Chips Anyone?

Well I found this kind of interesting, the first of this medical device that I've had a patient actually using. OK let me explain this one.

I was doing a ECG on a patient in the ER tonight and the ECG machine was picking up a lot of artifacts on the tracing so I readjusted all my leads and checked my wires and disconnected the lead to the ER monitor and still the same with the artifacts but the ECG machine was saying it was detecting muscle tremors. Now here is the part the that I though was quite interesting the patient said to me "Could it be the chip a doctor had implanted in her when she had heart surgery last year?" so now I'm curious and I ask her what chip is she talking about and she continues to tell me that it was told to her after the surgery that the doctor implanted a microchip in her with information of her surgery for future knowledge.

Now I start thinking maybe this is one of the RFID chips that I have heard about which can carry your medical information. I'm thinking yes, but is this becoming more common practice now for different surgeries? Now I have to go searching.

What I found out is that the company Verichip is manufacturing a chip called the VeriMed chip which links you to a database they maintain and can be accessed with a RFID reader that some ER's and Hospitals are starting to carry.

I read this little interesting story also:

In May 2006, William Koretsky made medical history when he became the first
emergency patient to be identified from an implanted radiofrequency
identification (RFID) chip. Koretsky, a 44-year-old sergeant with the Bergen
County Police Department (NJ, USA), had crashed his car into a tree during a
high-speed chase. When he was taken to hospital, an emergency-room scan revealed an RFID chip in his arm, which had been implanted in 2004 for identification
purposes at the suggestion of his police chief. Doctors retrieved the ID number,
identified Koretsky using an online database, reviewed his health history and
learned that he had type 1 diabetes. While treating his other injuries,
physicians quickly began monitoring Koretsky's blood sugar level. The RFID chip,
which was manufactured by VeriChip (Delray Beach, FL, USA), might have saved his life. “I was unable to communicate, but the chip talked for me,” Koretsky said.
“I couldn't lose the chip, like I could a MedicAlert® bracelet. The VeriChip™
was a home run.”

That I found in a great article about the Verichips and the different uses, which can be found here in the full article.

Looks like they are targeting people with diabetes, cancer, coronary heart disease, stroke, chronic obstructive pulmonary disease, cognitive impairments, seizure disorders and Alzheimer's, and people with complex medical device implants, such as pacemakers, stents, joint replacements and organ transplants. These are some patients where it could save a life is the clinicians could have information of the patient faster. The future seems to be coming around faster and faster all the time now, I have noticed that our tablet PC's we use for charting now at the bedside do have a RFID reader, along with the barcode reader but we don't use either of those YET.

So is this a good thing or is it to much "1984" like with the possiblity of Big Brother watching. It's one thing to microchip your dog or some other belonging but are we ready to have human's microchiped? I think I can become quite helpful, like a guy I read about a couple years ago in Wired Magazine who was microchipped and when he would come home the house knew this, as he walked through the house lights would turn on and off as he would move from one room to the next. Ok that's a little extreme and lazy but interesting nun the least. So are we ready for this, time will tell.

Drive on RT's

It's Pouring!!!

Remember that "Wow it's been really slow for awhile now" thing I wrote a couple posts back? Well it's over now, tonight has become hell night, so I'm not able to blog about what I wanted to but I will at a later time.

Well I've been hit with a ton of COPD patients tonight along with multiple Chest Pain which cause use to do EKG's. It's just been crazy and we are assuming that it was the nicer weather that awoke all the bacterias up and now it's getting colder and we are expecting 3-9 inches of snow today, so yep weather and barometric pressure change can really effect those people with COPD and it's happening tonight at my little hospital. It's also happening at my wife's big hospital were she is a ER nurse, they have been just as busy.

Here in my little slice of heaven I am the only RT on a night so I'm running all over with the new patients we are getting and I'm only able to write a little due to forgetting to get the chance to do the controls on our ABG machines so I'm doing that now. Actually I walk into here one is stuck in the MS Windows start up screen and is spitting out paper as I speak slowly, now what the hell do I do? I'm not trained to mess with this type of problem, oh well we have 2 machines and I'm going to assume that the broke one will run out of paper soon.

Well enough typing for me right now the paper is yelping at me again so back out into the war against COPD and when this is over I have a couple days off to actually get to enjoy my Christmas presents.

I'm still driving on.

Need a Harmonica player for your band?

I found this interesting article from the Arizona Republic about a program at the John C. Lincoln hospital in Phoenix Arizona.

Basically it is a class put on by Mike Clark, a registered respiratory therapist at the hospital where patients with mainly COPD are learning to play the Harmonica. By using the harmonica these patients can hear exactly how they are breathing along with learning a instrument and getting some PEP therapy along with it I'm sure. They used to use therapies for strengthening their lungs by blowing out candles, walking treadmills or blowing up small balloons but it sounds like this one is a bit more fun.

I have to say therapy must be easier to do and stay with it is interesting and fun. Can't help but be a little impressed with this "alternative therapy". I have noticed over the years that the people who do get this highest amount on their Incentive Spirometry seem to have played some type on instrument in the past, mostly it seemed to be a trumpet like instrument where you purse your lips to play. Well I don't smoke but if I ever get COPD, I'm taking up the trumpet.



In another note I was asked for a update on a patient I had recently blogged about so here is a update:

This patient is currently still on the ventilator but we were able to finally get the inspiratory pressures down in the mid to upper 20's on pressure control. The ABG's had PH's in the 7.20 range for about 3 days in a row with no improvement. Overall what seems to be happening to this person is backing up with fluid. There was a 9 pound gain in weight over my last night's shift. Today dialysis was given and over 5 liters were taken off and guess what happened? We were able to drop the PC pressure to 22 and the PO2 from the first gas after the Dialysis on 70% was in the 100's finally, before the last 3-4 days we were lucky to get it in the 50's. Now this isn't first round of dialysis but it seemed to be a bit more effective after the fluid was removed this time around. Think maybe we might be on the upswing with this one.

I might blog a bit more tonight if I can remember the other topic I wanted to talk about, sounded good at the time now It's slipped my mind.

Drive on all and hope you had a great Holiday.

Deadtime....

Ok just did 2 posting but this is kind of interesting to any night shifters out there.

My wife and I have been watching this show called Paranormal State which is basically about ghost and paranormal hunters. Its a show where the video the actual hunts and the attempt to contact and remove the paranormal activity, this in not a Docudrama its real footage.

Anyways there is a time called Dead time which they say is when there is the most paranormal activity and this time is between 3:00am and 4:00am. OK if this is true and we work in hospital where people die and there are surely ghost around, maybe we should keep our eyes open during this time. Kind of eerie.

What do you think, seen any ghosts at your hospital? I have at another I worked at in Germany while I was in the military, but I will keep that story for a later post.

Keep calm.

Cardiorespiratory Therapist?

So why does it seem that the duties of EKG's always fall in the hands of us RT's? Where we trained in cardiology, or given the knowledge of ECG/EKG's or even doing these tests on patients? I know I was never given a class on this type of testing during my schooling, but it the powers that be seem to think that EKG's should fall onto us RT's. Now I'm sure this isn't the case for all RT's who work in Hospitals, but so far in the last 11 years doing this it seem to be the standard where I have worked.

Now being a male RT doing EKG's can become a little touchy at times, but we must know to remain professional at all times also. Ok now I'm not trying to sound perverted but really is it to hard to ask for a hottie patient to do a EKG on every now and then, I think not. Really think about it what is our EKG population like and the problems the come with it.

