It's been awhile.

I've been gone for awhile, I started taking classes again and just got myself busy trying to get back into this school thing and realized I missed having a outlet to post things on my mind when it comes to Respiratory Therapy. So, I'm back and hopefully I can get some good posts out here in the RT blogosphere which can spark some thoughts and conversation.

There that's my 2 cents worth and I will be posting something more substantial later.

Thanks for reading.

What we see, not everyone does.

We are currently very low in our census of respiratory patients but we still have some interesting ones come in and out of my place here. Tonight I had a patient come into my ER who was very tachycardic to the tune of 170's and higher along with a respiratory rate of 40's and sweating very profusely.

What does that sound like? If you said a pulmonary embolism you would be correct. Now this really is nothing very new to most RT's but what really struck me about this one is the mortality of this person that was brought up to me. I had previously done a EKG on this patient when he first came into the ER and was called back to do another one about a half hour later. What I noticed was his rate had increased along with his heart rate and the patient just being very anxious, but he was very alert and awake.

When I finished I went out and talked with the doctor, I asked him if this patient had some sort of bad infection also because of a high fever according the the nurse. The doc said no, he has a bad PE and he was pretty sure this person was going to die.

Right there is was struck me, "pretty sure this person was going to die". Does this patient know that, are we looking at a dead man walking type of issue, somehow he can tell that this person who is alert and awake has a clock that is ready to stop. Well the doc was right, he got to the point that he needed intubated and not more than 2 minutes after the intubation his HR went from 170's to the 30's and a code was started.

After all was said and done this patient didn't make it, but between when I talked to the doctor until the code was stopped, I couldn't help but think that I was this alert person that we knew that his time was up and it was just a matter of time. I was talking to this person knowing that the doctor could be right and I could be the last person he talks to. We watched this person just fade away, did all we could to save him but in some sense we all knew there was not much hope at all.


This all started me thinking about what we see as RT's compared to other people in the world. If you think about it how many people actually get the chance to actually watch someone take their last breath? How many people get to see a person who is injured beyond recognition from a car accident? Really I don't think many people get the chance to experience the things we sometimes do and a daily basis. Yes most people will probably see a dead body after the fact at a funeral but really how many are able to see life just slip away from a person or see us as caregivers struggle to resuscitate a person and get their heart started again?

Honestly do people in our lives, friends and family really understand what we see and deal with at our job? Do you think they have a good idea of what our job involves? Unless you are around our job you can never really know what we see or do. In my 12 years as a RT I couldn't even guess how many people I have seen die, and really I feel I have been desensitized to the reality of death and dying. I often wonder that if, God forbide, one of my parents would pass away that I wouldn't be able to show much emotion but I do know I would be sad. It is possible that I am so used to seeing people die that I might not even be able to cry for my loved ones.

All in all as a RT I really think that we see more death that a lot of RN's in the hospital. Think about it, as the RT we are required to respond to all codes, not all RN's are. There is the possibility of a code happening in the floor that the RN works at, but we as RT's are responsible to respond to ALL codes in the hospital. So are we around it more, I think so. This fact I can see in the eyes of some RN's who I see in codes, it's in their eyes they just seem a little out of sorts. We on the other hand usually have been though many of codes and are a rock in the sea of turmoil called a code. Don't get me wrong there are a lot of RN's in the position to see a lot of this also, namely ER nurses, they probably see a bit more than us. They are also a special breed.

There are many jobs out there that see things that most people would not want to but that's what separates the people who are able to do these types of jobs. It's not for everyone, you have to have a certain toughness and mindset to do this type of work. We have that mindset, and it is needed to not only do you job but to be a calm face in a stressful situation.

Friends and family might know what a RT is, but will never understand really what we see and deal with as a RT. Sometimes it can get to you when you think about it.


Drive on RT's.

