Sunday, July 30, 2017

Oxygenation and Ventilation, there is a difference.

I got a call from a nurse the other day at the beginning of my shift telling me about a patient who's oxygenation saturation had dropped to the 80's, she continues to tell me that this patient has a neb treatment coming up and if I can give it a bit early.  I ask her what oxygen device and flow the patient is on and she tells me and I respond with, "Increase the flow and give the patient more oxygen."  The nurse continues with chatter about the neb tx so I tell her, "You know that neb tx's are not to increase oxygenation they are to help with ventilation."  There is a pause and she says, "Nebs don't help the oxygen of a patient?"  She seems just plain stunned, and this is a seasoned nurse.

This is a topic that I've had to explain it multiple times to non RT's.  Neb's relax the smooth muscle tissue so it's easier to take a deeper breath if there is bronchoconstriction.  Neb's do not increase the oxygen in the blood, honestly you only running the neb and giving about 40% oxygen, if the patient is on a higher oxygen percentage their sat will most likely decrease if we go from a non-rebreather to a neb.  The particle size from a neb is 0.5 micron's where the size of alveoli is only 0.1 micron's,  how is Albuterol supposed to fit into the alveoli to help it oxygenate the blood?  Albuterol helps with ventilation not oxygenation, if you want to increase the oxygen level of a patient GIVE MORE OXYGEN, and then figure out why they need more oxygen.

Oxygenation and ventilation do not correlate with each other, increased ventilation does not necessarily increase oxygenation and visa-versa.  I have seen asthmatics struggling to get a breath and still have good sats and I have seen people with sat's in the 70's and still be breathing comfortably.   Treat the problem, if oxygen is low give oxygen, if the patient can not get a breath in and is tight treat the problem causing ventilation issues, just as if CO2 is elevated increase ventilation to remove this CO2.

This is another reason why there are RT's to educate on about one the most important systems in the body, we need to breath.  Oxygenation vs Ventilation, if we teach the difference we may start to get calls for the correct treatments.

Frustrations of Advancing up the chain in Respiratory.

Respiratory Therapy is a great and rewarding career, you get to help people daily, see them improve and unfortunately see their health deteriorate also, but that's the nature of the game in a health care field.  RT's get to move around the hospital getting to know many areas of the hospital and you're not stuck in a cubicle anywhere.  Unfortunately I do see a downside to this career, and that's room for advancement.

I've been a RT for 20 years now and have been looking for opportunities to advance and move up the so called "Chain of Command" and get into the management side of healthcare, and the problem is there is not a lot of room for RT's to move up, really the only spot is the head of the RT department or maybe if you're in a bigger hospital a shift leader position.  Nursing on the other hand can move into management in many different area's of a hospital, for instance my department just went through 2 years of having our Operations Leader who is a RN, not a RT which is was for decades.  Fortunately recently we went back to having a RT as a Operations Leader.

RT's who are looking to move up in management have to look around outside of the hospital unless a opening comes up in your department because it seems people who get into RT management like to stay there because of the lack of opportunities for positions in management in the RT field.  I've known RT's who have moved a few states over just to take a management position over a RT department, or just moving to another hospital when they noticed something opened up.

So if you're looking for move up in the chain, a lot of times it's not easy and you either get lucky and something opens up in your department, otherwise you basically have to look outside of where you work, or get a degree and something else.

Drive On RT's.