygen in room 1" so I have them call me and they tell me "The nurse took her off vapotherm and just wants a nasal cannula now"
This is now at 7:45pm, so the RT who got there to assume those patients at 6:45pm said "I will handle that"
at 8:00pm the other RT is relieved and we both walk out together, debriefing from the last 4 hours of hell and go home.
Then I walk out with the surgical team just in time to hear "RT ROOM 99 STAT" on my phone. So I jog over, room 99 is three rooms from where I was and the surgeon is right behind me.
The attending is shouting orders and this baby is very clearly unconscious, not breathing and more cyanotic than I have ever seen in my life, and I have seen many many deaths (by cardiac arrest secondary to respiratory arrest) in this line of work. There are two fellows changing out on compressions, another RT that got there before me is bagging and I am setting up all the stuff to intubate.
I have never been so amazed at what I saw next, because I was now at the head of the bed setting everything up for intubation I got a stage-to-audiance point of view and at this point there are over 20 residents, fellows and medical students watching. The attending takes the scope from me and intubates the baby himself, which I am fine with. He loves intubating. The amazing part is still yet to come; remember I had just walked out of a bed-side surgery. The attending looks up from the baby and mid-command of epinephrine he yells an order for heparin and then yells "Call ECMO stat!" and then its repeated "ECMO has been called stat!" and then the surgeon, that I had just been working with comes into the room, says "Surgery is here" and in less than 1 minute, and I am not exaggerating the scrub-techs had the surgeon in sterile gear with a tool in the first 10 seconds and he was cutting, in the next 50 seconds as if they had done this exact impromptu surgery every day for the last 50 years, had every single box they needed opened in the order the surgeon would need it in the next 50 seconds they had the entire room sterile-fielded, and they even put gear on people that were involved in holding the baby and I watched them dress out the RT while she sat there bagging unable to stop.
It was like a scene from fantasia, no scrub-tech attempted to grab the same thing as another one; everything got done in probably the most efficient manner ever to exist.
Then the trouble starts, the surgeon is ready, ECMO has arrived and another surgeon shows up and the other surgeon says "whats up, do you need me?" and the primary surgeon is really upset and says "I dont know what the fuck happened Dan, this is one of my norwoods from last week that was doing fine. He is struggling to get everything on lock down and yells "Son of a bitch, is ECMO here yet".. "ECMO is here doctor" to which he replies "Fucking say something then, I cannot see you, you have to talk to me, tell me everything because I'm waiting on you."
at this point I am an observer, my the other RT cannot move because they did not tape the tube because they could not confirm past an end-tidal that it was in the right place so she was holding the tube in place while the anesthesiologist maintained ventilation.
I leave and I take her phone from her pocket and have assumed her patients at this point. I start getting calls on both of my phones now, change the ETT here, advance ETT there, withdraw ETT over there. "RT TO ROOM 1 for extubation" comes over my phone. I jog over there and there is a Swahili family with their 3 year old daughter who is trying to shred her ETT out of her throat, 4 nurses are holding her down and the doctor is talking to another doctor at the door. I come in, and say "are we ready?" and I'm given a big yes so I grab the yawnker, I suction her mouth out, and its full of blood, I drop the cuff and in-line suction. I announce I'm extubating and its out. She has an audible stridor that seems to be actually going away and she sounds course, with full-body retractions so I say "she had a leak greater than 20, with obvious issues should we give racemic or what?" The doctor says "lets goto vapotherm and wean her fast" and I said "ok" so then I hook up the vapotherm at 10L, 30% FiO2 and she improves, a little.
I leave and go to check on the other people and to make sure all the therapy is done for my patients and the other RT's patients. I get a call to "setup oxygen in room 1" so I have them call me and they tell me "The nurse took her off vapotherm and just wants a nasal cannula now"
This is now at 7:45pm, so the RT who got there to assume those patients at 6:45pm said "I will handle that"
at 8:00pm the other RT is relieved and we both walk out together, debriefing from the last 4 hours of hell and go home.
