Surviving RT School

Seeking Some Advice

noreply@blogger.com (Trauma Junkie) — Fri, 03 Jul 2009 23:13:00 +0000

So here's the deal...

I've decided that after five years at one hospital as a CNA, it is time for me to try somewhere new. There are several reasons for this, but the biggest being:

1. Pay. The pay is decent, but below average for what CNAs make in the area. Even with an annual merit raises, I'm still not making what I should.

2. Hours. I'm PRN at this hospital and am technically only required to work 16 hours every four weeks. Obviously, in order to support myself and my daughter through school, I need to work quite a bit more hours than this. I was working pretty close to full time hours (about 72 hours bi-weekly), but lately that has drastically changed, to where I'm hardly able to get any hours.

3. Staffing. I realize staffing is a problem in health care and most likely always will be, but at this particular hospital, the staffing is dangerous and somewhat scary. We're talking one CNA to about 40 patients, most of which are total care (living dead) patients. To some of who are or have been CNAs, I know this may not be considered terrible-- this sort of assignment is normal for a nursing home, but keep in mind these are acute care patients.

All that being said, it is time for a change. The hospital across town is a level II trauma center and has openings for CNA in their per diem (pool) staff. Which brings me to the part where I need your help:

This particular hospital has a base pay that is higher than what I currently make with 5 years experience. However, I've known them to pay several nurse aides with as much experience as myself $13-15/hour. I believe that with my relevant experience and the set of skills I possess, I should make at least $13/hr (right now I'm barely pushing $10.)

So, how do you handle this situation? On the application, there is a spot that says, "Desired salary ____." I'm always careful to not put something I feel may be viewed as too much so that my application isn't thrown in the pile of people they'd never consider hiring, but I never want to put an amount too small because I fear they may give to me. I've heard writing "Negotiable" is an option, but I also hear that most employers will throw at an application with this written because it shows that an applicant is incapable of making decisions.

Salary always come up during a job interview. Sometimes I've felt it really makes or breaks the interview and your chances of being hired.

What do you do?

My First Time

noreply@blogger.com (Trauma Junkie) — Wed, 24 Jun 2009 20:58:00 +0000

The ICU at Trauma Hospital is always busy, as I've heard, and this particular day was no exception. Alarms were blaring in the background, post-op open hearts and GSWs were rolling in from ER and surgery 90 miles a minute. Nurses, doctors, and respiratory therapists were always present and on their toes. Every second that you had to sit, you find yourself practically waiting for something to happen. Experience, and even only six hours spent in this unit as a student, will tell you that much.

I finally had a chance to sit down and catch up on some charting. And since the RT and I had a few minutes to spare, I decided this was as good of a time as any to give report.

"Room 401 received their treatment, DuoNeb, at 0741. Sats were 98% on room air, heart rate 76 before and 81 after, breath sounds were diminished bilaterally, respirations--"

Suddenly, I'm cut off by a nurse who runs up to us rather frantically.

"Do you have bed 23?!"

"We do. Why?" I'm instantly visualizing the chart in my mind, thinking about what I have or haven't done.

"The doc wants to tube him. He's declining. Long periods of apnea and mental status has changed, we need you in there NOW."

I look to the RT and he looks back at me. We shrug our shoulders and make way to the room.

"Never a dull moment around here," the RT says, laughing a bit.

It's insane how things can change in an instant. That's what I love about intensive care rotation. One minute, your patient is sitting up on 40% BiPAP in no apparent distress, and the next minute you walk in to find a room full of people crowded around your patient and the monitor, with someone at the head of the bed squeezing an ambu bag the intubation supplies set out on the patient's bedside table.

It sounds sick. But it really isn't. Nothing validates your knowledge or assessment skills like a crashing patient, and your ability to act fast and play a part in their team of health professionals, well, their life basically hangs on that. And that is the best and worst feeling in the world.
Think, TJ, think...

A quick glance at the monitor reveals sats are 88 with bagging, HR is in the low to mid-50s, and B/P is plummeting. Even increasing the FIO2 on the BiPAP to 80% didn't help. All the signs and symptoms this patient was showing indicated intubation...and fast.

I make my way through the crowd of people, to my place at the head of the bed next to the intensive care doc. I'm noting the time, what size blade he is using, the size of the ET tube laying next to the patient's head, and many other things. I reach over and grab the ambu bag from the nurse, giving it a tight squeeze and releasing slowly. And again...about every five seconds.

The pulmonologist looks over at me, the laryngoscope with a size 4 Macintosh blade in his right hand.

Wait...right hand? What the hell? Everyone knows blade in the left, tube in the right...

I'd never have seen this coming, but he handed me the blade.

I'm sure I looked very confused at this point. I mean, I know I'm able to intubate. I got the checkoff in lab, but didn't see this coming.

"Go for it, kid," he gave me a nudge.

Okay. I can so do this. I positioned the patient's head, placing a towel under his shoulders. I open his airway, using the "cross-finger" technique. I squat down just a little, and slide in the laryngoscope blade.
Vallecula. Epiglottis. Vocal chords. I'm surprised at how clear it looks. It feels like I've been down there forever, but it's only been about four seconds at this point.

Keeping a close eye on my landmarks, I reach for the size 8.5 sitting beside the patient, stylet in place. With the ETT still most of the way inside the package, I give it a slight crook at the end.

I apply a small amount of water-soluble lubricant to the tip of the tube, grasping it firmly in my right hand. I'm not really breathing at this point, because someone once told me if you hold your breath while the patient is without oxygen during intubation, you'll get an idea of how long it takes you to do it and be certain to keep it under 30 seconds from start to finish.

Before I knew it, someone was bagging my patient again. Visible chest rise. 23 centimeters at the teeth. Positive breath sounds in all lobes/bases. I advanced the tube just about a centimeter after the chest xray.

Sats returned to normal, HR increased, and the pt was doing well last time I left.

Having successfully intubated my first patient, I guess you can say I'm no longer a virgin. What was your first time like? I'm curious.

How RIM/BlackBerry Helps Me Survive RT School

noreply@blogger.com (Trauma Junkie) — Tue, 23 Jun 2009 18:44:00 +0000

I'm back!
For all of you faithful readers, I apologize for my leave of absence. A lot has went on in the past few months, but for the sake of time, I blame my lack of posts on my BlackBerry Bold from AT&T.

But wait, you don't have an iPhone? Nope, don't want one.

Let me tell you a bit about the specs on this baby:

Half VGA resolution 480 x 320 pixel color display
Backlighting, with a light sensing screen
Trackball
QWERTY keyboard with backlighting (by far my favorite feature!)
Bluetooth v 2.0
Supported video formats: DivX 4, DivX 5/6 partially supported, XviD partially supported, H.263, H.264, WMV3
Supported audio formats: .3gp, MP3, WMA9 (.wma/.asf), WMA9 Pro/WMA 10, MIDI, AMR-NB, Professional AAC/AAC+/eAAC+
2.0 megapixel still camera with flash and 3x zoom (also has video capabilities)
Battery life: Standby -- 13.5 days, Talk time: 4.5 hours
4.48" x 2.6" x 0.59"
Weight 4.8 oz (nice!)

