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 care. Show all posts
Showing posts with label Respiratory care. Show all posts
American Association for Respiratory Care
The websites for the AARC and NBRC and CoARC are all terrible, *terrible*; but the websites for the individual state societies are *way* worse.
Alabama - http://www.alsrc.org/
Alaska - no-website
Arizona
Arkansas
California
Colorado - http://colosrc.org/
Connecticut
Delaware
District of Columbia
Florida - http://www.fsrc.org/
Georgia - http://www.gasrc.org/
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas - http://www.krcs.org/
Kentucky
Louisiana
Maine
Maryland
Massachusetts - http://www.msrcol.org/
Michigan - http://www.michiganrc.org/
Minnesota - http://www.msrcnet.com/
Mississippi
Missouri
Montana
Nebraska - http://www.nsrc-online.org/joomla/
Nevada
New Hampshire
New Jersey
New Mexico
New York - http://www.nyssrc.org (and another? http://www.nyssrc.com/ )
North Carolina - http://www.ncsrc.org/
North Dakota
Ohio - http://www.osrc.org/
Oklahoma
Oregon - http://osrcnw.org/
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah - http://www.utahsrc.org/
Vermont
Virginia
Virgin Islands
Washington - http://www.rcsw.org/
West Virginia
Wisconsin
Wyoming - http://www.wysrc.org/
Alaska - no-website
Arizona
Arkansas
California
Colorado - http://colosrc.org/
Connecticut
Delaware
District of Columbia
Florida - http://www.fsrc.org/
Georgia - http://www.gasrc.org/
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas - http://www.krcs.org/
Kentucky
Louisiana
Maine
Maryland
Massachusetts - http://www.msrcol.org/
Michigan - http://www.michiganrc.org/
Minnesota - http://www.msrcnet.com/
Mississippi
Missouri
Montana
Nebraska - http://www.nsrc-online.org/joomla/
Nevada
New Hampshire
New Jersey
New Mexico
New York - http://www.nyssrc.org (and another? http://www.nyssrc.com/ )
North Carolina - http://www.ncsrc.org/
North Dakota
Ohio - http://www.osrc.org/
Oklahoma
Oregon - http://osrcnw.org/
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah - http://www.utahsrc.org/
Vermont
Virginia
Virgin Islands
Washington - http://www.rcsw.org/
West Virginia
Wisconsin
Wyoming - http://www.wysrc.org/
------
Canada on the other hand, has some really nice websites.
Manitoba - http://www.marrt.org/
British Columbia - http://www.bcsrt.ca/
off for a few days
I have been captain cystic fibrosis for the last two weeks and its been fun but I think I move into the PICU this next schedule. Its both awesome and awful that at this hospital they move "regular" therapists all over the place. Once I have had a year of RRT experience I can join a specialized team and stay in one place all the time but I am not sure I like that idea.
I have been trying to use my off-days to meditate a lot and listen to music. I need a hobby because during my off days I feel like I need to be productive or else they're wasted.
I am open to suggestions for hobbies. I have a really short attention span (ADHD) and so I rarely love video games, but I have been trying some out. Mario Brothers for the Wii is pretty awesome actually.
Maybe I should learn to cook exotic foods.
Baptized in blood
For those non-RRT's that are reading this, I implore you to attempt to see passed your profession and try to consider what it would be like if you were the only person in the room with your credentials and expected to operate entirely solo. The only real resource for an RRT is either a pulmonologist, a critical care physician, or a physician very well versed in pulmonology. I didn't really understand this until working at the place I work. I am sortof at a disadvantage when I say this though, because I am sure a room full of seasoned nurses and doctors are an amazing resource to the RRT, and a seasoned RRT is just as valuable to them (though the pay-scale would not suggest this). However in my limited exposure so far, when it comes to pulmonary disease, distress, arrest, intervention and just general maintenance I am rowing the boat alone. I am asked my opinion on chest x-rays and we have a respiratory driven protocol that pretty much says "whatever the RRT wants, or the CRT wants with the RRT's co-signature" in regard to hygiene and ventilator management.
I had a pretty baptismal day last week. I had a baby crash 20 minutes after returning from surgery, we had a very familiar episode again where they called ECMO stat, I was the only RRT in the room, managing everything, as the baby begins the most wicked pulmonary hemorrhage on the planet I have to deal with a lot of blood, when the surgeon said "The heart is empty, hurry with the bolus" I wanted to say "If you're looking for it, its all over my hands and arms and all inside the bag-valve".
Immediately following the code (which ended up as a successful ECMO installation with good volumes and saturations (Arterial, %sat, and cerebral ox) and when I left the attending said he predicted the outcome to be a good one) - following the code I was called stat to another one of my patients rooms, where as I am walking in the attending says "we might intubate" and I get the stuff together and then says "lets intubate, right now" so I intubated. Taped that badboy down, stayed to evaluate all my numbers and make sure he was good. Then I am called to be "standby" while they did a planned exploration of one of my patients chests at the bedside.
All of these were my assigned patients. I need to not whine about being "more clinician" because I did not leave the bedside very often all day with these super high acuity patients.
I did all of this 100% alone, I was the sole practitioner, with no one to double-check my decisions. Even the physician just said "whatever you want to do" insinuating that I am there to worry about the lungs so he doesn't have to.
Respiratory Care week is coming up, are your departments doing anything special for it?
I had a pretty baptismal day last week. I had a baby crash 20 minutes after returning from surgery, we had a very familiar episode again where they called ECMO stat, I was the only RRT in the room, managing everything, as the baby begins the most wicked pulmonary hemorrhage on the planet I have to deal with a lot of blood, when the surgeon said "The heart is empty, hurry with the bolus" I wanted to say "If you're looking for it, its all over my hands and arms and all inside the bag-valve".
Immediately following the code (which ended up as a successful ECMO installation with good volumes and saturations (Arterial, %sat, and cerebral ox) and when I left the attending said he predicted the outcome to be a good one) - following the code I was called stat to another one of my patients rooms, where as I am walking in the attending says "we might intubate" and I get the stuff together and then says "lets intubate, right now" so I intubated. Taped that badboy down, stayed to evaluate all my numbers and make sure he was good. Then I am called to be "standby" while they did a planned exploration of one of my patients chests at the bedside.
All of these were my assigned patients. I need to not whine about being "more clinician" because I did not leave the bedside very often all day with these super high acuity patients.
I did all of this 100% alone, I was the sole practitioner, with no one to double-check my decisions. Even the physician just said "whatever you want to do" insinuating that I am there to worry about the lungs so he doesn't have to.
Respiratory Care week is coming up, are your departments doing anything special for it?
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.
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