A few things I have learned and you should know.
Mechanical ventilation is an interesting thing, and I have discovered that its being shown that we should have soft music playing for patients who are being ventilated; it improves outcomes[1]. Respiratory therapists as a profession need to expand our practice to being a lot more bed-side and directly involved in the patients outcomes because in our current state, we are struggling to constantly prove our necessity while simultaneously delegating our scope to the bedside clinicians[2]. Oh yeah, and there are only four (4) modes of mechanical ventilation, the rest are all brand-names that represent a strategy within one of those four modes[3]. Lactic acid is a good indicator that the patient is not being ventilated well enough and their work of breathing has increased, in addition to the typical pH balance measurements[4]. I also have far too much free time.
- Hunter BC, Oliva R, Sahler OJ, Gaisser D, Salipante DM, Arezina CH (2010) Music therapy as an adjunctive treatment in the management of stress for patients being weaned from mechanical ventilation. ''J Music Ther'' 47 (3):198-219. PMID: 21275332
- Rose L (2010) Clinical application of ventilator modes: Ventilatory strategies for lung protection. ''Aust Crit Care'' 23 (2):71-80. DOI:10.1016/j.aucc.2010.03.003 PMID: 20378369
- Preferred Nomenclature for Mechanical Ventilation for Manuscripts Submitted to RESPIRATORY CARE (2011). On the web: AARC.org
- Marjanović V, Dordević V, Marjanović G (2009) Oxidative stress in patients on mechanical ventilation. ''Med Pregl'' 62 (11-12):578-81. PMID: 20491385
This week has been exhausting.
In the Neonatal Intensive Care Unit I worked pretty hard at evaluating and consulting with the teams working on babies; I would be assigned up to three "pods" which is a fun way of saying "hallways". Each pod has 6 rooms so I could be assigned 18 patients, with acuity in mind (...of course). In the Pediatric Intensive Care Unit I am way busier. I was only assigned 6 patients to "start me off" but 5 of them were being mechanically ventilated and all of them required therapies. I had hyperinflation therapy (HIT) on all 5 every 4 hours with an intermittent-percussive-ventilation therapy (IPV) on one of them every 4 hours. Along with general evaluations, answering questions for nurses and families, and running blood-analysis. The latter was probably one of the most annoying and time consuming parts of my day. The respiratory department at this particular hospital is not allowed, isn't given the responsibility of actually drawing the blood, but we are required to analyze it. I loathe mindless task-oriented "technician" types of things, but there really is an issue of consistency at stake when we are required to plug blood into a machine but we have no idea what has happened to the blood before it got to us.
The partial pressure of CO2 in the atmosphere is .28(ish) and O2 in atmosphere is 160(ish). When those two values are some of the more important things we're measuring, its not really okay to let blood touch air very much. I am getting syringes with an entire milliliter of air sitting in a cup of ice for who even knows how long.
Not to mention I have been told "capillary gas is not relative to arterial gas" hundreds of times by other RTs to whom I reply "If the capillary pO2 is 0, would you consider it to be irrelevant?"
Anyway, I digress.
The conditions of the kids in the PICU and the PCVICU are way different than the NICU, its almost like the "If its not congenital, it comes here!" catch-all type of place. Maybe my problem is time-management, I admittedly suck at that and I have not made a lot of progress in the 2 years during clinical or in the 5 months since I have been practicing. So maybe that will get better. So far though, I miss the Pediatric ER and the NICU the most.
Addendum to the Medbuntu concept:
I think that Medbuntu could operate a lot thinner than I even suggested in the first place. Medbuntu would be the ultra-thin OS that ran apps if it absolutely had to, but running every single other thing through the google-chrome (or modified firefox) would be pretty hot. With a really cleverly designed "chart" with intuitive designs to make it easy for practitioners to know whats going on and see things that the previous clinician may have forgotten to tell them.