None of that means much to most of you. So let's get down to how I use this phone in school, seeing as this blog is focused around RT School--

The good thing about a smartphone is that if you know what you are doing, it will run your entire life for you.

As respiratory therapy students, we are pretty busy. Between class, school, and clinicals, the calendar application that comes installed on all BlackBerry phones is most excellent.

Who needs pen and paper anymore? You will receive an alert directly on your phone, and you can set reminders at different intervals (1 day before the event, 1 hour before, etc.). There's also a snooze option-- which I don't recommend. If you're really good with techy things, I believe there is even a way to set it up where the phone will switch to silent during your meetings and classes scheduled in the calendar.

Other programs I find most useful that come installed on the BlackBerry Bold-- at least AT&T's version-- include voice notes (just as it sounds-- the phone doubles as a voice recorder for lectures), Word To Go, Sheet To Go, and Slideshow To Go.

(I find the ToGo software suite most useful in clinicals, when you need to look over your class notes, drug spreadsheets, or review a short PowerPoint presentation to refresh your knowledge over a topic).

Heck, even the web browser isn't that bad:

Okay, enough with what comes installed on the phone. Today it is all about apps, apps, and more apps. There are millions out there, but the ones I use for school are as follows:

-Google Sync All of us know how pesky it is once you get a new phone to set up all of your contacts. And if you know your schedule for months, or even weeks, in advance, well, it would take hours to add it to your phone. That's where this app comes in. You can add contacts to your Google (GMail) address book and update your calendar online (much faster!), then simply sync it all to your BlackBerry smartphone. This is by far my favorite productivity app.

-Epocrates Rx for BlackBerry The makers claim this application has been shown to, "Improve patient care and safety, save time, and enable confident clinical decisions." Need I say more? I realize there aren't many drugs we handle as respiratory therapist (students) but, every now and then, you get that drug you covered in Pharmacology and have never seen again. Plus, Epocrates is useful when making recommendations to the physician or checking for drug interactions.

-gCalc Since a lot of what we do as students and practitioners involves equations and most of that involves converting units (inches to centimeters, etc), this app is as good as gold!

-Google Maps I know that most of you aren't nearly as directionally challenged as I am, but throughout the duration of our program we visit several outlying "rural" hospitals, some of which are an hour drive or longer. When you wake up at 0430 to leave for your affiliate site, it's nice to know that you don't have to worry with trying to decipher a paper map. This one has saved me from being late more times than I can count.

I really am back this time. Stick around, because coming up tomorrow: A more detailed review of the BlackBerry (from a user's perspective, not a student perspective) and a few of my most favorite apps that I use for fun.

Test Post

noreply@blogger.com (Trauma Junkie) — Sun, 21 Jun 2009 09:49:00 +0000

Testing CellSpin for BlackBerry app -- www.cellspin.net

Does this ever happen to you?

noreply@blogger.com (Trauma Junkie) — Wed, 13 May 2009 23:04:00 +0000

You sit down to right what you feel will be an amazing post. You assume that it will be riveting, emotional, and thought-provoking. Hell, maybe you even feel that it will cause people to take a second look at their life and realize that there is a lot to be thankful for. You figure that said post will draw a lot of comments, attention, and most of all, will do a great service to the anonymous patients involved by sharing their story.

Then, somewhere in the middle of about the 15th paragraph, you realize that you can't write it. You can't publish it, because things that were said to you by the anonymous patients should be kept between you and them? Ever actually end up feeling that by publishing this post, you will be doing a disservice to one man, woman, and child? What about starting to feel as if you should just let this man rest in peace and not share his tale?

Well, that's happened to me.

Just know that somewhere out there, a man and women who were very in love a long time ago parted ways and were rejoined in the same unfortunate car accident. The man died, the woman lived. The woman was coherent enough to recognize this man as the person she had thought about for the past several years.

Oh, and did I mention the woman's kid is alive because this man made the decision to be an organ donor? Yep.

The kid would have died due to internal injuries sustained to his organs. This woman now knows that the love of her life, the one she lost, has saved the life of her son.

That, my friends, is amazing.

Too Afraid to Die

noreply@blogger.com (Trauma Junkie) — Sun, 10 May 2009 04:35:00 +0000

The curtains pushed aside
Show an old man in bed.
Fear lives in two dark eyes
Staring from his tired head.

His knuckled grip is strong,
He shakes like a sailor,
But his next breaths are long,
A high price for his labor.

Underneath his sun-beaten shell,
Sliding sinews bring bones upright.
What his muscle memory might tell
Given time before the birth of night.

The chart shows no sign of fever
And his heart beats just as it should,
The numbers say he’ll live forever,
All of the peaks and troughs look good.

My gut knows the answer,
But I ask anyway,
I am here to help you,
Why are you here today?

He says, my problem’s this,
Then looks me in the eye,
I’m just too tired to live
And I’m too afraid to die.

Via Life in the Fast Lane

Do CFers Dream?

noreply@blogger.com (Trauma Junkie) — Tue, 05 May 2009 00:45:00 +0000

(UPDATED: 5/4/09 to include a link to Run Sickboy Run, all about one man's journey with Cystic Fibrosis, quickly becoming my favorite patient blogs.)

You bet they do.

On Wednesday, I had my first experience in clinicals taking care of patients with Cystic Fibrosis at Big University Hospital. You see, at Big University Hospital, they have an actual pulmonary inpatient ward, so I felt very much appreciated the entire day, because these patients are the ones who know respiratory therapists by heart, having spent countless hours in ERs, clinics, and hospitals for treatment of COPD exacerbation, refractory asthma (asthma that is resistant to convential methods or treatments, often requiring hospitilization), and a number of pulmonary infections related to diseases such as Cystic Fibrosis and Bronchiectasis.

The one that stood out the most was a patient with CF. This is just a page in her story:

For those of you who are unfamiliar with Cystic Fibrosis, here is what the typical day is like for my 15 year old patient with CF:

Waking up at the crack of dawn, treatments are as follows:

1. Xopenex neb (~8 minutes) done at the same time as chest percussion therapy per the ThAIRapy Vest to dilate the lower airways while sometimes clearing secretions
2. hypertonic saline SVN to aid in the clearance of retained secretions (~9 minutes)
3. Inhaled Tobramyacin-- 28 days on, 28 days off: an antiobiotic given by nebulization to prevent pulomonary infections caused by immobile secretions (~8 minutes)
4. Pulmozyme per small volume nebulizer-- also known as dornase alpha, which hydrolizes the DNA present in the sputum of CF patients and reduces viscosity in the lungs (~10-12 minutes),
5. Advair diskus, one puff, an inhaled corticosteroid also used for anti-inflammatory effects (1 minute)
Total: Approximately 40 minutes (mind you, this is an estimated time given without consideration to the fact that CFers must often stop treatments due to heavy bouts of coughing)

Around noon:
1. Hypertonic saline 7% neb (~9 minutes)
2. Albuterol 0.5 neb (~8 minutes)
Total: 57 minutes

3-4 hours later:
1. Xopenex SVN (~8 minutes)
Total: 1 hour, 8 minutes

Around 7pm:
1. Albuterol SVN with ThAIRapy Vest (~8 minutes)
2. Hypertonic saline 7% neb (~9 minutes)
3. Tobramycin neb (~8 minutes)
4. Advair, one puff (~1 minute)
Total: 1 hour, 34 minutes

There are, of course, variations in this depending on the patient's status and a number of other factors. Sometimes, the ThAIRapy vest is used four times a day and Pulmicort nebs are given in place of Advair.