Small Town Patient Privileges

Patients in a small town hospital like the one I work happen to be a totally different animal than the ones in the bigger cities. This idea I'm pretty sure Freadom over a Respiratory Therapy Cave and agree with me about because it seems that he is in this same small town hospital category.

Some of the differences I have noticed are the types of reasons that people come in for are pretty simple compared to larger hospitals but there are exceptions also to this. There are the injuries that can be more local to the type of hospital you work in. For example where I work is a large farming community, we have had rolled over tractors, getting kicked by horses, falling off of barns, and my favorite the guy who him and a couple of buddies were drinking out in the cow barn and had a little to much and passed out and coded right in the middle of cows, down in the hay and manure. The EMT's said they were worried that the cows would kick them while they were working on the patient. This guy smelled awful and had cow manure and hay all over him, unfortunately he didn't make it and the ER room smelled and had hay all over the place. Then there was the Ethenol Toxicity patient who decided to drink some straight ethenol from the ethenol plant, yep not smart it's 200 proof!!!! He was quite red.

Tonight I had another one of my small town patient who received a privilege that I have not come across so far in my 12 years as a RT.

I was on my way to do a breathing treatment with a older patient at around 8 pm and when I got to her room there was no one there. Fine I thought she must be walking around the unit, we do encourage our patients to get up and walk. I see her nurse and ask if she is out walking and I'm told no she isn't, she is - get ready for this -

Ok here is the dialog:

Me: Hey Nurse Betty do you know where Mrs. Bing is at, she is due for her treatment?
Nurse Betty: No she isn't here right now, she's out.
Me: Out, not here, is she at a test?
Nurse Betty: Uhhh nope, she is at a Wedding.
Me: She is what??? (confused look on my face)
Nurse Betty: Yep you heard me right she is actually at a wedding, she left about 1 pm.
Me: Really, is she coming back?
Nurse Betty: Yea the doctor said she had to be back by 9:30 pm.
Me: So she is gone to a wedding and has a curfew. She is really sick isn't she. (dumbfounded)
Nurse Betty: (sarcasm) Oh yea she is so totally sick.
Me: Did she wear a dress? Get all dolled up?
Nurse Betty: No Idea I just go here at 7 pm.

Ok this I found interesting as she must not be very sick at all, send her home and have her follow up with a doc at the clinic. Your wasting our time.

So about Midnight I have to go assess her for respiratory status and she is there finally and I can give her the treatment also now.

Me: So I hear you went to a wedding today?
Mrs. Bing: Oh yes I sure did.
Me: Was it a good wedding?
Mrs. Bing: Yes very pretty and the reception was a lot of fun to.
Me: So what time did you get back?
Mrs. Bing: A little before 10pm, the doctor gave me a curfew. Can you believe it, I'm 86 years old and I was given a curfew. I really don't remember ever getting a curfew.
Me: Yea that is pretty funny, well glad you had fun and made it back before the doctor grounded you. Alright here's your neb.

I just really found this interesting that a inpatient is released to go to a wedding or really anything while they are sick. Granted we cannot hold someone against their will but why not just discharge this person, they seem to be okay. Oh well I thought it was funny.

Then tonight there is this younger 20 something in the ER who I had to do a EKG on. The police were here for this one because he was a bit unruly. Seem like he had a couple to many drinks or drugs of some sort. So anyways I'm in there and he threatens to spit on people so the conversation proceeds:

Big Dork: Get away or I will spit on you and give you the SARS I have!!!!
Me: I don't really think you have SARS.
Big Dork: Yes I do get away.
Me: How did you get SARS?
Big Dork: I don't know, how can you get SARS?
Me: It's not in the United States, have you traveled overseas recently?
Big Dork: Yes I've traveled overseas recently.
Me: Where to, because there are not to many places that have SARS?
Big Dork: What places have SARS?
Me: Japan, China, over in that area.
Big Dork: Well yeah exactly, that's were I went to Japan.
Me: Yea Okay, if you spit on me SARS or not I will let that cop beat on you.
Big Dork: I'm not really going to spit on you.
Me: Ok hold still so I can run this EKG, thanks all done and good luck with your SARS.
Big Dork: Thanks, can I have a glass of water.
Me: Let me ask you nurse, cya.