The partial pressure of CO2 in the atmosphere is .28(ish) and O2 in atmosphere is 160(ish). When those two values are some of the more important things we're measuring, its not really okay to let blood touch air very much. I am getting syringes with an entire milliliter of air sitting in a cup of ice for who even knows how long.
Not to mention I have been told "capillary gas is not relative to arterial gas" hundreds of times by other RTs to whom I reply "If the capillary pO2 is 0, would you consider it to be irrelevant?"
Anyway, I digress.
The conditions of the kids in the PICU and the PCVICU are way different than the NICU, its almost like the "If its not congenital, it comes here!" catch-all type of place. Maybe my problem is time-management, I admittedly suck at that and I have not made a lot of progress in the 2 years during clinical or in the 5 months since I have been practicing. So maybe that will get better. So far though, I miss the Pediatric ER and the NICU the most.
Addendum to the Medbuntu concept:
I think that Medbuntu could operate a lot thinner than I even suggested in the first place. Medbuntu would be the ultra-thin OS that ran apps if it absolutely had to, but running every single other thing through the google-chrome (or modified firefox) would be pretty hot. With a really cleverly designed "chart" with intuitive designs to make it easy for practitioners to know whats going on and see things that the previous clinician may have forgotten to tell them.
Neonatal ICU over and now its Pediatric ICU time.
I have spent a lot of time thinking about what to write but have come up short every time on actually writing. I will try not to be spastic in this entry but I don't know if I can help it.
I discovered the other day that our facility is doing research on continuous epinephrine in situations with exacerbation of asthma in our emergency department. I discovered this after searching pubmed and uptodate for hours for supporting research, to ultimately ask and find out it is a research trial in emergency treatment. I couldn't help but feel excited that I had been involved in a cutting edge and possibly "ground breaking" development of asthma management in pediatrics. With all of that said, it feels very awkward that continuous epinephrine (not racemic epinephrine) is just now being researched, I will admit the person who told me may have been wrong and there is another reason we do it.
Anyway, the NICU has been amazing and I am one of the only therapists in my group that thought so. I like how involved I am as a therapist in the treatment and evaluation-of-progress in the NICU population.
I was actually asked for recommendations by a few physicians. I really enjoyed the side-by-side position I have as a therapist in the NICU and the treatment of the babies. As therapists we care much more about the "Why" we do something instead of just "How" to do it, which I think is a fundamental issue with the future of the profession... Why is a therapists job, How is a technicians jobs; what do you want to be? I enjoy being a therapist.
My first day in the PICU was pretty much an overview of protocols and equipment and a general orientation to the units. We have something like 115 beds in the PICU, and we had 90something in the NICU so its going to be pretty intense...
I will definitely miss the NICU, ultimately I still don't know where I want to be primarily, maybe an ED and NICU therapist. Though at this facility after a year I have to pick just one and become a primary therapist in that specialty. I am very lucky to work at a facility like this, considering almost every other facility doesn't have specialties, but instead just forces therapists to do everything with only staffing in mind instead of capabilities.
You'll hear from me again soon.
Tampa in November? I am considering it.
I discovered the other day that our facility is doing research on continuous epinephrine in situations with exacerbation of asthma in our emergency department. I discovered this after searching pubmed and uptodate for hours for supporting research, to ultimately ask and find out it is a research trial in emergency treatment. I couldn't help but feel excited that I had been involved in a cutting edge and possibly "ground breaking" development of asthma management in pediatrics. With all of that said, it feels very awkward that continuous epinephrine (not racemic epinephrine) is just now being researched, I will admit the person who told me may have been wrong and there is another reason we do it.
Anyway, the NICU has been amazing and I am one of the only therapists in my group that thought so. I like how involved I am as a therapist in the treatment and evaluation-of-progress in the NICU population.
I was actually asked for recommendations by a few physicians. I really enjoyed the side-by-side position I have as a therapist in the NICU and the treatment of the babies. As therapists we care much more about the "Why" we do something instead of just "How" to do it, which I think is a fundamental issue with the future of the profession... Why is a therapists job, How is a technicians jobs; what do you want to be? I enjoy being a therapist.