As a man we have to handle these women's breasts which are in general terms a taboo region just to bear in front of a stranger. With the older women you can't help but wonder is this offends them due to how they were brought up. Middle age women usually there is a husband in the room with them and they of course are watching another man handle their women and I have yet to meet someone like Suzanne Summers in this age group. Then comes the large overweight women where you need a crane to lift those monsters to get a little sticker under their, sure wish they came with a kickstand. You actually wonder if they feel bad putting you under all that stress of lifting those things.

Now we get to the younger population of women, which is usually not the case for EKG's but it does happen. As a guy you might think great a woman I really don't mind touching but then professionalism takes over and you attempt to put these stickers on with averting your eyes as to not make her think you are staring at her in a way other then medically. Then there is the possibility of teenagers getting a EKG also and as a Dad with 2 girls, I do my best to keep them covered up because I don't want a parent thinking anything or being uncomfortable with a man touching their daughter.

As for the guys, who cares they don't. Just get it done and move on, these are the easy ones and the easiest to find their landmarks.

Over the multitude of EKG's I have done at this current hospital I work at my initial worries I had doing these has since gone out the door but those were real concerns at one time. Professionalism has taken over and I just get it done, try to make the patient feel comfortable and work on getting them covered back up as soon as possible. Yes I still get a little grossed out from the underboob sweat along with other funky things that are under there with the bigger women but we drive on and get the job done.

Yes some of use are CRT's .... CardioRespiratory Therapists, but please don't ask me what I see in that EKG because I cannot tell you because I'm only trained to put stickers on you.


Next Episode: What to look for on a EKG/ECG.

Moments of Busy.

As you might of noticed from my last post that we are really not all that busy here in my RT Cave, but we do have our moments of busy and last night was one of them.

I get here at my normal time of 1830 figuring on a pretty decent night. I do the normal thing, put my coat and my food in my locker and fridge and then page the RT on shift to see if they need any help, usually it's a "Nope, I'll be right up.". Well not this tonight it was more of a "Could you get started on the treatments and meet me in the ICU, or I'll find you when I'm done." Ok still nothing to really get me thinking busy, I mean our treatment load is 2 QID's and one Q4, sure I can knock that out.

After I get those 3 really tough nebs (sarcasm) done I head off down to the ICU to see if my partner needs any help, well yep she does with a patient who is vented. Now I notice that she is bagging this patient and the vent is next to her and running, so I ask whats going on? She had been bagging this patient for over a hour now because the vent will not ventilate the patient. I go ahead and check out the vent to make sure it's working properly and passes all the self tests ... Yep works just fine, this patient is crap.

I go ahead and take over the bagging and get some report, this patient is septic in falling deeper into ARDS (Adult Respiratory Distress Syndrome) and is so tight that on Assist Control the most tidal volume we can get in is 30-50 ml's, not good. Alright next try is Pressure Control, great we have a Inspiratory Pressure up to 40 with no peep and can only get about 100-150 ml's VT, still not good.

My Partners pager goes off ... now what. Of course it's nothing good, we have another patient that I had done a neb on just about 20 mins ago now crashing so off she goes and there I am bagging a patient who cannot ventilate and is stiff as a board.

So it's now a Hour and a Half later, my hands are cramping and I'm still bagging and trying to figure out what to do, well dialysis is called in to get some fluid, almost 5 kilo's are wanted to be taken off, and hey here comes my partner with the other patient behind her while she is pushing a bipap machine, great what the hell is going on there. Turns out he has a reaction to a antibiotic that was just given to him that looked just like orange juice, now I'd think that would be rough going in on the veins. With further questioning I find out that the med he was give required you to premedicate the patient with Tylenol and Benedryl before it's administered, wow hardcore stuff there.

Finally 2 hours later my partner is able to give me some relief in the bagging area and the dialysis is started finally and a half hour later we are able to ventilate with PC on the ventilator, phew finally we can step back and relax a bit.

Now This patient pretty much stayed the same during the night. I ran three ABG's on the patient and from number 1 to number 3 the biggest change was a PO2 from 45-49 to good in the oxygenation department and spo2 was showing in the low 80's, but Doc said he was good with that and really didn't know what else to do because nothing was working.

Now getting a chance to think of everything that happened you start to notice the limitations of a smaller hospital. Heli-Ox would of been nice but we have none of that. PRVC mode might of worked but we don't have that on the PB 840 vent, there is VC+ which is supposed to be like PRVC but didn't really work to well as I tried it. Would of been perfect patient to transfer out but the weather was crap. So what do you do? Improvise and do the best with what you have, what else can you do, in a way it does make you use you knowledge a bit more versus using technology so much.

I must say I do like interesting patients and this one is interesting. Tonight I get the honor to having this patient again and so far nothing is improving, just a little increase in the saturation of oxygen area, but that could be due to the peep going from 12-16 cmh2o today. So tonight my last day before Christmas working I am still slow, with a Ventilator and a Q4 neb but as we all know anything can change at anytime.

Happy Holidays.

Where's the patients?

Now I'm not complaining but it can get a little boring around here without patients to work with. Yes I'm talking about having no patients through the night and this is my 4Th shift in a row where it's been like this. Actually we have only 7 total patients that require our RT expertise, which is 5 more than there was 3 days ago.

It is damn cold here lately with a lot of snow and ice around so maybe the cold is killing all the Bactria's off so nothing to get anyone sick. That's not true the Flu is running through my house. My 9 year old had a Asthma flareup with vomiting from the Flu which then went to my 9 month old who has been vomiting for 4 days now, but better today. Now did anyone know that doc's don't give medication to babies anymore to help stop the vomiting? I didn't!!! Nor did my wife the ER nurse, but the pediatrician said there was a study of some sort and they don't recommend anti-vomiting meds anymore for babies, so we just had to keep washing his sheets and 6 changes of clothes a day. Anyways this also got passed onto my 3 year old, yep more vomiting and laundry washing along with diarrhea also....what fun. Now he was able to get Zofran (spelling) to help but not his brother, but with a ER nurse mom what do you think she did? Yep cut it in half to help the little one and it worked...well he had to eat something and keep it down he was losing weight plus he made me late one night. Just as I was getting ready to leave I was holding my son and of course...BLAAAHhhhhh...all over my scrubs. So of course I have to iron a new pair but what are you gonna do.

Is anyone else's census down? I'm curious how long this will continue because winter is usually the busy season. As of now I'm catching up with some DVDs I've been meaning to watch, cleaning the department a bit and just wandering around to stay awake.

Take care and Happy Holiday all.

Does smoking drive our profession?

Is it possible that smoking drives out profession? Is it also possible that the patient load of our profession could be decreasing significantly in the future?

This is just maybe a theory I have thought about but let me explain myself. If you look at the patients who we give nebulizer tx's to on a regular basis the majority of them are COPDer's and Asthmatics in trouble. Now say we cut out the COPDers and notice how much our census will drop because to me it seems that I see more COPDers than I do asthmatics so if we see less of them our census goes down right, also with more education and better use of medications there can be less of the admitted in the hospital. Here is a article showing this.

Self-Management Education for COPD Patients Cuts Hospital Admissions

There are a couple of sites that have shown that study that I have found, but I'm only going to post one for now.