That was just plain funny, I like funny drunk/high people you can mess with then and they will never even really notice you messing with them.

Well hope this was as entertaining to you as it was to me tonight as it did make the night more interesting because I actually had no patient that were due anything overnight. Easy night

Drive on RT's

Pixie Dust...What can it do for us?

There is a article at CNN.com about some stuff coined "Pixie Dust" which is being experimented with on soldiers who have a amputated body part like fingers, arms, legs or toes but not heads. This is being trialed at Brooke Army Medical Center (BAMC) in San Antonio Texas where I took my Respiratory Training.

You can read the article here: Pixie Dust

This pixie dust is supposed to give the body a salamander effect and trick the body into regenerating the missing body part. The powder forms a microscopic "scaffold" that attracts stem cells and convinces them to grow into the tissue that used to be there.

"If it is next to the skin, it will start making skin. If it's next to a tendon, it will start making a tendon, and so that's the hope, at least in this particular project, that we can grow a finger," Wolf said.

This is pretty interesting, how could this help our profession? Could this "pixie dust" help regenerate lungs destroyed by smoking, improving quality of life for COPD patients? Could it help people exposed to substances cause them to get fibrosis?

Interesting to say the least and I will keep a look out in for how it turns our for humans and for the soldier in the article. Hope it works.

Protocols Do Work.

Today I had to come into work early due to the requirement of the monthly Staff Meeting. Ohh what fun, but I did actually gain some information this time that I thought was pretty interesting.

If you have read one of my earliest posts I talked about a Therapist Driven protocol that we had implemented at my little hospital about 7 months ago. This protocol had to do with us the RT's assessing patient and then being able to adjust nebulizer, MDI and Oxygen therapy's as we deemed needed. Well we are now done with the testing phase of the implementation of our therapist driven protocol and a letter from our director is out to the doctors with surveys to see if we continue with this type of therapy.

There are some statistics that we pretty interesting that were compared from this 6 months of the protocols being in use and the 6 months prior to the protocols being in use. These stats were pretty interesting and pointed in favor of using these protocols and making them law. The only areas of care that were talked about were patients with Pneumonia and COPD issues.

Hospital staylLengths for Pneumonia and COPD decreased by 1 day in both areas. So we were able to adjust treatments for the patients and decrease their length of time in the hospital.

Now here is what I though was pretty amazing in the financial aspect.

In patients with a Pneumonia the cost of Respiratory Therapy given to the patient was DECREASED by 23% with the protocol in use. We saved the hospital 23% per patient on average if they had pneumonia.

And

Patients in with a COPD issue the cost of Respiratory Therapy given to the patient was DECREASED a whopping 36% with the protocol in use. Here we saved the hospital 36% per patient on average if they were in for COPD.

These facts speak strongly for the use of Therapist driven protocols and that we might actually know what we are doing.


During this meeting I did get into a disagreement with the director and supervisor about how we should for the first 24 hours do the treatment exactly how the doctor ordered it due out of respect to the doctor so they don't think we are just saying they don't know what they are doing.

Whats the point of doing the protocol assessments in the first 24 hours if we are not going to change anything? The doctors signed off on the protocols, so we have a right to use them as needed, otherwise you need to change what the protocol says.

I think I stunned the director when I said "So basically you two want us to suck up to the doctor's so they don't feel bad?" They said no it's a teamwork thing.

I don't know I feel as though if we don't use the protocol as written the doctor's might get the impression that we are skeptical on our abilities as therapist to assess our patients and choose the right treatments.