My first day in the PICU was pretty much an overview of protocols and equipment and a general orientation to the units. We have something like 115 beds in the PICU, and we had 90something in the NICU so its going to be pretty intense...
I will definitely miss the NICU, ultimately I still don't know where I want to be primarily, maybe an ED and NICU therapist. Though at this facility after a year I have to pick just one and become a primary therapist in that specialty. I am very lucky to work at a facility like this, considering almost every other facility doesn't have specialties, but instead just forces therapists to do everything with only staffing in mind instead of capabilities.
You'll hear from me again soon.
Tampa in November? I am considering it.
A short blurb...
I have been really thinking about this a lot. The AARC had assigned a task force for a thing called "Transitioning the Respiratory Therapist workforce for 2015 and beyond" where they held three conferences between 2008 and 2010. They decided a lot of things and one of those things was that the CoARC needed to abandon the AS and AAS credentialing of Respiratory Programs and only credential BS degrees.
I originally agreed with this, because it makes sense; a BSRT means that you are more prepared than an ASRT, right? Probably not, actually. There has been no difference in the clinical judgement abilities of AS vs BS new graduates that I have seen, but with a BS we do have more opportunity for advancement through management; which is cool.
I have decided the change needs to be in the ability of an RT to climb a clinical ladder. There needs to be a Masters degree and a Doctorate degree available to an RT, where there currently is not.
I propose these additional program developments available to RT's
Masters of Science in Cardiopulmonary Medicine
"Pulmonology Associate" or "Pulmonology Physician's Assistant"
* Credentialed by the CoARC and the AAPA
You would become a credentialed PA by the AAPA, and the school would be accredited by both the CoARC and the AAPA. Prerequisit would be a requirement to hold a BS and be a Registered Respiratory Therapist.
The scope of practice and prescriptionary allowance would be the same as a PA.
Doctorate in the Philosophy of Cardiopulmonary Medicine
This would not require additional credentialing other than the normal PhD program requirements.
The idea behind this would be a Philosophy in Pulmonology allowing for Research Scientist work or the ability to be a highly educated, educator.
Creating a clinical ladder would help the field a great deal and stop people from leaving to join other ladders that have better growth options.
Respiratory Therapy is a very unique profession, we are an interventionist like no other and cannot really be compared to any other profession without a great deal of exception.
I originally agreed with this, because it makes sense; a BSRT means that you are more prepared than an ASRT, right? Probably not, actually. There has been no difference in the clinical judgement abilities of AS vs BS new graduates that I have seen, but with a BS we do have more opportunity for advancement through management; which is cool.
I have decided the change needs to be in the ability of an RT to climb a clinical ladder. There needs to be a Masters degree and a Doctorate degree available to an RT, where there currently is not.
I propose these additional program developments available to RT's
Masters of Science in Cardiopulmonary Medicine
"Pulmonology Associate" or "Pulmonology Physician's Assistant"
* Credentialed by the CoARC and the AAPA
You would become a credentialed PA by the AAPA, and the school would be accredited by both the CoARC and the AAPA. Prerequisit would be a requirement to hold a BS and be a Registered Respiratory Therapist.
The scope of practice and prescriptionary allowance would be the same as a PA.
Doctorate in the Philosophy of Cardiopulmonary Medicine
This would not require additional credentialing other than the normal PhD program requirements.
The idea behind this would be a Philosophy in Pulmonology allowing for Research Scientist work or the ability to be a highly educated, educator.
Creating a clinical ladder would help the field a great deal and stop people from leaving to join other ladders that have better growth options.
Respiratory Therapy is a very unique profession, we are an interventionist like no other and cannot really be compared to any other profession without a great deal of exception.
NICU week 2
I have been in the Neonatal Intensive Care Unit (Level 4, Research Medical Center) for two weeks now. Tomorrow is my last day of the two week run. I will be here for two more weeks and then I move to the Pediatric Intensive Care Unit, I dont know what level - whatever the highest level is probably...