Another way to look at my thoughts on how our census will decrease in the future goes like this: The majority of COPDers in the world are of a older age. Now here is where my thinking comes in so stay with me, but it shouldn't be that hard. Due to the fact that the COPDers are older and there wasn't a whole lot of education on the harmful effects of cigarette smoking at that time versus the education there is now (seriously the military packages cigarettes with the soldiers meals in WW2) and the perception of smoking has in the United States in today's day and age. It's getting banned everywhere, the price is increasing, there are warnings everywhere, you have to be a certain age, and it's almost getting to the point where it is illegal to smoke anywhere anymore. All of this in my opinion equals less COPDers in the future which will in turn should decrease the census for nebulizer treatments with COPD patients.

Lets look a little deeper now also. In the past there was asbestosis which caused respiratory problems and this is now outlawed. Different jobs that have fumes that can be inhaled are not required by OSHA for the personnel that do these jobs to wear a mask that filters out these fumes which can cause respiratory issues for example automobile painters which have the paint that can be inhaled. These precautions can cause a decrease of people with lung problem due to inhaled fumes, particles or whatever is able to be inhaled at certain jobs.

Well there you have it my ideas on how our job census will decrease in the future, basically when the current population over 65 passes on there is a possibility of a decrease in patients due to education and studies of smoking and harmful inhalants. According to this study Half of elderly patients discharged from hospital following a first admission for COPD are dead within 3 to 7 years. So that right there could show that it really might not take to long.

Remember this is in no way a scientific study but just a thought I have had, but I would love to hear anybody else's opinion on these ideas. Of course there are also the studies about air pollutants causing COPD like symptoms in people also, so maybe if we don't get green enough as a country it will stay the same but the cause will be different.

Drive on RT's

A Good Holiday.

Well I haven't written in awhile due to the holiday's, I was a little busy. I hope everyone had a great Thanksgiving, I did.

So what's new in my RT world. Well as we know I work in a smaller hospital and one thing I recently noticed is that our ICU is being used as a Drunk Tank, or detox for alcohol. Well what I mean is lately we have had a bit of patients in the ICU who were just in for alcohol poisoning as their diagnosis, in my opinion they were just intoxicated, drank a bit to much and maybe a little depressed due to the holidays coming up. Yes this is a small town hospital and from what I have heard there is only like 6 police in this town so really that probably don't have the resources to service these people in the jail like they did on the Andy Griffith show when Otis would get drunk and then come to the station to sleep it off. Now really is this a good place to put these people? All of them have been men and normally the majority of RN's working in the ICU are women and these drunk men can get a little unruly at times so it doesn't make much sense to me because if there is a physical problem or threat I'm usually one of the people who are called, not that I mind because I enjoy messing around with the drunk people, makes me laugh, but it could become dangerous for the RN's sometimes I'm thinking. In all honestly when I first started here I asked about security and people snickered a bit. Then I was told that if a security risk should come up like a combative patient or family member that the call will go out overheard for the men to come to that area. Kind of funny because on any given night there are maybe a total of 3-5 men in house at night and sometimes less I'm sure. Lets see tonight there is me, a Doc in the ER and a old lab tech, and possibly a guy from engineering. I'm alright, I lift weights a few days a week, was a soldier for 10 years, played football and I workout on a heavy bag a couple times a week so I'd like to think I can hold my own. It just made me laugh a bit that there were really no type of security here in this small hospital, I came from a hospital where there were uniform security, no guns but night sticks and pepper spray, oh and handcuffs to.

Since I have been here for the last 8 months there has been no calls for security so maybe it's warranted for the no official security force, but with all the drunks being admitted lately the time may come sooner than they think.


Oh well, happy holidays everyone hope it's not to busy.

Mean Patients Suck!

Is it just me or does anyone else find it fun to antagonize Mean Patients?

You know the ones who come into the hospital but don't want anyone to do anything with them and are just plain mean and unruly. Now these are the ones I like to stay in the room with and just keep irritating them. The ones that yell "Get the hell out of my room!" when you come in. Now is the time to institute operation sarcasm, within limits but it can be a fun game.

Then there are the ones who tell you to "Get that f*&^ing thing away from me, I can't get any damn sleep around here." Well sir your not here to sleep only to get that infection out of your body and when you finally get home then you can sleep.

There are many patients who don't realize that a hospital isn't a place for rest and relaxation, no it's not R & R time, it's healing time. If your admitted to the hospital it's because you need some extra help that you cannot get at home and you will get this help all night long. In reality the doctor's don't care if you get much sleep, they just want to kill off that bacteria or virus you might have. They want to stop your lungs from bronchospasming by any means necessary and if that means we wake you up every 2 hours to get you better, then so be it.

Of course there are mean people due to confusion and there is not much we can say about them except that confused people are much more fun when they are happy confused and they say some funny stuff. I had one patient watching Tiger Woods riding a horse on the roof outside his room. He watched him for hours and I be it was interesting to watch.

I do like to tell my tired patients to take a extra day off of work when you get home to get some good rest because being in the hospital can become like a good jetlag and your sleeping pattern can become very disrupted. Sleep is needed but the hospital is not the place for R & R it's a place to get rid of a sickness or injury, sorry there is not Red Roof on this inn.

What's what my inspiration for this post, well that guy yelling at me to "Get the F*&^K out of his room" and then commenced to try to hit me with his call light, hmm what do I chart now.....REFUSED TREATMENT, PATIENT COMBATIVE. I'm off to see a patient who really needs help.

Drive on RT's

Pro Atheletes and Respiratory Problems

Sitting around watching University of Illinois (I take classes through here) beat #1 ranked Ohio State University in football WOOhhooo, I began thinking. What Pro Athletes are out there who have respiratory related problems? I've heard of Pro Athletes who have asthma so there must be more than the couple I have heard of, so the search began. Not only did I have a good amount with asthma but a bunch of information on Pro Athletes with Obstructive Sleep Apnea (OSA).

I found an article from Sleep Review about Pro Athletes and OSA which was a bit suprising and I will try to make a synopsis of the main points I thought was interesting, but of course feel free to read the whole article.

• More than 10 years ago, a trend became evident that a high incidence of asthma appeared to be a common condition across the athletes. Numerous Olympic athletes in recent years have been diagnosed with some form of asthma.
  


• The incidence of sleep apnea cuts across the entire populace, there is increasing evidence that the condition is quite prevalent in those who are considered particularly fit like professional athletes, especially football players.
  

• Over the past 30 years, body size of football players has increased dramatically. Today, more than 300 players in the NFL weigh over 300 pounds. These are the men who are most at risk for obstructive sleep apnea.
  


• There have been studies of more than 1,200 retired NFL players with a average age of 52. Sleep apnea among those studied ranged around 40% or so. OSA was most prevalent in linemen with 60% to 70% of them diagnosed with the disorder.
  


• Lineman have necks that average 17 inches or more and they weight close to or more than 300lbs, these are factors with them having OSA.
  


• A study of 8 randomly selected NFL teams and more than 300 players, including the smaller receivers and defensive backs, found evidence of sleep apnea in 14% of the players, nearly 5 times higher than noted in previous studies of similarly aged adults. The prevalence of the condition in linemen jumped to 34%.
  


• One study conducted at the Douai Memorial Hospital in Tokyo noted a high incidence of sleep apnea in sumo wrestlers whose ring weight averages between 300 and 400 pounds.
  

Reggie White, the star NFL defensive end of 15 years died at the age of 43 suddenly. His death was believed to be related to untreated sleep apnea. Supposedly he had tried CPAP at one time but was unable to continue to wear it due to claustrophobia.

Former Syracuse University star Kevin Mitchell. A three-time All Big East Conference nose guard, who also went pro and won a Super Bowl ring as a linebacker with the San Francisco 49ers, he also died young in his sleep at the age of 36. It was said that OSA was strongly suspected but not fully proven.