Fortunately I have a couple of other therapist who agreed with me and backed me up in my thoughts. Good to know I wasn't alone in my thoughts. So this was to be a unwritten rule that I'm not so sure people will follow. I for one will keep doing it as I have been and that's by the book on how the protocol was written up. Can't get into trouble for that.

Statistics show that we must be doing something right, and there are no complaint's about how we have done our assessments so far. Hopefully the doctors do really see it that way and the surveys come back in good shape, then we can make this law and continue on.

Drive on RT's

Stop and put you hand on that person.

I'm coming up on my re certification of my CPR card very soon and I was looking around on the guidelines at the American Heart Association to see if there are any new changes, and wow did I see something different:

Hands Only CPR.





There are only 2 Steps to save a person's life:

1) Call 911
2) Push hard and fast in the center of the chest.

So I started looking around a little bit and from what I understand is that this simplifies the process for the standard layperson. Just make a phone call and press that chest.

This is just for a adult who was witnessed collapsing not someone who possibly has been down for awhile or a drowning victim. So basically if you see someone collapse just start pressing that chest. Easy right.

One of the big things I see this helping is the though of most people that they don't want to put their mouth on a strangers mouth for fear of disease, this is understandable and this technique removes that problem. Also this is a very simple process so the person who is going to do CPR doesn't have to worry about not remembering the proper steps to do CPR. These 2 factors could possibly help a person faster than before because now maybe people will be quicker to react and not hesitate because fear of doing this wrong or getting their mouth on a strangers mouth, unless of course it is some Hot person you would want to put your mouth on.

Back to the topic at hand. Of course is this is the full standard now there would really be no need for a CPR class because it would take like 2 minutes to teach, so no this isn't all there is anymore you still need to learn the regular way for if you find someone down and not sure how long they were down. This also isn't for the pediatric population only for Adults witnessed collapsing.

Hopefully this isn't old news to everyone but I found it interesting, now to sign up for my CPR class and get this over with.

Drive on RT's.

Miracle, sure it is, but something is missing.

I ran across this new article here from Newsnet 5 talking about a woman who was clinically dead but miraculously came back to life and all was well.

Here is the article, for you RT's out there you might find something out of the ordinary, or which I have given a hint by making the area's bold. This will also all into line a bit with my previous article about respiratory mishaps in movies and TV shows.

Woman Wakes Up After Family Says Goodbye, Tubes Pulled

CLEVELAND, Ohio -- A West Virginia woman was being transferred to the Cleveland Clinic after walking the line between life and death. Doctors are calling Val Thomas a medical miracle. They said they can't explain how she is alive. They said Thomas suffered two heart attacks and had no brain waves for more than 17 hours. At about 1:30 a.m. Saturday, her heart stopped and she had no pulse. A respiratory machine kept her breathing and rigor mortis had set in, doctors said. "Her skin had already started to harden and her fingers curled. Death had set in," said son Jim Thomas. They rushed her to a West Virginia hospital. Doctors put Thomas on a special machine which induces hypothermia. The treatment involves lowering the body temperature for up to 24 hours before warming a patient up.After that procedure, her heart stopped again.

"She had no neurological function," said Dr. Kevin Eggleston. Her family said goodbye and doctors removed all the tubes.

However, Thomas was kept on a ventilator a little while longer as an organ donor issue was discussed.

Ten minutes later the woman woke up and started talking.
"She (nurse) said, 'I'm so sorry Mrs. Thomas.'
And mom said, 'That's OK honey. That's OK," Jim Thomas said.
Val Thomas and her family strongly believe that the Lord granted them their miracle and they want everyone to know."I know God has something in store for me, another purpose. I don't know what it is but I'm sure he'll tell me," she said. She was taken to the Cleveland Clinic for specialist to check her out. Doctors said amazingly she has no blockage and will be fine.