I have had only around 30 total patients with around 8 needing real therapy over the course of the two weeks, but even that load is pretty heavy considering the acuity.
I don't know how I am going to write about the cases specifically, I am attempting to stay as anonymous as possible, but when I know everything about the patients and apparently I think the world revolves around me; I can't help but feel obvious about who I am talking about.
This is something I suppose I will have to have someone read as a 3rd party before publishing to this blog.
In the most general of terms, hopefully I will get brave and get more specific later; I have managed some jet ventilators, some nitric oxide therapies, oscillators and a lot of conventional ventilators. I have bagged a 500g baby and have gotten really good at a task im sure is overlooked, the capillary blood gas (CBG). The CBG is so humdrum its almost not even worth mentioning when asked what you've been doing for the last hour, but as a new therapist, I can't help but get excited when I fill my vial without any errors.
Vent Checks are okay, but I wish that there was a system in place for recommending a ventilator change. In acute situations, we are allowed (RRT only) to use clinical judgement to change ventilator settings to fit the need of the moment, but for general care when everything is fine except maybe a blood gas tweak, it would be nice to have a place to submit a suggestion for physicians to view when they round.
Giving report is hard when some receiving therapists want to know nothing really, and some want to act like the clinicians we're supposed to be. I have started to give a full clinician report every time and just deal with the eye-rolling. I can't get in trouble for being too-informative, at least thats my mantra for the week.
I know this was choppy but I wanted to log something.
Talk to you soon.
I have had only around 30 total patients with around 8 needing real therapy over the course of the two weeks, but even that load is pretty heavy considering the acuity.
I don't know how I am going to write about the cases specifically, I am attempting to stay as anonymous as possible, but when I know everything about the patients and apparently I think the world revolves around me; I can't help but feel obvious about who I am talking about.
This is something I suppose I will have to have someone read as a 3rd party before publishing to this blog.
In the most general of terms, hopefully I will get brave and get more specific later; I have managed some jet ventilators, some nitric oxide therapies, oscillators and a lot of conventional ventilators. I have bagged a 500g baby and have gotten really good at a task im sure is overlooked, the capillary blood gas (CBG). The CBG is so humdrum its almost not even worth mentioning when asked what you've been doing for the last hour, but as a new therapist, I can't help but get excited when I fill my vial without any errors.
Vent Checks are okay, but I wish that there was a system in place for recommending a ventilator change. In acute situations, we are allowed (RRT only) to use clinical judgement to change ventilator settings to fit the need of the moment, but for general care when everything is fine except maybe a blood gas tweak, it would be nice to have a place to submit a suggestion for physicians to view when they round.
Giving report is hard when some receiving therapists want to know nothing really, and some want to act like the clinicians we're supposed to be. I have started to give a full clinician report every time and just deal with the eye-rolling. I can't get in trouble for being too-informative, at least thats my mantra for the week.
I know this was choppy but I wanted to log something.
Talk to you soon.
a month in acute care
I recently completed a month rotation through general care / acute care. In pediatric respiratory therapy this means I spent every day working with Cystic Fibrosis patients. Respiratory Therapy with a Cystic Fibrosis (CF) patient is a big workload. While admitted to a hospital, a CF patient receives respiratory therapy 4 times (QID) a day. Each segment of therapy requires around 60 minutes of constant therapy and atention to the patient. Meaning if therapy is given appropriately, a single therapist can not take more than three CF patients during a 12 hour shift.
Treatments are just like I learned in school, except we have some additional rules that I probably just forgot. Typically a regimen goes like this: Albuterol MDI or nebulized, wait 10 minutes for proper peak onset, administer hypertonic saline (percentage is different per patient, but 7% is standard for most kids) and then administer 30 minutes of chest percussion. Vest therapy can be substituted for manual percussion and in both every 5 or 10 minutes stop the treatment to get good strong huff coughs to help mobilize the secretions even more. After percussion, Pulmozyme (Dornase Alfa) is given and then any add-on steroid treatments.
