The (Respiratory) Graduate

You Know You’re A Respiratory Therapist When…

2008-05-08T12:45:00Z

I came across these a while back when I was browsing through the groups section on the site Facebook.com. I would like to share them with you...all credit goes to the original writers.

(Read original post.)

See how many apply to you.

-- B.J.

You Know You're A Respiratory Therapist When...

- "clubbing" no longer refers to the hitting up of the bar scene downtown

- You call someone "SOB" and are NOT calling them a son of a...you know.

- You look at bigger people with no necks and think, "man, they'd be a difficult intubation"

- SpO2, MDI, SOBOE, DPI, AECOPD, IPPA, FiO2 and R/A all mean something to you

- You measure the amount someone smokes in pack years

- You can hear the phrase "bronchial toilet" and not laugh

- You know the alveolar air equation backwards and forwards, in your sleep

- You know that the "breathing tube" doesn't actually go down the "throat" per se

- "pink and frothy" no longer describes that strawberry shake you had for lunch

- "blue bloater/pink puffer" means something to you

- You can measure someone's RR just by walking by the patient

- You've been shot by an uncovered trach

- You know there's an "H", a "G" and no "F" in phlegm

- You call it a "ventilator", not a "respirator"

- You measure things by color, consistency and smell

- You know "BiPAP" doesn't involve a smear

- A/C no longer stands for "air-conditioning"

- You find yourself breathing with the same force/technique/frequency as the patient when doing things like spirometry and puffer teachings. You are then as out of breath as the patient.

- You can guess a saturation pretty accurately just from looking at the blood

- You never underestimate the importance of nurses, and keeping them happy at all times

- You discover that sedation can be your best friend, and your worst enemy

- You realize a jaw thrust is not something that happens in a bar fight; and a chin lift doesn't only happen during plastic surgery

- PEEP has a meaning other than a sound made by a chicken

- You are happiest when newborns are crying(at birth)

- Your long, tiring day of missed lunchs/breaks is made complete when a patient gives you a unexpected 'thank you'

- You start to think you've forgotten what normal breath sounds sound like

- You have auscultated your significant other

- You count chocolates as a meal, and ALWAYS welcome them into the department

- You know and fully understand the dangers of an uncovered trach, and avoid standing directly in front of one at all costs

- You would rather intubate yourself than do equipment change

- Your Lego skills as a kid some into play when trying to hook up two things that don't want to go together

-You take the best care of any patient

The 9-Hour Code

2008-04-30T11:31:00Z

Throughout my clinical experience in school, I have collected many stories, just as my teachers had warned me. Through all these countless experiences, one outshines every other as probably the most prominent and ethically complex situations I've ever been in.

It wasn't the time I tripped over that patient's Foley catheter and almost pulled it out, or the time that man with a lobectomy insisted I keep listening for breath sounds. Don't let the title of this post fool you folks, the situation I am referring to is in fact, a 9-hour code.

First, a little background scenario of our patient for all the students reading this. A 65 year-old man presents to the ER with increasing shortness of breath, orthopnea, and dyspnea upon exertion. Our patient also has a history of aortic stenosis, diabetes and hypertension. Vitals on admission were a blood pressure of 140/76, heart rate of 122, temperature of 36.7, while breathing at a shallow rate of 22 bpm. It was determined that this man would have to undergo an aortic valve replacement.

Flash forward five days later and our patient is in the Cardiac Care Unit post surgery, holding stable on a Bear 1000 ventilator (SIMV Vt 700mL, 12bpm, 70 percent, PEEP 8, PS 8). Thirty minutes after the first vent check of the shift, significant pulmonary edema could be seen throughout the vent circuit and HME. Copious amounts of blood were being suctioned through the endotracheal tube, and peak pressures were rising on the vent. Within an hour, the patient could no longer be managed on the Bear 1000.

We switched our patient to a heated wire circuit, and the Servo-i ventilator (for the pressure-regulated volume control mode). Even with the ventilator working to keep the peak pressures down while ensuring our set tidal volume, high pressure alarms were going off with readings in excess of 60-75 cmH2O. He could no longer be managed on the vent.

For the next eight and a half hours, the patient would be bagged until the sats reached 100 percent, then a sterile suction catheter would be inserted down the ET tube to remove the frothy, bloody secretions.

Bag to 100 percent. Suction. Repeat.

Now, like any good team of therapists and students, we worked in cycles. Bag and suction two rounds, then swap out. Through all of this work, it was the family's wish to make the patient DNR, while allowing us to continue bagging. So we did.

Eight hours, and two 3000cc suction canisters later, we got the patient back on the ventilator.

He would unfortunately pass away the next morning.

The respiratory department was commended for going the extra mile in this case, as were the nurses and doctors. And I, as a student, got my first real lesson in pressures with mechanical ventilation, and the resolve of a health care team and a family determined to hold onto hope. However, amongst all the "job well done's" that night, for me, the real lesson was in ethics.

People can give you a number of different opinions on the extraordinary measures taken in that code (and the therapists I share this story with, do), but it's up to each and every person to draw their own line in the sand.

With that being said, what do you think? How do you feel? Is there an ethical point in which the patient should just be mercifully let go, or should we as therapist and health care workers keep fighting for the glimmer of life that may or may not be there?

Stern Lady

2008-04-22T18:46:00Z

While walking from room to room in the ICU, it is immediately evident that I am new. I'm a respiratory therapist on his last clinical rotation ever, at a mid-size community hospital. I am green to the profession, a point that is only stressed more by my green scrubs amongst a sea of blue worn by everyone else.

This day was slow, just a few vent checks and treatments all around. I have become fairly confident in most aspects of respiratory care, particularly in communication and small talk with patients, which is probably the most notable growth I've made through two years of school.

Four patients down, two more to go. I walked into the next room and was greeted by a patient who was hunched over in her bed and clamping down with the bed rails. She had a very stern look on her face.

"Hi hun, how are you?" I asked.

Nothing.

"Are you ready for your breathing medicine?"

Nothing.

Hmmm, I thought. Maybe she's just unhappy and doesn't feel like talking. I put her treatment on, and checked all vitals. Nothing out of the ordinary.

She must just be unhappy. Can't say I blame her, who wouldn't be upset, stuck in an intensive care unit, I thought to myself.

Once the treatment let up, I took off the mask. Vitals good. Appearance is good, other than the same stern look and clutching of the rails.

I'll leave her alone, I concluded.

Upon telling this to the other therapists, it became evident that this was a well-known occurrence. She simply had not talked or made any type of motion while anyone was in the room with her.

A few days later, I was helping a floor therapist with a huge patient load. I walked into a different room, and to my surprise, there was the woman. Her treatment was still running, and she had the same exact appearance as she did in the ICU.

This time, however, she freed one of her arms from clutching the bed rail to try and pour herself a cup of water. Soon, the water was overflowing from the cup and getting all over the bed table. I took the pitcher of water from her hands and set it down. I grabbed some paper towels and cleaned up the mess. The treatment ran out, so off came the mask. The lady was still hunched over, not making a sound. Before I went out of the room, I grabbed the cup of water and held it to her face.

"Do you want some water?" I inquired.

She took a sip. I placed the cup back down at bedside and began to leave the room. She looked up at me.

"Thank you!" she said with the biggest smile I've seen in some time.

"You're welcome," I said and smiled back.

Yep. This is why I love this job already, I thought while leaving the room.