I thought there was some interesting information there in that article, and I found others online confirming that article, feel free to google some more information if interested.

Here is a list of Pro Athletes I found to have asthma:

• Jerome "The Bus" Bettis (NFL star of the Pittsburgh Steelers)
  
• Amy Van Dyken (Olympic gold medalist in swimming)
  
• Jackie Joyner-Kersee (Olympic gold medalist in track and field)
  
• Nancy Hogshead (Olympic gold medalist in swimming)
  
• Art Monk (NFL leading receiver for the Washington Redskins until 1995)
  
• Emmit Smith (Pro NFL running back)
  
• Greg Louganis (Olympic gold medalist in diving)
  
• Jim "Catfish" Hunter, (Baseball Hall of Fame pitcher)
  
• Isaiah Thomas, (former NBA basketball player)
  
• Dominique Wilkens, (former NBA basketball player)
  
• Dennis Rodman (former NBA basketball player)
  
• Mary Jo Fernandez, (top women's tennis professional in the 1990s)
  
• Keith Brantley (Olympic Team Marathon Runner)
  
• Bill Koch (Olympic silver medalist in Cross Country Skiing)
  
• Kristi Yamaguchi (Gold medal in Olympics figure skating)
  
• Jim Ryun (Olympic Silver medalist in track and field)
  
• Alexi Grewal (Olympic Gold medalist cycling)
  
• Tom Dolan (Olympic Gold Medalist Swimming)
  
• Paula Radcliffe (shattered the women's world marathon best in Chicago)
  
• Mark Spitz (9 gold medals in swimming)
  
• Jan Ullrich (Tour De France winner)
  
• Alison Streeter (has swam the English Channel more than 40 times)
  

I also found a article in the NY Times with a interview of Jerome Bettis talking about his asthma and asthma in general. This article here has a list of more famous people who have asthma if your interested. I was just mainly interested in athletes who have it which here we see there are many and I'm sure many more, this just shows if your patient is able to control it and deal with it, they can do pretty much anything.

Interesting? I think so...Drive on RT's

Sometimes it gets busy.

I've been off for 3 days now and I walk into work at the beginning of my 12hr shift with a note on the desk that says "Come down to ICU and join the fun!", now this is probably not a invitation to a party in the ICU I'm thinking. Nope it isn't after I answer the phone right after I read this it's a coworker wanting me to come on down asap, ok let me just hang my jacket up at least and grab my stethoscope and off to the ICU I go.

In I walk and there my coworker is getting things ready for the Doc to intubate a patient. I can hear this patient outside of the doorway...wow major fluid issues, then I look, puffy like the stay puff marshmallow man and gray, yep this is gonna be fun. We finish getting the intubation stuff ready and the Doc slides the tube in, I place the CO2 tester on and give that first breath and it takes all my hand strength to get a breath in, wow is this patient tight...then I see it, pink frothy and bloody THICK secretion up the tube. Yep that could be a problem, time to suction. Finally I look up and see one of my coworkers, she looks about ready to cry...it's been one of those days I can see. The vent is set up and we place the patient on and that vent is just high pressuring, wow this person is tight from fluid time to try pressure control. I adjust the pressure and I times and I get volumes anywhere from 70 - 250ml's, not good we need a bit more but I have the pressure already up to 35 cmh2o time to continue bagging.

Back with the bagging the monitor starts alarming we look up and just watch the QRS's widen on this patient until it turns into V-Tach, not good. Check for a pulse, there is one and she converts back, phew dodged that code. A couple minutes later there it goes again, V-Tach, this time is stays, and we shock, back to a normal rhythm but a BP of 30 systolic. Again back to V-Tach and it stays, but there is still a good pulse so my coworker asks the patient to squeeze her hand, which she does, asks if she is in pain and the patient shakes his head no, can you move your feet, they move all over. We look up and still a full out v-tach on 2 different monitors and a good pulse with good responsiveness but the BP is still 30 systolic, now this is something I haven's seen before, a responsive patient in a condition like that. The doc now decides that there is now way this person can be responsive with a BP that low so it must be wrong. Now we need blood work and a ABG.

Here is where I feel like a stud. A doctor has already tried a A-Line and wasn't able to get any blood, another RT has tried to get a ABG already and nothing, so I say let me do it. I fell zero pulses in either the radial or brachial areas so it's time to use anatomy. I grab my kit, take aim and go for it...nothing...readjust...nothing...again and I strike blood!!!! WOOT!!! The syringe fills and I get the gas, it was said it couldn't be done.

Finally this patient stabilizes for the most part and we are able to ventilate but for most of the night it's back and forth....V-Tach and Sinus heart rhythm until finally in the morning things just give up and HR drops, BP drops and QRS's widen and the patient passes on.

Busy night, and from what I hear busy day I was told from the RT who looked like she was going to break down said and ultimately did break down and cried in a back room. I don't know exactly what all went on during the day but it was enough to get to her and she still felt like she should stay and help us until things got caught up with. I told her to get out of here, go home, have a drink and relax we will be just fine.

Yes our small hospital's can become very busy at times and it ways can be more stressful because of the small amount of staff we have to run with, but you adjust, adapt and make it work with what you have, all in all people do understand that you can get busy.

What is this post about, nothing educational just a post to talk about my night and how it can be. But ya know these are the nights that make this job fun, I enjoy the stressful situations like this.

Keep it up RT's and drive on.

Lets Lighten it up a bit.

Ok so that last post was a bit on the downer side so now I have to lighten up the mood a bit with a anecdote from my wife and where she works. She is a ER nurse at a much bigger hospital than mine.

Anyways I thought this was hilarious.

A nicely dressed lady in her late 30's comes in complaining of stomach pains. My wife goes in to get her history and information about the complaint and the patient goes on telling her that she and her husband drank a big the night before and started playing around and her husband decided to try something new and use a beer bottle as a ----- on her and she awoke this morning with stomach pains. So off the xray she is sent for a abdominal series and the xrays come back to show a bottle cap insider of her. Yes the husband used a unopened bottle that seemed become open, OUCH I would think and where the hell did the beer go. Ok now that isn't the funny part. So the doctor does in to do a pelvic exam to get the bottle cap out, and after the exam he comes back out to the nurses station with a Budweiser cap in a biohazard bad and exclaims:

"DAMMIT, I said I wanted a Bud Light."

True story, what a great sense of humor this doctor has. ER's are always fun to hang around at they people there are a different breed, especially night shift ER personnel.

Drive on and go have a beer.