Other than CF kids, I had a series of nasotracheal suctioning and a lot of PRN treatments. Acute Care in pediatrics is incredibly busy, though even being so busy - I don't have any remarkable stories, other than I made friends with my CF kids and their families, it would be hard not to. I spend at minimum 3 hours with them every day and if the kid is a handful even more.
I started the Neonatal Intensive Care Unit last week, I hope to include some cool stories about that soon!
Treatments are just like I learned in school, except we have some additional rules that I probably just forgot. Typically a regimen goes like this: Albuterol MDI or nebulized, wait 10 minutes for proper peak onset, administer hypertonic saline (percentage is different per patient, but 7% is standard for most kids) and then administer 30 minutes of chest percussion. Vest therapy can be substituted for manual percussion and in both every 5 or 10 minutes stop the treatment to get good strong huff coughs to help mobilize the secretions even more. After percussion, Pulmozyme (Dornase Alfa) is given and then any add-on steroid treatments.
Other than CF kids, I had a series of nasotracheal suctioning and a lot of PRN treatments. Acute Care in pediatrics is incredibly busy, though even being so busy - I don't have any remarkable stories, other than I made friends with my CF kids and their families, it would be hard not to. I spend at minimum 3 hours with them every day and if the kid is a handful even more.
I started the Neonatal Intensive Care Unit last week, I hope to include some cool stories about that soon!
My first two weeks.
I have been debating on whether or not to write this. I decided that I don't know what my ultimate medium will be but I should try to pen some of the experiences I have recently and my perspective as a Respiratory Therapist.
Another preface is that I became a Registered Respiratory Therapist with the NBRC in May of 2011, so any reference that makes it sound like I have been a therapist for hundreds of years is simply assumption or a perspective from how it seems from where I am standing. I also became a state licensed and nationally registered EMT-I in 2003, so my point of view about EMT related stuff might slip in and that's where that comes from.
First, I will preface this entire blog with how optimistic I currently am about this profession. I realize how big the hill is in front of all of the entire profession as far as getting respect for doing what I am doing. I say that now so I don't have to continually repeat it in future entries.
I also think that it should be a change in the feeling of self-importance by therapists. I don't mean to be super cocky or anything, but be confident in the fact that a Respiratory Therapist is a necessary part of the team. The history of our profession may technically begin in the 60's, but our real profession milestones are somewhere in the 1990's and then again in the early 2000's.
We seem to have had a major influx of people who love trauma and emergency situations and that's great, sort of. Respiratory Therapy was pitched to me as a profession with a lot of application in a plethora of medical institutions, and I still believe it does.
The most embarrassing thing about Respiratory Therapy is the lack of acknowledgement and even understanding of the profession and its administration and history by even the practitioners in it. Have you ever looked at the wikipedia.org page for Respiratory Therapy? It is awful, its full of weird phrasing and horrible explanations of what we do. In the introduction paragraph it says something along the lines of "...respiratory therapists are an important part of the hospital code team and are in charge of oxygen delivery and give nebulizers"
While that is technically true, its like saying this about Nursing "Nurses are important parts of the code team and are in charge of giving patients blankets and reminding them to take their blood pressure medicine"
Saying "Code Team" might not be, but feels intensely uncomfortably improper. Not all emergency response teams are called "Code Teams" and maybe its just that I don't like how elementary the language portrays respiratory therapy.
I was referred to as a technician more than once recently and it bothers me. Its not just that people think the T means technician instead of therapist, but the fact that their opinion of the knowledge and ability of a therapist causes their brain to say technician instead of therapist is what needs to be confronted and corrected instead of simply trying to get them to say the correct word. People don't accidentally say Physical Technician when talking about Physical Therapy and why? You might just feel like its not the right word, and that might be because you have never heard technician used in that place, but I think its a little deeper then that.
There is nothing wrong with the word technician, but it changes the definition of what we do as clinicians.
I think I will try to split up my posts so that they aren't so scattered seeming.
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