I was just preparing to set up Stacy's third treatment; I had been in the room for 30 minutes, much longer than any of my other patients.

"Thank you," she said. I could tell she meant it.

"For what?"

"Well, it's not just you. I mean respiratory therapists in general. Just, I don't know, thanks. I know this isn't easy-- taking care of people like me."

I was almost puzzled for a second, and without hesitation, I replied, "Not a problem. I imagine it isn't easy, doing this at home every day. I'm more than happy to help out."

I was curious at this point. I wondered about life with this disease. I looked around the hospital room to see photographs of Stacy and her friends singing karaoke, dancing, and hanging out at the mall. To my left were cards from family members. And then... out of the corner of my eye I caught a glimpse of a photo of her junior high basketball team. Stacy was holding a trophy.

"You like basketball?" Nearly an hour of therapy without any conversation would have made for awkwardness. I'd never spent such an immense amount of time with one patient, but I didn't mind at all.

"I do when I'm not coughing up my lungs," she said, laughing a bit.

"That must be hard."

She set down her nebulizer and looked at me for a second. "Nothing is ever easy. I just take life one day at a time. Did you know that most people with this don't live past 40?"

I didn't know what to say. I paused for a few seconds, then Stacy spoke up again.

"Hey, I said most people. Not me-- I dream big."

Conversation died down after a few more minutes and I finished up in the room.

It's funny how things work. You spend hours in a classroom learning about diseases such as Cystic Fibrosis, then you enter the clinical setting, and the biggest lessons are sometimes learned from your patients.

Always dream big. Never sell yourself short, not for any reason.

Remember that often as important as it is for us to educate our patients, sometimes it is just as important for them educate us.

Best Way to Learn Intubation?

noreply@blogger.com (Trauma Junkie) — Sat, 02 May 2009 21:15:00 +0000

There are several ways to learn how to intubate a patient. However, I do not recommend that you try this method:

Just saying.

On RT School and Hitting a Plateau

noreply@blogger.com (Trauma Junkie) — Mon, 27 Apr 2009 22:00:00 +0000

I apologize for the serious lack of quality posts lately. It appears that I haven't had much to say about "Surviving RT School," or anything in general, because quite frankly, nothing interesting has been going on in my life as far as school and work are concerned.

That's right. My kind readers, the Trauma Junkie has been nothing more than a neb jockey as of late. And let me tell you, that gets pretty boring at times. Those of you who are in RT school know what it's like to work with a bad therapist: you know, the ones who dump their assignment on you, don't take the time to answer your questions, rush you, and treat you more like a coworker who has been in the field for 10 years as opposed to someone who is working in the hospital for the learning experience.

This is only topped off by the fact that every patient I've been assigned lately wasn't very complex, medically. Don't get me wrong; I realize that a lot of the patients RTs see in the hospital aren't admitted for respiratory issues, but it's been week after week of caring for mom or dad with a GI bleed or broken arm who has a history of asthma and gets q4h treatments, like they take at home. Nothing out of the ordinary, nothing thought-provoking, nothing interesting. Until today...

The RT I was working with, off the bat, told me to sit down, catch my breath, and look through my patients chart. He actually took the time to assign me patients with serious respiratory issues, answer all of my questions, and he allowed me the time I needed to spent with my patients and their charts to really feel as if I accomplished something, instead of driving home and wondering what I forgot to do.

One patient in particular was quite interesting, a 34 year old male who had a grossly unremarkable medical and surgical history (despite diabetes and a cholecystectomy years ago). During my shift assessment, the patient was noted to have increased WOB via nasal flaring, retractions, and tachypneic at a rate of about 28 (labored). Nurse's notes showed the patient was febrile for the past few days. He reported to me a dry cough that was progressing to a productive cough with large amounts of blood-tinged sputum. He complained of chills, dyspnea on exertion, and night sweats.

On auscultation, the patient was diminished bilaterally in all lung lobes and bases. Heart rate and rhythm were regular. No clubbing or cyanosis, but there was +1 peripheral edema.

Okay...this is my type of patient. In case you were guessing pneumonia, you are correct. What's so interesting, you ask?

Well, this particular patient had Pneumocystitis jiroveci pneumonia.

PCJ Pneumonia is a rare strain of pneumonia, most typically seen in patients with AIDS. In fact, we were taught in school that we would probably never see it in a patient who didn't have AIDS or was HIV-positive.

Never say never. Per the pulmonologists' notes, the patient reports homosexual encounters but was negative for HIV, even with repeat testing. Socially, he works as a CNA and has for the past 16 years. He reports no contact with TB patients. He doesn't currently smoke or drink, but has a 10 pack year history and quit cocaine 3 months ago. Urine drug screens were negative for illicit drug use.

We know that PCJ Pneumonia also only occurs in patients who are severely immunodeficient, which is often why it is linked to AIDS. CD4 counts of 200 or lower are typical.

So that begs the question-- What is compromising Mr. Jones' immune system? Histoplasmosis.

Histoplasmosis is a disease caused by the fungus Histoplasma capsulatum. The patient reported no previous travels, with the exception of visiting some caves in a nearby town around just about a month ago today. Histoplasma capsulatum grows in soil and material contaminated with bird or bat droppings. When asked, he did recall seeing bats and large amounts of guano.

As far as respiratory is concerned, the patient was receiving DuoNeb (albuterol/atrovent) q6h and q2h PRN dyspnea. I can also now say that I've administered Pentamidine SVN (another one of those drugs we were taught to be familiar with but not memorize because we'd probably never see it given). Although Mr. Jones has never required supplemental oxygen to sustain life, he now wears BiPAP at night and is on 5L nasal cannula during waking hours. Any attempts to decrease the liter flow at this time have failed, as the patient desats rapidly within seconds.

I guess this is just further proof that disease can strike at any time, and the outcomes can be very severe. In the area where I live, there are quite a few caves nearby and I've visisted them on many occasions, as do hundreds of people each day.

And that, my friends, is where we come in. As RTs, take the time to review your patients' charts, talk with your patients, know every relevant detail, and study to learn, not to memorize.

Your assessment skills, interviewing abilities, and being to recall what you were taught regarding both disease processes and pharmacology are undoubtedly the most important assets we possess.

Every now and then, you get to be more than a neb jockey. Hold on to those opportunities to use everything you've learned, and really, this career won't be too bad.

Challenge yourself. Often.

A Fight for Lives

noreply@blogger.com (Trauma Junkie) — Sun, 26 Apr 2009 22:38:00 +0000

Photo credit

Teamwork is definitely the greatest asset to any ER, as is proved by this story. People who have never worked in the emergency room on a busy night have no idea what it can be like when the traumas are coming in back to back.