How low can you go

So I'm going around doing my oxygen rounds (for the RT students, this is the fun time you get to check on all the patients who were or are on oxygen, mainly for charging purposes and sat checks), and I come upon this patient who has been in the hospital for awhile and notice that she looks awefully purple grayish in color, especially her lips. Now mind you this is in the middle of the night so the lights are off of course its 4 am. I proceed with my check by saying "Mrs. Namewithheldduetohippa I need to check your oxygen saturation levels" for which she complies and gives me the regulation oxygen check finger into my pulse ox device. After looking at the flow meter to see what flow she is on I look at the pulse ox and WHOA it's 52%!!!! So quickly I turn on the light, damn she really is purple grayish and not red in her lips at all. This lady has been on a 10-15 liter high flow nasal cannula and she had decided to take it off. I then ask her if she had been the one to take it off, she replied "Yes I did, I'm going to be a hospice patient and I cannot go home with this much oxygen on." So I go into my RT talk as to how with that low of oxygen in you blood you can cause damage to your heart and brain, along with a large increase of CO2 you your blood you might not wake up. Then I get the stunner "That's the point, I don't want to wake up. My lungs are really bad and I'm not good to anyone anymore, I don't want to be a burden on anyone, I'm just ready to let go and die." she says. Ok I'm a little shocked now and trying to figure out what to say next. How do you go about trying to lighten up this situation and help a dying person think they are worth being alive to people. Yes she is in bad shape but with her lungs, but her mind is in perfect shape and no she cannot run around with her grand kids in the yard, but she can talk with them, tell them stories. So I tell her, "You are not burden to us here, thats what we are here for it to help you out, and besides I enjoy talking to you and so does other people I work with so I'm sure your family enjoys just having you around to talk with." Not sure how much that helped but the nurse chimed in and added some more encouragement. So after this discussion with her I rechecked her sats and they were back up to 86% after about 15 minutes. This person is a great patient to have, had never complained or given anyone a hard time and yes she is enjoyable to chat with during treatments but yes she is past the point to getting well she was a 50 pack year smoker who was told 10 years ago that her lungs were bad and decided not to take the warning and get some help and now it's to late and she knows it.

How do you talk to patients like this, they are at the end of the line and they know it. I don't know it's just a bit surprising when something like this comes around, you never expect people to tell you that they are ready and want to die and they are being serious. This is a subject that comes up in our profession due to respiratory being involved with very ill patients but it's a population we have to deal with. Along this same line we deal with turning off the ventilators with patients have not chance to recover and are brain dead, these thoughts are very well explored over at Keep Breathing in a post he had about doing a terminal wean. I once worked with a RT who would refuse to do a terminal wean, he couldn't handle it personally and religiously... I don't think he is a RT anymore.

Once again it takes a certain type of person to do a medical job and it's not for everyone, but sick and dying people need this type of person, compassionate. That's what I would hope for if I was in their shoes.

Drive on RT's.

The Calm Before the Storm

Only 2 patients tonight, one a Q4 and one a Q2, yep nice and quiet. This actually give me 2 more nebulizer treatments I have to do than the last shift I worked, of course the Q2 isn't as bad as this person is thought to be, but no protocol is wanted on him so I kind of feel bad waking this patient up and taking loudly just to keep him awake and deep breathing. So ok he is wheezing and sats do drop without O2 so there is a need for something.

Wow ER just paged for a EKG....
Turns out nothing exciting, patient just left 10 days ago and has a Doctor appointment tomorrow oh and yep EKG was fine, doc says it's probably musculoskeletal pain, now get out of here and go home.

There has been some lazy shifts lately for my old RT department but isn't that how this job goes the patient load ebbs and flows like the tide. Feast or famine, you either run all night or you might sit all night and chat with the nurses or better yet blog about it.

Over my time in the profession I have noticed some trends of things where the patient load with increase or decrease and most of these have been fairly consistent, I'll try and lay them out and explain the idea behind these times.

Things that cause patient load to INCREASE or decrease:

• Summertime causes a decrease due to it being nice outside, and who wants to be stuck in a hospital when it's nice outside so more people come in for injuries than breathing.
• Exception to summertime is when humidity is high there is a increase, bring in the COPD'ers.
• Wintertime there is a major increase, it's cold outside and there are more sicknesses, cold air can set off a asthma attack, RSV is back along with croup.
• The night of or day after Thanksgiving there is a increase. Why you ask? Here you will see a large amount of Congestive Heart Failure patients because of the large amount of food people eat with a large amount of SALT which cause fluid retention.
• Christmas and Easter see directly above. Same thing with the CHF.
• Holidays in general you will see a surge of Frequent Fliers. Now these are mainly nursing home frequent fliers who want attention from the family during the holidays so on comes the sickness. I have seen this and could pretty much track it, when the holiday came so did these people.
• A Full Moon. I don't care what anyone says but a full moon always brings in more people, superstition or not. I have also read that the closer the moon is to the earth there is a larger gravitational pull on fluids which can affect fluid retainers.
• After the Super Bowl. The excitement of the game, the drinking, and the major one is the eating. Here you will get asthma attacks, CHF, and chest pains. Mainly this is evident in the ER but it's true.

Well these are the major ones I have noticed but of course there are other trends for different places in the hospital like the ER, for example the weekend magic hour is about 02:30 am, this would be the end of bar time....let the drunks get hurt and sick. Never know whats going to happen at any given time in the world of health care but some things just seem to fall into place.

I would like to hear any other trends that people have figured out, I'm sure there are more.

Drive on RT's

Vaseline and Oxygen: Flame On

I have been told before that you cannot mix oxygen and vaseline together because they can cause a flame and cause problems. How many others of you have heard this information, maybe this should be put on a new Myth Buster's show.

So I started looking around a bit and have came across some posting on nursing sites about whether this is a myth or not. I have found numerous references to this article, "Dispelling the petroleum jelly myth," in the November 1998 American Journal of Nursing but I have no way to access this article and cannot find a good free source for this. If anyone out there has access to this I would be interested to hear or see the information in this article.

Information I have found out about this being a combustible subject is that when a patient used a thin layer of petroleum jelly on their lips due to dryness from the oxygen that the oxygen from a oxygen device to provide the patient with oxygen can cause the petroleum jelly can cause a gas that when combined with oxygen can become very combustible, and then is a static spark can cause a flame. Supposedly there are many reports if this in a surgical rooms versus not many report from patient floor rooms. Could this be from a lack of people reporting this problem, I don't know but I think it's a interesting subject because I see vaseline and Carmex used a lot to moisten the lips of patients on oxygen. I do understand that oxygen does make your mouth and lips dry.

I am interested to see if anyone else out there has any good information on this topic.

Keep Driving on RT's

The Lungs have the Sound of Music.

Breath sounds, breath sounds, breath sounds. We all know and love them and listen to them daily but did you ever stop and think that there is a certain breath sound that you really enjoy hearing?

Fortunately tonight I have had the time to contemplate this and I came to the conclusion that there is a certain breath sound I really like the sound of. So much so that I much just try and get it onto my IPOD, or even better yet...as a ring tone.

So I'm sure everyone is in suspense wondering what the breath sound is that I find audibly pleasing, well wait no more because my favorite breath sound is the great and powerful CRACKLES!!! Why this one? Well it has a deeper bass sound and there is a range of pitches in this sound. The beginning of the crackles there is a faint noise of the crackling, then it gradually increases to the loudest sound, which this process in the musical world is called a crescendo, and then the process reverses and its gone. During the crescendo of a breath sound there is also the sound of the cracks, cracking on and off so you have a variety of sounds in this lung sounds. Yeah for pneumonia and CHF.

Anyways that's my take on my favorite lung sound, does anyone else have a favorite or is it just me? Could you imagine hearing Crackles or wheezes as a ring tone, would that not freak some people out. Oh my Gawd that person is having a Asthma Attack!!!!

Here is a website I found a long time ago called Lung Sounds, but on here are audio files you can click on and listen to different sounds I found this years ago in school and surprisingly it is still online and it is in my Respiratory Link section so enjoy.

Until next time Drive on RT's

A Stereotypical Patient

Everyone has some patients who are just stereotypical patients. The ones who are they way they are because of how they are. What I am going to do is try and describe a type of patient that I have noticed at every place I have worked as a RT and the reason they are this way.

Yep you might of guessed it, these types irritate me a bit because of what they could do to change their symptoms.