I just find this funny as we all know what you cannot talk while on a ventilator especially with a endotracheal tube in. I'm sure she wasn't trached with a Passey Muir valve on or a capped trach with fenestration since this seemed to only happen in about 24 hours. As bad off as she was I'm thinking a trach was the last thing they were thinking about. I just found that interesting how the media can get things wrong.

So what to do, well I'm going to drop a email off to this news channel just to see if I get a response. I'm thinking this was maybe make to be a little over dramatic as most of the public has not clue with some of this medical stuff. But us RT's will catch the little respiratory inconsistencies that people will make when it comes to our profession right.

If I get a response, it will be posted here for all to see at a later time, but I'm not really expecting anything to much, you never know though.

Drive on RT's.

Whoa It's been awhile, people are still nuts.

OK so I have to apologize for not posting for like 2 months now, I became a little busy with life and this was put on the back burner. My hospital started blocking personal (BLOGS) sites from viewing on the internet so I wasn't able to log onto Blogger here and post anything because I usually did it from work. Home has been a bit busy and there just wasn't enough hours in the day to do much posting.

So here I am posting again, my hospital set up a WIFI network for patient and others to use so I bring my laptop into work now and can have some time to post again. So stick with my I'm able to do this again.


Now on to more pressing matters, OK so it's only what I think is a funny little story about a patient at work who really either had no clue, or she just wanted to be difficult and not have to the my therapy.

We RT's here at my little hospital have to start and do Incentive Spirometers with every surgical patient for 4 times to make sure they are doing it correctly and acheiving 50% of there predicted volume, which I personally think should be 50% of their PRE-surgical volume they were able to acheive and not the predicted. Some people have trouble getting 50% of predicted without the surgery. So anyways if the patient cannot get 50% of predicted we start EZPAP until they can acheive this goal. OK now off to my story.

I walk into Mrs. White's room to do round 2 of her I.S. and it goes like this:

"Hello Mrs. White I'm with Respiratory Therapy and I'm here to work with your I.S."
"OK, hand it here and I will do it."

I hand her the I.S. and she of course blows as hard as she can into the mouthpiece and of course nothing moves.

"Umm your doing this wrong, you need to suck in on the mouthpiece to make it move"
"Oh OK I remember."

Now mind you she has been previously instructed on this, I'm there for round 2. She goes ahead and blows on it.

"No remember suck in on it like you would when drinking from a straw."
"I can't, I hate using straws, I don't use them."
"Ok well have you ever used them, while drinking some pop or soda?"
"Nope I have always hated them and have NEVER used one."
"Well how do you know you hate them then."
"I just know I do."
"Well lets try breathing on this again, OK"

So off she goes blowing in and out on the I.S. and it's doing nothing.

"Mrs. White, try to take a deep breath through the tube like you would if you were going to go swimming under the water."
"I don't know how to swim, I don't swim."
"Umm, you have never gone swimming or wading in a pool?"
"No, I'm from the Southwest there are no pools there."
"I used to live in the Southwest for a couple years there were pools there, it's hot and people have to cool off."
"Well not in my time there were no pools in the Southwest."
"OK, I see, lets try sucking in on this tube again."

So now she is like panting on the tube, quick short breaths.

"Now take the tube out of your mouth and put your hand in front of your mouth and blow out."

She does

"Did you feel the air on your hand?"
"Yes."
"OK do the opposite of that, ya got it"
"OK I see."

Back with the I.S. she if breathing deeper in and out of it.

"Did you see it move up there?"
"Yes I did."
"OK now do what you did to make it move up only do it bigger!"

FINALLY SUCCESS, she hit 1500 ml's on the I.S. and her predicted is only 2000 ml's so she is over the 50%, NO EZPAP, whoo hoo.


The next day I come to work and find out the day shift was having the same issues that I did with this patient, so like I said she either has:

A) No Clue
or
B) She is jacking with us.

Either way I didn't have to see her again. You can always find humor in this job. Actually I think you have to have a sense of humor to work this job.


Thanks for reading.

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.