Seriously, given the situation, I salute these guys. They are heroes in ways they don't even know. I only hope that I can emulate their abilities one day.

H/T WhiteCoat for linking me to this article.

From the Archives...

noreply@blogger.com (Trauma Junkie) — Thu, 23 Apr 2009 18:55:00 +0000

I realize that some of you have just came to my blog in the past few months, weeks, or even days (Thanks again, David!) I've had a bad case of writer's block lately, so in the mean time, here's something from the archives for your enjoyment:

YOU MIGHT BE AN RRT/RT STUDENT IF:
1. You spend so much time studying patient assessments, that you're aware of lung sounds in the checkout line.
2. Terms like "ASSS," "PISS," "DISS," and "clubbing," take on a new meaning.
3. You go to work and consider it a nice break from school.
4. Even if you have a job outside of school, when people ask what you do, you tell them, "I'm a student."
5. When you tell people your major, they say, "What's that?"
6. You know the significance of the phrase "Ninety-nine."
7. You've auscultated lung sounds on your mom, dad, kid, spouse, grandfather, grandmother, and so on...
8. You love the high amounts of caffeine in Starbucks coffee (great for late night study sessions), and you also know the affect of caffeine on the respiratory system.
9. You've considered intubating someone around you who just won't shut up.
10. You have started realizing that medical dramas/sitcoms aren't anything like the real world (What?! You mean the doctor doesn't bag the patient during CPR?)
11. You realize that a jaw thrust isn't just something that happens in a bar fight
12. You can look at and comment on the shape of someone's curves without getting slapped for it
13. You know and fully understand the dangers of uncovered trach, and you avoid standing directly in front of one at all costs (You probably learned this one the hard way)
14. You know what the Sputum Bowl is and have even considered participating in it
15. Your Lego skills as a kid have come into play when trying to put together two things that don't want to go together
16. Watching a doc shove a camera down someone's throat isn't just part of the job or something you have to do in school, it's cool as hell
17. You curse the operator at the mall or the grocery store for starting her announcements with "Attention please..."
18. You see someone smoking and think of it as "job security"
19. At least a couple of times a day you explain that you have to suck, not blow, to make the balls go up
20. You can guess a saturation pretty accurately just by looking at the blood, or the patient
21. Your day (or night) doesn't begin until you've had your first, or second, or third cup of coffee
22. You've learned that 90-something year old FULL CODES really exist
23. You've pulled the family into the room during a code to get them to tell the doctor to switch mom or dad back to DNR status
24. You know that tripodding is not just something you see in gymnastics
25. You know that "PEEP" is no longer a sound made by a chicken
26. You believe that unspeakable evils will befall you if anyone says, "Boy, it sure is quiet around here."
27. You hate working on nights with a full moon
28. Terms like "sympathomimetic adrenergic beta-2 agonists," "anticholinergic parasympatholytic bronchodilators," and, "hydropneumothorax," all make sense to you.
29. A nurse pisses you off, and you kindly tell your patient, "If you need anything, and I mean anything at all, don't hesitate to use your call light," knowing that you will be in the RT department for most of the shift.
30. In the RT program, a study group for you involves/involved Egan's Fundamentals of Respiratory Care, a Red Bull (or two), and your class notes.
31. You either work night shift or want to work night shift to avoid all of the daily, BID, TID, and QID breathing treatments.
32. You know that an SpO2 of 100% does not rule out hypoxemia
33. You have no problem discussing sputum over lunch.
34. You've ever had a nurse call you about an alarming vent or BiPAP, asked them what the alarm sounded like, and were able to tell them how to fix it over the phone.
35. You've found yourself saying, "Good cough!" to complete strangers.
36. Not only are you familiar with the terms "blue bloater" and a "pink puffer," but you can probably tell which one a COPD pt is just by looking at them from across the room
37. You coworker can tell you that they just spent 45 minutes on pulmonary toilet and both of you know that it has nothing to do with the restroom
38. You know that wheezing after a bronchodilator SVN is sometimes okay
39. You spent a ton of time learning about Heli-Ox in school and have maybe seen it used one time in your career
40. Dalton's Law of Partial Pressures, Law of LaPlace, Frank-Starling Law, Boyle's Law, the Ideal Gas Law, and Law of Avogadro: you know these inside and out, as well as their practical application
41. You've found yourself telling others that "COPD isn't a disease. It's a group of diseases."
42. You hear vent alarms on your day off
43. You have avoided people in stores who are SOB
44. You're tempted to carry a pocket mask on dates (or to the store)
45. You've ever heard "Code Blue" in your sleep
46. You know your ABG's to the point that you can interpret them in your sleep (and probably have at some point)
47. You have ever said or overheard the following conversation between an RT and a nurse: "You deal with the stuff below the waist, and I'll deal with the stuff above the waist."
48. You've had days where all you do is sit around and wait for someone to code
49. You've had more days in which you never get to sit down and people are coding left and right.
50. You have calculated the pack year history of all your relatives and friends who smoke

0327

noreply@blogger.com (Trauma Junkie) — Mon, 13 Apr 2009 19:13:00 +0000

"What time is it? I'm calling it."

The physician was sweating, and his voice was faint as he spoke the words that every doctor hates to say.

From across the room, the charge nurse spoke up, "O three twenty-seven, Doctor Jameson*." She scribbled the time down on her records.

And with that, the entire room was clear. Members of the code team dispersed back to their respective departments. Floor staff resumed care of their own patients. And it was almost like it never happened, like Mr. Smith never even arrested, because there were still other patients who had to be taken care of.

********

James Smith, Sr., was well-known to the staff at Memorial Hospital. You could say he was what is colloquially known by nurses and doctors alike as a "frequent flier." Just about once every month or two, Mr. Smith would return with a different medical issue than he present with before. He always ended up being admitted, and for some reason, he was always placed on Unit 3B.

Aside from being about the nicest man you could ever know, Mr. Smith was a man of God and man of the service. He was a captain the United States Air Force, attended church twice a week, and would be more than happy to tell you about the time he spent in a church or overseas.

It was fascinating just to hear him talk about any of it. He had been places that no one could imagine, from Paris to Germany to a makeshift prison where he thought he was going to meet his end many nights during World War II. He'd tell you that he never figured he would live to tell about any of it.

Mr. Smith never smoked, never drank, and never did illicit drugs. When asked, he would tell you he was, "As straight as an arrow..." So, needless to say, it was hard for Mr. Smith to understand why he developed so many health problems later in life. And to be quite honest, I don't think anyone else knew the answer either.

This particular time, however, he was in with community acquired Pneumonia.

*****

I just finished rounds at 0300. All of my patients were resting in bed, with no complaints. I headed back to the nurses' station to begin documenting from earlier in the night.

As I began to circle various things and check boxes on the documentation flowsheet, I start to get an uneasy feeling.

Something was out of place. Something wasn't right.

I had only been a CNA for two days at this point, and this was my first time working in a hospital. It could have been anything.

But something told me it wasn't a mistake in charting or something as simple as forgetting to move the patient's bedside table within their reach.