• They become short of breath with exertion.
• They most likely are diabetic.
• They are usually younger 30-50 years old.
• They have "Exercise Induced Asthma".
• They have hypertension.
• They seem to have back problems.
• They like to sleep and are become tired a lot.
• They like to order food at all hours, or have a stash of snacks in the room.
• They have decreased lung sounds.
• They get pneumonia a lot, or just plain sickly.
• They give a very lazy effort when asked to do a peak flow.
• They have that certain smell about them.
• They all seem to smoke.
• They seem to be on public aid.

Now you ask what patients am I talking about here, well these would be the morbid obese younger patients who have no motivation to help themselves. Just think how many trips to the hospital they could save just by losing weight.

Their breathing problems with exertion would be less, hypertension could be better controlled, diabetes better managed, they would have more energy, back problems could be gone, they could get a better job or a job in general with insurance and there possibly is not real asthma component. Finally that smell could disappear.

Now I'm sure this sounds like I'm bashing overweight people but I'm really not. The people I'm talking about just do not take care of themselves, are lazy and leech off the system. There are many overweight people who don't fit into this mold at all, but as for who I'm talking about...You RT's and RN's know exactly what I'm talking about.

Feel free to comment me on this but as always

Drive On RT's

Different Hospital, Different Rules.

As you might have noticed that this blog is just ideas that come into my head or interesting things that I come across at my place of work. The idea behind "Different Hospital, Different Rules" is about how hospitals differ on how the utilize their Respiratory Therapists. Now you might ask where do I get my knowledge about this, well it comes from the 6 different hospitals I have worked at in my almost 12 years as a RT and I welcome comments on other hospitals out there to on how they utilize their RT's.

This might be more geared to new RT's or students to give them a idea how you will work in the real work, but also can give insight to RT's who have worked in the same place the entire time they have been a RT. I personally think it is interesting as to how many hospitals really don't have a clue on what we learn in school and what our scope of practice could be. Without further chatter, here is how mine are different.

William Beaumont Army Medical Center, El Paso Tx - This was my first stop as a RT, here we had 2 ICU's and a step down unit along with 3 floor units. This hospital took civilian population along with military also. The RT's did the ABG's on the floor but not in the ICU or the ER, but we did run a ABG lab and ran the blood. Did all the nebulizer tx's but the mdi's were turned over to nursing on the floors. As for the Vent's we were mainly button pushers there were not protocols for us for anything. We did respond to all and every code in the hospital.

Kenner Army Health Clinic, Ft Lee VA - One of the rare opportunities for a RT to work in a clinic setting. Here myself and another RT ran a PFT lab 3 days a week along with giving nebulizer treatments if asked to in the hospital. There were not vents here and VERY RARELY were there codes. On the days we didn't do PFT's we were supposed go to the different areas and work as a CNA or Medic (all Army RT's have to go through combat medic course) but respond to any respiratory issue that might arise in the clinic. Most of the time we would just hang out, here I became proficient in the downloading of MP3's and how to look up information to help place bets on games. We were also able to take a 1 1/2 hour lunch so I would go and bowl 3 games almost everyday of the week, I got pretty good. All in all they really didn' t know how to utilize us. Not sure if we were supposed to be there really.

Provena Covenant Hospital, Urbana IL - Now here is my first place after the military, and this is quite possibly the best place I worked to use my RT skills. Here we used many protocols on vents, treatments, and oxygen. Vent protocol was great, the Doc would give us ABG parameter and we adjusted the vent to stay in them until he have us a wean to extubate order and it was all up to us. We decided when to draw ABG's, and what to do with the vent. On the floor we were able to change treatment orders as they fit into the protocol parameters, this was nice. In the ER though we pretty much were given what the Doc wanted done, but we had some say in how things were done, there we also good chances to intubate depending on what Doc was on. Now this was nice, we did all the ABG draws from sticks to Arterial Lines even in the NICU and as for the Arterial Line we put in all the Arterial Lines. If there was a order for a A-Line we were called, now talk about fun. We also did O2 rounds throughout the hospital, which is easy work along with maintaining the Glucose check machines, don't ask how we got those but we just maintained them didn't draw sugars for them. Overall this was a nice teaching hospital that utilized our skills nicely, but I still wish we could of intubated more often though.

Freeport Memorial Hospital, Freeport IL - Smaller community hospital here. One 10 bed ICU, a pediatric unit, 3 floors and a ER. During the day we also covered the Bronchoscopy lab and assisted along with PFT and EEG's. No protocols here, mainly a Neb Jockey and Button Pusher besides being able to turn over the patients who were on maintenance medications to the nurses if we were becoming to busy, we didn't have many RT's here. ABG's were all done by RT's and we ran them on our machines. In the ER there were times when we got the chance to intubate patients, but not to often. Really it is just a place where RT's go through the motions but are able to assess patients and make recommendations. We could have been better utilized here.

Rockford Memorial, Rockford IL - Bigger hospital, 2 ICU's, Large NICU, PICU, Peds Unit, Oncology Unit, 4 different Floor unit areas and a busy ER. When is came to vents we were button pushers, Doc wrote the orders and we changed it, unless it was a CABG patient and we had free range to wean to extubation. In the NICU we seemed to be just there to push buttons, very protective Doc's up there until they get to know you. Now here I did train and was on a Neonatal Transport team where we would fly or drive to get babies going bad from different hospitals, or transport babies to Chicago, this was fun to do. You did more on the team than in the hospital since it was just you and the nurse. Great experience. We were the only PICU in the area so all the very sick kids came to us. Now this hospital was in the rough side of town so the ER could get hopping with drug OD's, shootings, stabbings, drunks ect. It wasn't uncommon to have our ER or ICU's locked down for fear of either retaliation or someone trying to finish the job, could become interesting. Of course since we had a NICU there is a OB for birthing babies and as the NICU RT we in on every C-Section and rough vaginal birth so we had to be NRP certified. So I've seen some interesting births here good and bad. On the floors we are mainly a neb jockey with but also respond with the Rapid Response Team along with doing EKG's on the floors. One aspect we did nothing with was ABG's, lab took care of all this analyzing and the RN's did the drawing, I didn't like that to much. This was a good hospital to gain experience and to what people might call getting hardened to seeing different things.

The Monroe Clinic, Monroe WI - Current place of business, a small town community hospital where we only have 1 RT at night...Me. Why did I come from the excitement of the big city, well a couple of different reasons: 1. Better Schedule 2. Was getting burned out and to hardened 3. Money. Now here one thing I noticed right away that I like is the attitude difference from the bigger city hospitals, a lot more friendly both the staff and patients. Freadom over at the RT Cave talks about working in a small town hospital and puts it well and I totally agree with him. Here at mine we have a ICU, 1 Floor Unit, 1 Pre-Op unit on days, L & D, and a ER. Those are what we cover as RT's. In the ICU's we are mainly button pushers but have the luxury of most Doc's listening to our opinions. We do all the nebs, mdi's, I.S.'s, ABG's, EKG's and stock oxygen tanks throughout the hospital along with maintaining our ABG lab. Sounds like a lot but it really isn't much. Just recently we installed a medication and treatment protocol here that is great at containing all the unnecessary neb orders, we can now change the orders to what we deem appropriate and I'm sure we will be working on more protocols later. The day shift RT's also help in the Bronchoscopy Lab and do cardiac stress tests as they are scheduled. I do enjoy this hospital so far and yes it is comfortable and I can see us gaining more and more responsibilities as time goes on.

What does this posting say, I like to think that we are not fully understood by the places we work at and it's not very often that all our skills are fully utilized. If we were there could be a lot of useless calls to Doctors through the day and especially in the middle of the night. Hope everyone understand that each hospital out there seems to be unique for the RT's are used and that you should find one you feel you fit in with.

