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