I couldn't quite put my finger on it, so I decided I would start vital signs a little early. I knew that Mr. Smith wouldn't be asleep yet, so I went to his room first.

There, laying before me, was the body of Mr. Smith. There was no smile, his eyes were closed, and he was cocked off to one side, almost like he was stuck in that position.

You don't have to be a CNA for long to realize that something was wrong with this picture. This wasn't Mr. Smith-- not how we knew him.

Ten seconds. You can do it. Look, listen, feel.

The CPR class I took for the first time two days ago was playing in my head.

No pulse. No spontaneous respirations. I called the code.

I pulled the ambu bag from behind the bed, hooked it up, and gave two rescue breaths.

Where the HELL is the code team? (It had only been 20 seconds at this point.)

Still no pulse. Start compressions, I thought to myself.

Somewhere during the first cycle of compressions, entered a large group of people to include nurses, doctors, and respiratory therapists. I don't even really remember them coming in, but I do remember making eye contact with the doctor, and he gave me an affirmative nod.

"Just keep doing what you're doing. Let's get him on the monitor." Dr. Jameson's voice was calming. When he spoke, the entire room became silent, awaiting his orders.

I watched the cardiac monitor as I circulated blood through Mr. Smith's body and I couldn't help but think that this man was talking to me not even thirty minutes ago. His heart was circulating its own blood. He was breathing. He was alert, awake, and oriented.

Don't you die on me, Mr. Smith. You've got grandchildren who love you. James...

I pretended for a second that he could hear what I was thinking as I pumped on his chest then I snapped back to reality. The room was loud again, full of people talking, everyone's eyes affixed on the monitor.

"Stop CPR. Let's see if we have a rhythm," piped up Dr. Jameson over all the commotion.

It was clear that when the compressions stopped, Mr. Smith was still asystole.

"One milligram of Epi in. Resume compressions."

And again, I began pounding away at his chest, pumping my arms up and down. I knew the compressions were truly effective at the point in which I was forcing blood into the syringe with each compressions as the respiratory therapist obtained an ABG from his femoral artery.
One...two...three...four...five...six...

I counted. I'd worked in health care for a long time before becoming a CNA and I had heard stories of people gasping violently for air and opening their eyes during CPR, only to return to this earth fully recovered and move on with their life. Part of me thought that would happen. Part of me wanted him to wake up and look at all of us.

Mr. Smith received two more doses of epinephrine just about five minutes apart.

Dr. Jameson spoke up, "How long was he down?"

Seven... eight... nine...

"Hard. To. Say. Ten minutes at most. I was just in here." I was out of breath at this point, but I didn't want to stop. I couldn't stop. I could feel my entire body aching.

"Are we still asystole?"

I stopped compressions long enough to glance at the monitor.

An ICU nurse spoke up, "Yes, still asystole."

"Let's get in one more set of compressions."

*****

On that particular morning, at 0327, CPR stopped. Mr. Smith's heart wasn't beating and he wasn't breathing on his own. I'd like to be able to say that we left the room for a few seconds and the monitor showed Sinus Brady with a rate of 20. I'd love to be able to say that Mr. Smith saw his grandkids again. I'd like to be able to say that Mr. Smith got a second chance at life. But you know I can't do that.

What I can say, however, is that he is in a better place. If I could talk to him now, he'd tell us he appreciated everything we did. Our perseverance, our determination, and our empathy.

This, my friends, is the day I became a trauma junkie. I'll never forget 0327.

The Things You DON'T Learn in School

noreply@blogger.com (Trauma Junkie) — Fri, 10 Apr 2009 23:00:00 +0000

Epijunky over at Pink Warm and Dry has written an excellent post titled, "A Blur of Pink." I won't give away too much, but here is an excerpt:

He was a large bear of a man, holding what looked like a blur of pink in his hands. A woman was shrieking inside the house, her screams a soul shaking guttural wail. All of a sudden things were becoming very clear to me.

This was not an old couple. There was no 80-year-old man laying on the floor of his kitchen waiting for me.

I didn’t even get two steps outside of the truck before the man practically heaved the Baby to me...

Can you imagine? What you assume is a fairly normal call, turns out to be an entirely different story. Some of us in healthcare thrive on the fact that we never know what is going to happen. It's safe to say that those of who are drawn to trauma love the challenge, the ability to apply our knowledge, and the use of our assessment skills and clinical knowledge that we use to treat the most severe patients at the worst time of their lives.

Most of that is learned in school. But what about the stuff you don't learn?

A friend of mine came up to me the other day and we were talking about our recent rotation through the emergency department in clinicals.

My friend says to me, "How do you not get attached?"

The most obvious answer that any EMT, Emergency Physician, or Nurse will tell you is that you never look the patient in the face. It's just as simple as not letting yourself get attached.

What no textbook or years of experience can prepare you for are those rare moments where you do, in fact, become attached.

There's going to be a time in all of our careers when we look at a patient who is crashing and think, for just a moment, that this could by my kid or my mom. How do you deal with it?

I don't know that there is a right or wrong answer, or if there even is an answer, but I'd definitely recommend that you take the time to read this post.

An Update on "A Source of Inspiration"

noreply@blogger.com (Trauma Junkie) — Mon, 30 Mar 2009 16:29:00 +0000

That's right.

"Just when you think things can't possibly go wrong, they usually can and will, in fact, go wrong." -- Confucius.

Well, maybe Confucius didn't actually say that. If he knew about computers during his time, he might have.

My computer is in the shop. It decided to up and get sick on me and since it doesn't need a nebulizer treatment or anything like that (Or maybe that would cure it???), there isn't much I can do at this point except wait until it is fixed.

It should only be a few days, but seeing as how the next edition of "A Source of Inspiration," was set to be posted today, I thought I'd let everyone know was was up.

In the meantime, feel free to check out my archives (don't get lost in the madness).

For those of you who have yet to submit and would still like to do so, I'm now extending the deadline until Wednesday at 11:59pm CST.

First time submitting? No problem. It's as easy as:

1. Head over to the submission page on Blog Carnival
2. Enter all requested information into the required fields
3. Sit back and wait for the next edition

Or, if it's a bit easier for you, just send email submissions to me directly at js0095001 (at) gmail (dot) com.

Thanks for your patience, and I promise it will be well worth the wait!

Since the carnival is still in the "beta" stage, expect that it will only get better as I get more of a routine down.

Doctor Anonymous Show Recap

noreply@blogger.com (Trauma Junkie) — Fri, 20 Mar 2009 23:05:00 +0000

As I mentioned, last night I was a guest on the Doctor Anonymous Show.

In case you didn't get to catch the show live, you can listen to the show in its entirety by clicking the link above and pressing the play button on BlogTalkRadio player on the right hand side of page, or simply listen below:

I'd encourage you to listen as we talk a lot about A Source of Inspiration (my blog carnival), what drew me to respiratory therapy, the RT education/training process, blogging, my thoughts on school so far, and even my plans for the future of this blog as well as a few projects I have up my sleeves.