At any one place you could be a button pusher, neb jockey, ABG King, Transport RT, intubate patients, run EKG's, perform a stress test, insert a A-Line, restock Glucose machines, do PFT's or EEG's and the list goes one, we can wear many hat in this profession but either way it is a good and rewarding profession.

Drive on RT's....

You Heard What?

A patient comes into the ER the other night with complaint of chest pain so I'm called down to do a EKG on the 35 year old with chest pain. I get into the room start to do the EKG and she becomes very shy about me putting on leads. Every lead I put on she quickly pulls up her gown and the lead falls off. "Sorry ma'am I have to get this back on could you please wait until we have the EKG done, I will go as fast as possible." So I finally finish and EKG is showing normal sinus rhythm and she going into this excruciating pain look and perfectly complaining "Owwww it's hurting right over my heart and very heavy right now with the pain going to my jaw and radiating down my arm." So I give the EKG to the Doc and she say this person has been here like 20 times in the last week, she is a nut case. Great so off I go.

35 Minutes later I'm called to come down and do a nebulizer treatment in the ER and when I get there the Doc tells me it's in the same room as the nut case. I ask "Is she short of breath, she didn't seem short when I was in there and didn't complain of that?" Now here is the response I received from the great and powerful doctor, "She is having a slight wheeze with a forceful exhalation, so maybe she has a little asthma component with exertion." Okay key phrase here if you didn't notice it, "With a FORCEFUL exhalation...".

Damn right she does with a FORCEFUL exhalation, so do I watch.....wheeeeezzzzeeeeee....See I can do it also and I have no breathing problems what so ever, and I'm sure you can do it to. The Doc actually told her to breath out as hard as she could, what the *&^%!!!

Well so I didn't actually say all that to the Doc. But I took a peak flow meter in the room with me to check the patient, we use the low flow ones in the ER (don't ask why) but it only goes up to 375. I give the PF to the patient and she all about blows the room off the room with that thing, plus her lungs are clear as a bell. Off I go and let the doctor know my observations and she is stunned and says "Wow maybe I just heard something at the right time, I guess her lungs are good, but lets give the neb anyways because I might soothe the patient a bit." Alright whatever again the nebulizer works as a pacifier.

After the nebulizer the doc then tells me that she is indeed a nut case and a attention seeker and it's thought that she does a bit of research so she can use the correct symptoms of the problem she is seeking help for. Ya have to love these types of patient and how they can just take up your time and run you schedule right into the ground.

Oh well all is life in your friendly community hospital. I work in a small town hospital now instead of the big city one I used to and when you compare the to there is a difference but in a small town one it seems there are a lot of bored people, namely elderly, who just want some attention so they go to the ER. Job security is the way to look at it.

Until next time, don't inhale chasing it with a exhale.

Reading Chest Xrays

I was thinking the other day that it would be nice to be able to read a chest xray better than I currently can so I set off to find some information on looking at different xrays and what I'm looking at. Now let me clarify that I'm talking about reading just chest xrays as this is most revelant to the job of a Respiratory Therapist, we don't really need to know if a patient has a tib/fib fracture of his left leg, that doesn't really help me out much. Well doing some searches here on the old internet I ran across a couple really good sites in my opinion on reading chest xrays so instead of writing a whole article and teaching a class on reading them because I'm not a pro at this here are a couple of sites I recommend.

• Wikipedia on Chest Xrays - Really good information article on chest xrays.
• Introduction to Chest Imaging - This many great image examples from the University of Virginia Med Program.
• Chest Xray Atlas - This has older images but also good explanation on what your looking at with many different items with xrays.

Now for the ABC's of the technique to read a chest xray:

A - Airway: are the trachea and mainstem bronchi patent; is the trachea midline?
B - Bones: are the clavicles, ribs, and sternum present and are there fractures?
C - Cardiac silhouette: is the diameter of the heart > ½ thoracic diameter enlarged)?
D - Diaphragm: are the costophrenic and costocardiac margins sharp? Is one hemidiaphragm enlarged over another? Is free air present beneath the diaphragm?
E - Effusion/empty space: is either present?
F - Fields (lungs): are there infiltrates, increased interstitial markings, masses, air
bronchograms, increased vascularity, or silhouette signs?
G - Gastric bubble: is it present and on the correct (left) side?
H - Hilar region: is there increased hilar lymphadenopathy?
I - Inspiration: did the patient inspire well enough for 10 ribs to be counted, or was the patient rotated?

Well I hope this bit of information has helped someone look at a xray and see it better, I know doing this has helped me and will help me in the future with my patients.

RT's vs. RN's

I was out just searching around the old Internet when I ran across this discussion: Respiratory Therapist VS Nursing and it got me to thinking of the differences between the two. Now I know there are nurses who appreciate us RT's and on the flipside of the coin I know there are RN's who think of us as a highly paid nurses aide or trained monkey. So what are the differences between us? Who really works harder? So here I go with another list of the differences between RT's and RN's.

1. You can become a RN in either 2 or 4 years of college. Wow you there are 2 and 4 years school's for RT also, along with the 8 month route with a commitment to the Military.
2. RT's specialize, RN's don't but they can specialize.
3. RT's know a lot about the Respiratory system, RN's know a little about a lot of different systems.
4. RN's have a bunch of patients on a floor, RT's have a bunch of patients on a lot of floors. So we walk further.
5. RN's make more money, that's a given but we seem to be creeping up.
6. RN's do have more opportunities of different places to work like hospitals, clinics, doctor's offices, jail's, factories, home health, and of course as a school nurse. RT, well not so many. Mainly just hospitals and home health.
7. Everyone knows what a RN is, but not everyone knows what a RT is, we are small stealth unit like special forces.
8. RN's are stuck on a floor so a lot of times they don't really know many people in the rest of the hospital. RT's get all over the place, so we know people all over the hospital.
9. RN's get a big todo for nurses week. RT's have to do something to get RT week known.
10. RN's are the one's who call RT when the patient is going downhill fast.
11. RTs get to shove RNs out of the way to get to the head of the bed during a code. (Thanks Freadom of the RT Cave)
12. RT's don't have to talk to the family (Thanks Freadom of the RT Cave)
13. When a codes over RT can split, while the RN has to clean up. (Thanks Freadom of the RT Cave)
14. RTs have to pay more than twice as much for their license, at least in Michigan, (Thanks Freadom of the RT Cave) and in Illinois and Wisconsin which is cheaper than Illinois.
    

Ok this is mainly just for fun and that's just a short list off the top of my head. Overall nurses work hard and so do RT's, just in different ways and of course both are needed to make the hospital run smoothly. My wife is a ER nurse and I have utmost respect for her as a ER nurse because I know the crap they deal with and the disturbing things they see. All in all it takes a certain type of person to be either a RT or a RN, but RT's don't let those "high on their horse" RN's talk down to you like we are a hired hand and they are the ones in charge. Sorry a little rant there, could be from running into a certain type of RN, or not.

Anyways...

Drive on RT's and Happy Respiratory Therapy Week.

Free Rice!!

Here is a link I ran across on another board I go to: Free Rice .

It is a site by the world poverty organization where you play a little vocabulary game and for every word you get correct they will donate 10 grains of rice to the United Nations for starving countries.

Kinda fun, I just donated 240 grains whoo hoo. And don't worry there are not signups or personal information to give them, Just Play.

Desaturating while giving a Neb Tx. What to do?