Last but not least, I just wanted to give a big shoutout and thanks to all of you who were live in the chatroom, and to Doctor Anonymous for having me as guest. If you're able, check out Doctor Anonymous every Thursday night at 9pm ET, as well as the Night Shift with Dr. A on Saturdays.

Catch Me LIVE on the Doctor Anonymous Show!

noreply@blogger.com (Trauma Junkie) — Sun, 15 Mar 2009 15:37:00 +0000

I said at the beginning of the year that I had big things planned for this blog, and I meant it.

Along with the creation of the very first Respiratory Therapy blog carnival , I've also been planning a few other ways to advance the profession and answer any questions that both the general public and other health care professionals may have regarding this field.

On Thursday, March 19, 2009 at 8pm CST, I am going to be LIVE on The Doctor Anonymous Show.

Dr. A Show 84: Trauma Junkie
Length: 2 hours
Description: Blogger and Respiratory Therapist student "Trauma Junkie" talks about his blog "Surviving RT School" and a new blog carnival called "A Source of Inspiration"

For those of you who are not familiar with the show, Doctor Anonymous (or @DoctorAnonymous on Twitter) is a Family Physician in NE Ohio who hosts an internet radio show on BlogTalkRadio every Thursday and Saturday night. From the show website, the Doctor A Show is best described as, "A show that connects you to the best people in medicine and new media. We go beyond the blog to bring you up close and personal with the brightest stars of the medical blogosphere... We talk a little medicine, health, news, entertainment, public policy, politics, pop culture, new media, and whatever else comes up."

I'm very excited to be the guest on this week's show, and I'd encourage you all to be present as I talk about a number of issues in Respiratory Therapy, answer any questions that callers might have about the field, and talk a bit about the newest carnival to hit the medical blogosphere, A Source of Inspiration.

For those of you who are just stumbling upon my blog for the first time in the past few weeks, "A Source of Inspiration" is a blog carnival highlighting the best of all things respiratory therapy on the blogosphere, in one location.

There will be lots of talk about the carnival on the Doctor A show, but you can read more about it here.

The next edition will post March 30, 2009, with a submission deadline March 27, 2009 at 5pm CST. I'd encourage EVERYONE to submit (especially the RT bloggers) to help contribute to the success of this endeavor. What better way to have your voice heard?

***********

And last but not least, some of you may not be familiar with BlogTalkRadio. So from Dr. A's blog, here are some instructions:

For first time Blog Talk Radio listeners:
*Although it is not required to listen to the show, I encourage you to register on the BlogTalkRadio site prior to the show. I think it will make the process easier.

*To get to my show site, click here. As show time gets closer, keep hitting "refresh" on your browser until you see the "Play/Chat" button. Then, of course, press the "Play/Chat" button.

*You can also participate in the live chat room before, during, and after the show. Look for the green "Chat Now" button. If you are registered with the BTR site, your registered name and picture will appear in the chat room.

*You can also call into the show. The number is on my show site. If you have a headset microphone, you can "call" into the show by looking for the "Click To Talk" button at the top of the chat box to try out the BTR VoIP option. Hope these tips are helpful!

I hope to see everyone there! Bring your questions... I'll come armed with answers.

Is it just me...

noreply@blogger.com (Trauma Junkie) — Mon, 02 Mar 2009 22:14:00 +0000

...or is this not totally awesome?

H/T Sarah (A Spoon Full of Sarah)

Call me a nerd, call me a geek, or whatever. I have to make a video like this.

Hang in there

noreply@blogger.com (Trauma Junkie) — Mon, 02 Mar 2009 02:15:00 +0000

My blog is acting very weird, I know. I appreciate those of you who have sent me messages telling me this. It's going to take a few days to get straightened around. Just some minor technical stuff.

If you are having a hard time reading my blog posts on my blog site, I'd suggest subscribing to my RSS feed if you already haven't. You can do so here. For those not familiar with this, it's basically a plain text version of my posts that updates in real time.

Thanks for the patience.

This is JEOPARDY!

noreply@blogger.com (Trauma Junkie) — Fri, 27 Feb 2009 16:45:00 +0000

***EDIT: Pt was on 100% NRBM in severe respiratory distress. I realize this is a metabolic issue (Partially Compensated Metabolic Acidosis and DKA), so those of you who read the post earlier may have thought intubation wasn't indicated.

The Category:

INITIAL TREATMENT OF
METABOLIC ACIDOSIS

Here's your clue:

This is what you would do after reading a recent ABG, results are as follows:*
pH........................6.88
PCO2........................20
PO2........................140
HCO3.......................2.1

BUUUZZZZZZZZZZ!

What is...intubation, Alex?!

(By the way, the patient was not dead. He was fighting intubation, and they had to restrain him. Crazy, huh?)

-----------
*Legal stuff: JEOPARDY © Sony Pictures Digital, Inc. blah blah blah. Posted in accordance with HIPPA....blah blah blah. No names, no ages, no identifying stuff. If you think it is you (and I'm not sure how you'd know your exact ABG values), it's not. You're intubated in the ICU right now.

It's bad enough that the patients do this...

noreply@blogger.com (Trauma Junkie) — Tue, 24 Feb 2009 20:31:00 +0000

We've all been there. There is nothing more annoying than stepping into a room to assess your patient, administer a medication, or carry out an order, and just as you have everything set up to do what you need to do, RRRRINNNNGGG. "Yeah, um, I'm gonna have to take this. Can you come back in a minute?"

Sometimes I do, and to be honest, sometimes I don't. Sometimes I tell the patient that if I do not do this now, I won't be able to come back for a few hours, and I will have to chart their refusal. It sounds rude, but sometimes you just have to do things like that. A few thoughts come to mind when a patient feels their phone call is more important than the "acute" care they are receiving in the hospital:

1. They really aren't very sick
2. They really aren't very smart
3. They really aren't very nice

And of course, any combination of the three. You see, it's all about the patient having their rights, and I totally understand that. If they have to talk to a husband from Iraq, that's okay. If their But at the same time, patients should understand that they have been admitted to the hospital for urgent, around the clock care, because a doctor has deemed it necessary.

However, as much as this pushes my buttons (and I hope you can just feel my anger), the newest thing I have observed is not only the patients talking on their cell phone, but...

The doctor? Yes, the doctor.

The other day while doing clinicals at a medium-sized facility, the Respiratory Therapist I was working with was paged to a Rapid Response Team call. There are some mixed feelings among researchers and health care providers alike as to whether or not these teams are successful, but that is a whole other post waiting to happen.

Let me paint a scenario for you:

A patient with a history of Sinus Bradycardia and COPD is undergoing a chemical stress test. Minutes after being injected with Adenosine, the patient's HR spikes to 106-108 BPM (well over the pacer) and is throwing frequent PVC's. He is very hypertensive (200/108) and extremely dyspneic and tachypneic. He becomes diaphoretic.

Enter: The cardiologist. Before even fully examining the patient, his cell phone rings. Okay, no big deal. We assume he is paging the hospitalist who is seeing the patient to explain what is going on. This happens all the time. Much to our shock, he says:

"Yeah, honey? Can you hear me?! Look, sweetie, I'm with a patient who is very dyspneic and not doing so well. I still want to do dinner. Can I call you back?"