There are times when a patient is on a large amount of O2 and a nebulizer tx has to be given, but we know that a standard neb given with only 6-8 lpm is not enough flow or fio2 to keep O2 saturation >= 90% (our current protocol), so what do you do?

Drawing on my personal experience and reading about other RT's idea's and experience here are some ways to help keep the patients saturation at appropriate levels or at least close appropriate.

1. Place a nasal cannula under the aerosol mask or run with a standard HHN.
2. Place 6 inch large bore tubing in the holes in the aerosol mask, looks like elephant tusks.
3. Tee in the nebulizer into a non-rebreather mask. This gives the highest fio2 in my opinion.
4. With a regular HHN instead of using a 6 inch reservoir tube on the end, increase the length of the reservoir tube to 3 lengths of 6 inch tubing or whatever you think will work, this will decrease the amount of room air that patient with entrain.
5. You could always just put the HHN under the Non Rebreather mask but this can also cause comfort issues for the patient in my opinion.
6. If they just need a little extra fio2 you can always use a HHN with nose clips, this way it decreases the amount of inspired Room Air through the nose.
7. Place the HHN in the side port of the aerosol mask and run oxygen from the normal port of the aerosol mask.

Alright there are a few different ways to increase fio2 while running a neb and I'm sure there are many other rigged ways I would like to hear about, but you must also think, is the flow of the extra oxygen going to hinder the deliverance of the medication of the neb or not? I guess if this situation comes up see what works and go for it.

If anyone has any other ideas of ways to complete this task feel free to post a comment or criticism on the ideas I have posted here. Thanks for reading and responding.

VAPaWAY

Don't ask me how but I ran across this european website about Ventilation Acquired Pneumonia (VAP) called VAPaWAY.

Here is their mission objective:

The VAPAWAY website is dedicated to bringing together European physicians, nurses and other related professionals to discuss and agree on how to develop and disseminate a European consensus on VAP prevention.

Definitly respiratory related. Currently there are 7 different articles in about VAP which all look interesting. No I haven't read them all, scanned a couple, but they look promising. Also I noticed a nice set of links on the site that all real with medical information that I have never seen before.

All in all it deals with a type of pneumonia which we all know us RT's love to deal with. I could be a promising site, it looks professional and could become something worth checking out periodically in the future.

www.vapaway.eu

Respiratory Therapy in TV and Movies.

Have you ever caught yourself watching a movie or TV show, where there are hospital scenes, looking for respiratory related things in the show? Finding something done correctly is hard to do. What got me on to this idea? Well I was watching the movie with Billy Bob Thorton called "Astronaut Farmer" and there is a part where he ends up pretty injured and in the hospital supposedly on life support. Looking a little closer in the scene I notice that he is connected via endotracheal tube to a Vision Bipap and with a closer shot he is on a t-piece connected to that Bipap. Finally the scene pans out and I notice there is a Puritan Bennet 840 Ventilator on the other side of the bed with NOTHING connected to it, now granted the average person will not notice these things but Us as RT's should notice these things. So yes this is what has me thinking where have I scene RT issues in movies and TV shows and what better way to get this going but to start a list.

My List to Respiratory Therapy things in Movies and TV shows

1. Astronaut Farmer - Billy Bob Thorton connected to Vision Bipap with a T-Piece and a PB 840 Ventilator next to the other side of the bed.
2. ER - Many shows the yell "Page Respiratory", but you never see them. The Doc's bag the patient then they either die or move off to O.R.
3. Sopranos - Tony's nephew Chris is in the hospital and a Incentive Spirometer is on the bedside, and there is a Episode where Uncle Junior gets fitted for a CPAP machine for his sleep apnea, and a scene he falls asleep and his girlfriend puts in on him. I'm actually impressed here, to items you wouldn't think directors would think of for a show.
4. Sherlock Holmes Returns (TV) - on there is a film credit for Peter Kelamis as the Respiratory Therapist. This I came across in a google search, click on the link to see, never actually saw the show but now I'm curious.
5. Million Dollar Baby - Hillary Swank's character Maggy Fitzgerald is shown talking, while she is being ventilated via a tracheostomy tube in her throat. Although people can talk using "fenestrated" tracheostomy tubes, they can't be ventilated at the same time. But then again how many people actually know this.

Anyways I'm sure there are many others out there, I know I have seen a show/movie where the MA-1 ventilator in the corner breathing away and the patient is sitting there talking with a cannula on. I think there is a shock factor of the bellows moving and the sound of, shuuuu hahhh shuuuu hahhhh. I will continue to explore this RT related issue on the silver screen and would appreciate any noticeable scenes anyone else might have seen. Maybe somehow I could become a consultant for Respiratory Therapy on upcoming movies and TV shows, I would love to show the proper way to do mouth to mouth to Halle Berry or Jessica Alba and check some lung sounds, hell I'll even do a EKG on them. Could happen right?

Talk care and keep breathing.

Don't smoke with Oxygen: NO REALLY.

We always warn patients not to smoke with their oxygen running at the same time. Why? Because it's damn flammable!!! Well there is a lady in Michigan who not only didn't heed the warning not to smoke with oxygen running once but she did it twice, I guess old age does make you forget things.

Anyways here is a article about a 90 year old Ann Arbor Michigan lady who set her couch and herself on fire while smoking when using her oxygen delivery system.

Article about burning lady on oxygen.

We all know the people who have the old burn marks on their face like whiskers on a cat, but we can talk until we are blue in our faces about to smokers about the how flammable oxygen is, but there are still going to the stupid ones who don't believe us, Oh well we can only educate but cannot make them smart.

Check this image out of a burnt oxygen regulator for you entertainment...yes they do burn...HOTTTTT!

Why Respiratory?

So what makes a person want to become a Respiratory Therapist (RT)?

This isn't a job that most people think of to go to college for in high school, I know it wasn't mine because my thought in high school was to be Architect which also didn't happen. The Military was my calling, from there I just kinda fell into the job of RT.

Most people I have talked with over the years became a RT due to an opportunity to that brought the job or course of education to become a RT in front of them out of luck. Some reasons I have heard have been:

• They are a asthmatic and have been around RT's.
• Physical Therapist didn't pan out and they heard about RT.
• Lost their Job and was given money to go back to school and it look like a good paying job.
• Was looking for a medical Job that only took 2 years and RT sounded fun.
• A parent was a RT and introduced them into the profession.
• Didn't know what to major in, the Counselor suggested to look into it.
• Ect Ect Ect....

Ok my story how I become a RT is that I was a combat medic on the Army and my 4 year Enlistment was coming to a end and I want something to make myself more marketable in the civilian world so I looked through the different medical military occupational specialties (MOS) I could go to in the military. The one that came up for me was Nuclear Medical Technician, sounded good so I signed up. About a month after I has submitted all my recommendations I received word that the last slot of the year was taken, needless to say by a soldier in my platoon. Well now either stay a medic (which is not all bad) or find something else. Started looking again and this 91V MOS came up and had a 3A bonus attached which amounted to about $12,000 bonus and of course money will spike your interest. Well guess what it happened to be Respiratory. Great a nice bonus, low promotion points to get promoted, now what does a RT do, something with breathing, I know what that respiratory system is, and here I am a RT.

I did a little more research before I went to the school, but when I signed up I didn't know much of that we did, I went for the money and it turned out pretty damn good. I got out of school, received my bonus and them my SGT stripes 3 months later and enjoyed my job, sweet deal.

Well that's my thoughts for today, I'm sure more RT's than any just kind of fell into this profession and didn't plan this out as a teenager. That's my theory and I'm sticking to it.