Oh, you can only imagine how INFURIATED I was. His patient could have died in the seconds he was on the phone. I mean, I know I'm just a student, but come on?

We can't very well ask patients if they mind hanging up their cell phone so we can talk to them if the doctor does it.*

*I'm not talking just about doctors doing this. I've seen nurses, lab techs, CNAs all using their cell phones during patient care. I'm in no way simply ragging on docs, but this is what made me mad the other day. /End rant.

REFERENCES

Reinberg, Steven. "Rapid Response Teams Don't Cut Hospital Heart Attacks, Death Rates." U.S. News & World Report 02 12
2008 24 Feb 2009 .

"Rapid Response Team: The Rapid Response Team at Vanderbilt University Hospital." Vanderbilt Resuscitation Program. Vanderbilt Medical Center. 24 Feb 2009 .

A Source of Inspiration, Volume One, Number One: A New Beginning (in quotes and pictures)

noreply@blogger.com (Trauma Junkie) — Mon, 16 Feb 2009 23:03:00 +0000

Welcome to the first edition of "A Source of Inspiration: A Respiratory Therapy Blog Carnival." It is my hope that this will become a tradition similar to the more notorious medical blog carnivals, Grand Rounds and Change of Shift.

My goal was simple: To find a few respiratory therapists, nurses, doctors, and even patients that have a true interest in respiratory care and urge them to contribute to the medical/respiratory blogosphere. My job would then be to organize all of these wonderful posts into a concise format that highlights the best of all things respiratory, in one location.

I'm certain you can judge the success of my endeavors in the following submissions.

Without further adieu, I present to you, and the world, A Source of Inspiration, Volume One, Number One: A New Beginning.

*********************

Since my creation of this carnival, some of you may coming to my blog for the first time by way of others. A good number of you will wonder exactly how many respiratory therapy related blogs are circulating the internet.

Look no further, as Rick Frea over at the Respiratory Therapy Cave presents the Top Respiratory Therapy Blogs of 2008. Along these same lines, and definitely worth mentioning, is his post, The Top "Living with Lung Disease" Blogs of 2008. In the latter post, he notes, "I think it's great for people with chronic illnesses to get online and blog about their illnesses because it shows other people suffering from the same disease that they are not alone." I couldn't agree more.

*********************

A journey of a thousand miles must begin with a single step. -- Lao Tzu, Chinese Taoist philosopher, and founder of Taoism.
Photo Credit
If you ask me, Tzu really hit the nail on the head, as I have recently learned in a way that I never imagined, as I myself set out to begin RT school this past August. For many of us, respiratory therapy school is but a chapter in the great book of life. A few of you shared your experiences and insights on this topic.

Marcus, one of the more popular RT student bloggers, shares with us his post, What a Day at Clinicals, and I can guarantee that you'll find some excitement as he chronicles his clinical experience at a large hospital emergency department. After all, the post begins, "The day started basically quiet (a word you never say in an ED) . . . ." This post is an excellent example of why we in health care often fear the "Q" word.

Sarah, of the blog A Spoon Full of Sarah, looks in retrospect and compares her first day of clinicals to that of one of the students she is proctoring, in At Least She Didn't Lock Herself in the Bathroom.

I know from my personal experience that some students can be pretty bummed when they learn that they have to do a clinical rotation at a small, rural hospital basically located in the middle of nowhere. Freadom of the Respiratory Therapy Cave, shares with us a post in which current and prospective students will learn 10 advantages to doing at least one clinical rotation at small town hospital near you. It's definitely food for thought, especially since it is the perspective of an RT at a small hospital.

Holly, of Sputum Happens, presents her post Surviving RT School (what a great title, right?!) As she is almost finished with RT school, Holly takes it upon herself to offer some of the most solid advice I have ever received to students the world over. While this post is geared toward respiratory therapy students, I'd imagine this advice can be applied to most any health degree program.

*********************

To accept good advice is but to increase one's own ability. -- Johann Wolfgang von Goethe, German Playwright, Poet, Novelist, and Dramatist.

Blogger BJ Smith writes an excellent post titled Hands: Remembering an Unsuccessful Code, on his blog, The (Respiratory) Graduate. As you read this post, you may be wondering at what point the author comes out and shares his advice with you, but it's implied if anything. Several things can be taken from this post, but what I gather is that it is important not to wear our emotions on our sleeves, especially after a code, because we all have a job to do and a duty to our patients.

Along a similar school of thought, Victoria Powell of VP Medical, shares her experiences in caring for a patient with Myasthenia Gravis during her clinical rotation as a nursing student. Appropriately titled A Death Wish, she speaks of a patient who wanted her to help push them over the edge, so to speak. She learns that it is important not to be afraid, because you never know what the next day has in store for you.

(My pocket contents at clinicals the other day.)

The Anonymous Therapist ("KeepBreathing"), of Respiratory Therapy 101: Just Keep Breathing, presents How to Pass RT School, his insights of how to achieve success (in the non-traditional sense) in school, based on his experiences when he was there, and also taking into consideration a few things he has learned after some time in the field. Who would have known that two words can make such a difference?

*********************

For breath is life, and if you breathe well, you shall live long on earth.-- Sanskrit Proverb

Yes, that's where we come in. The humble respiratory therapists. If a patient is breathing, we are the first one they call. How amazing is that?

Respiratory Therapists: Do you find yourself wondering if you made the right career choice? Ever wonder if something is totally wonderful will happen that really tests your skills and experience, then confirms that you are doing the right thing? Well, Glenna Muse, the RT blogger of G's Spot, talks about a recent experience that reaffirmed her admiration for the field in THIS Is Why I Love Respiratory Therapy. You can read part two of this post, which has a bit of humorous twist, here.

You've worked with doctors for years, but your enthusiasm for respiratory care is in an agonal rhythm. Yes, as with all careers, respiratory therapy has its flaws. Some people become burned out to the point that they decide to leave the profession. If you've found yourself feeling this way, Cheryl may be able to help you in her post, Voodoo Therapy for Hexed Careers (No Dolls Needed). Through a simple series of questions, described as step-by-step critical care intervention before you call a code on your career, she might have the answers you are looking for.

*********************

And now, we've reached the part that most people have a difficult time writing when they sit down to do a carnival post. The "Un" category. Yes, often the best submissions can not be grouped with others, as done above.

"A picture is worth a thousand words." -- Fred Bernard
This could not be more true, and Vijay of scanman's notes proves this in an excellent series of posts in which he presents several case studies, all respiratory related, with excellent high resolution CT scans to boot. Learn his systematic approach to reaching these complex diagnoses by reading scanman's casebook: Case 9, scanman's casebook: Case 10, and scanman's casebook: Case 11.

"Caring is the essence of nursing." --Jean Watson
Now, for my favorite submission. I'm sure this quotation is geared toward patient care, but Kim of Emergiblog takes this a step further in my opinion, when she presents A Shout Out to Respiratory Therapists: When You Absolutely, Positively Have to Breathe! She tells of how she learned most everything she knows about the respiratory system from respiratory therapists (not nursing school,) and how you can really come to appreciate what RTs do when you are forced to be the RT. Hats off to Kim!

As you now may be able to tell, this edition wasn't based on a certain theme. The contributors were not asked to write their insights on a specific topic. The only thing you will find in common as you read the posts highlighted above is that they all have to do with the most wonderful and crucial aspect of medicine: the Respiratory System. It has long been said on many occasions that if you aren't breathing, you aren't doing anything else. For those of us in the classroom, in clinicals, in the trenches, at the bedside, and on the other side of the bedrails, breathing is not something to take for granted. Even if you think that what you do doesn't matter, you're wrong.

****

Kudos to all who contributed to the first edition of "A Source of Inspiration." I hope you enjoy reading all of these wonderful submissions as much as I did. If you submitted, a link back to this post would be great, as it will help spread the word about this carnival and that I welcome all submissions respiratory-related. As well, if you didn't submit, it's still a great way to help me spread the word-- Just a simple post will do, saying the first edition is posted, and that it is worth reading (if you agree!).

Doctors, nurses, allied health professionals and patients: Your experiences with respiratory therapists, in the care of patients with respiratory diseases, or otherwise, both positive and negative, are always welcome.

----------------------------------------------------
A Source of Inspiration, Volume One, Number Two, will be posted on March 30, 2009, with a submission deadline of March 27, 2009 at 1800 CST.

I will host the next edition of the carnival so that I can get a routine established. In the future, you can expect to see it hosted all over the blogosphere, and I will keep everyone informed of where they can send submissions to future editions, as well as where they will be hosted.

For the March 30th, 2009 edition, submit your post(s) using the carnival submission form at Blog Carnival. Once I have received your submission, I will shoot you an email saying so. If you do not receive an email within 24 hours of submission, please contact me at js0095001 (at) gmail (dot) com.

If you prefer, you can send submissions directly to my inbox using the same email address listed above. Please include in your message the title of your post, the URL, a short description of the post, and what you prefer to be called in the carnival post.

And please, don't forget to contribute to "Grand Rounds," and "Change of Shift."

(Special thanks to Kim of Emergiblog for helping me get the ball rolling on this. Without her advice, based on the success of her own carnival, I'm afraid this may not have happened.)

Technical Difficulties

noreply@blogger.com (Trauma Junkie) — Sat, 14 Feb 2009 21:52:00 +0000

I realize that I mentioned that the first edition of A Source of Inspiration would be posted this past Friday. However, due to some technical difficulties, a few late submissions, and a few of you who are still working on posts *AHEM:, the first edition will be up on Monday night at the very latest.

Thanks again to everyone who has submitted as well as those you who plan to submit. Also thanks to everyone for their support. This is going to be a huge success-- I can feel it.

Let's make this a big deal

noreply@blogger.com (Trauma Junkie) — Sat, 07 Feb 2009 19:39:00 +0000

From Inspiration

A while back, I mentioned that I was going to start a blog carnival specifically for all things respiratory therapy. This is just a friendly reminder that all submissions are due by Feb. 12th at midnight CST, as the first edition will post on Friday, February 13th. So far, I've received a lot of great submissions, but am still lacking in posts from respiratory therapists/respiratory therapy students.

Yes, while everyone is encouraged to submit their respiratory-related posts, I would like to see most of the submissions come from those working or studying in the respiratory therapy field. I really think this is our way to shine.

Here's a basic recap of the rules:
1. A Source of Inspiration does not intend to compete with Change of Shift or Grand Rounds. If you submit a post to CoS or Grand Rounds and that edition has not yet published, please don't submit the same post to A Source of Inspiration. (It is fine after your post has been published on said edition.)

2. Anyone is welcome to submit, from RTs, to doctors, to nurses, to radiology techs, to other health professionals, to patients and even those simply interested in respiratory care. As long as the post is related to respiratory therapy in some form or fashion, you can guarantee inclusion in the carnival. The idea is to spread to the word about respiratory therapy and give the perspective of various individuals. Some ideas for posts include encounters with patients who suffer from acute or chronic respiratory illnesses, emerging technology, breaking news, opinions related to respiratory care, and so on.

3. Anyone is able to host A Source of Inspiration on their blog, and is very much encouraged to do so. Simply email me at js0095001 @ gmail. com and I'll tell you what dates are available. If you are hosting the upcoming edition, all posts will be emailed to you anonymously using the Blog Carnival submission form, unless you would like to have submissions emailed directly to you.

As for right now, that's really about it.

There is no theme for this edition, so posts can simply be about anything related to respiratory therapy, respiratory patients, respiratory illness, respiratory technology, you get the idea.

There are two ways to submit you post:
1. Send an email to js0095001[at]gmail[dot]com.
The subject line should be "A Source of Inspiration"
In the message body, please include the name of your blog, the title of your post, the DIRECT link to your post, and a short description of you post.

2. Use this form. It sends the message directly to my inbox.

Thanks for all the submissions so far! I'm confident that, with your help, we can take the blogosphere by storm.

In Lieu of My Own Quality Content...

noreply@blogger.com (Trauma Junkie) — Tue, 03 Feb 2009 23:00:00 +0000

...I'd like to send you to a blog that has some.

I've recently started reading THE ECG BLOG, which I'd like to define as, "The Cardiac/Tele Junkie's Best Friend." I may or may not have mentioned before that in addition to being totally interested in all things trauma, I also enjoy reading and learning about telemetry, rhythm interpretation, and all things cardiac. It only makes sense, right?

Now, I'll also admit that while I'm intrigued by ECGs, I really do not have an expansive knowledge when it comes to interpretation of strips. At this point in my life and RT school, I'm able to look at a heart monitor and either say, "Oh, that's good," or, "Holy crap! Do something about that." (You see, we haven't covered this topic in detail as of yet.) So don't worry, I won't be coming to a hospital near you any time soon as a student, and be the one in charge of making sure your mom or dad's heart isn't in a dangerous rhythm. The point I'm trying to make is that, well, this site is awesome!

Not only do you get to see a variety of rare heart rhythms, like a complete (third degree) atrioventricular block with junctional escape rhythm, but you also get to learn something along the way, as the blog author does a very good job at explaining how to interpret this rhythm.

When you get a chance, I'd definitely recommend you follow The ECG Blog.

That is all.

No pressure, right?

noreply@blogger.com (Trauma Junkie) — Tue, 03 Feb 2009 18:44:00 +0000

So, let's say, hypothetically, that your adjunct (proctor) called in sick. Let's say that I you (the hypothetical student) arrive to clinicals to find that the director of the respiratory therapy program where you attend school is your adjunct instructor for the day. He's the one that will be following you when you least expect it, making sure you dot your I's and cross your T's.

Now, fast forward a few minutes later. Let's figure that the therapist you are assigned to work with (by the way, this hypothetical decision is made by the facility where you are doing clinicals, not your adjunct) is just happens to be your program director's wife. With regards to HIPAA, your program director has mentioned in class several times that he and his wife discuss the patients she is caring for, as well as the students that she is working with. Hypothetically.

No pressure, right?!