Surviving RT School

One Last Breath.

noreply@blogger.com (Trauma Junkie) — Mon, 02 Nov 2009 05:41:00 +0000

As RT students, we are always taught how important it is to maintain a patent airway. We are taught from the beginning of school how to treat shortness of breath, airway obstructions, hypoxemia, and respiratory failure. This is our job. It's what we do for a living.

Many of us pride ourselves on being in a profession where we help people breathe better. I can't imagine anything better than treating an asthmatic who comes in with a full-blown attack and seeing her get discharged from the ER with a respiratory rate of 12-20, non-labored. Or weaning a vent patient to nasal cannula successfully. As they say, if you aren't breathing, you aren't doing much else.

At the same time, sometimes we have to go against what we have learned, based on the patient's decision. And that can be both emotionally trying and somewhat difficult to do. But it's important to keep in mind that we're in this for the patients and for no other reason.

Yes, I did it. I finally had a time where I had to withdraw care from my ventilator patient. I was the one who had to go into the room full of crying family members and turn off the patient's vent, knowing there was basically no chance of him being able to breathe on his own. And let me tell you, that...was the most difficult thing I've ever done, next to coding a pre-schooler.

For the first time, instead of helping a patient breathe, I had to take their breath away.

Instead of using everything I've learned to make adjustments to the vent to help this patient breathe on their own, I had to put it all aside and D/C the ET tube.

It was no longer my job to notify the nurse when her patient started bradying down (50s, 40s, 30s, 20s).

I did not treat his shortness of breath. I watched as he went into respiratory arrest, followed by cardiac arrest.

But...

I held his hand and told him it would be okay.

I comforted his family members and reminded them we were carrying out his wishes.

I prayed with them when they asked if we could pray.

I did not become startled as he gasped for his last few breaths. I squeezed his hand tighter and told him it would be over soon.

And, as my patient took his last breath before my eyes, I didn't reach for the ambu bag. Not this time.

He's in a better place. There was no chance of recovery from his condition. I wondered how I would sleep that night, feeling like I was the one that caused him to die...

But then I realized something. We all love saving lives-- there isn't a better feeling in the entire world. And sometimes "saving a life" doesn't mean bringing a patient back after CPR. Sometimes, saving their life, involves putting them totally at ease. He can now breathe better. And, in a sense, so can I.

It's nice to be appreciated...

noreply@blogger.com (Trauma Junkie) — Sun, 25 Oct 2009 06:41:00 +0000

Keeping in mind that Respiratory Care week is just around the corner (Oct. 26th-31st), I came across an excellent post by a blog I've been following for a while.

When you get a second, head over to Nurse Jane's blog, See Jane Nurse, and read her feelings towards the respiratory department at her hospital.

Does that patient really need another neb?

noreply@blogger.com (Trauma Junkie) — Thu, 22 Oct 2009 20:11:00 +0000

(credit to KeepBreathing for the pic)

It's that time of year again. Everyone and their friend and brother is catching pneumonia, bronchitis, or even...H1N1. Which means, for some reason which is beyond the RT (or RT student), 99.999% of all patients in the hospital and emergency department will be given SVN treatments. Okay, so maybe that's a slight exaggeration. But not really.

Due to the seasons changing (or God smiting the lowly RTs-- one of those), everyone's asthma also starts to act up. This, in turn, means that we get to give a lot of nebs. (It's what we do, ya know.)

I have no problem with that. I love being busy. I love getting to use my assessment skills. I love being able to help people breathe better. But the problem comes into play when you have a particular doctor that overuses neb txs. You know what I'm talking about. Case in point:

I'm working ER yesterday at clinicals. A 5 year old male presents to us. No past medical history except asthma. On assessment, he is in distress. Intercostal retractions, tachypneic, coarse rales on inspiration and expiration. Auditory wheezes. Okay, this kid needs a neb.

Doctor orders 0.63 Xopenex (x2) and 0.5 Atrovent (x2). I don't really agree with this, but being the student, I give the treatment anyway. Post-tx, he has improved aeration and clear breath sounds, but he is still tachypneic and now slightly tachycardic (go figure, right?). It's not rocket science to figure out that the kiddo needs some steroids. Maybe Solumedrol IV?

An hour later, I'm called back to the ER. Xopenex .63 (x2) and Atrovent .5 (x2). Yes, an hour later. BBS are clear pre-tx. I give it anyway. My kid's HR increases from 136 to 180. I notify the ED MD and suggest politely that we hold off on more nebs or even consider a continuous neb, since they run at a lower flow and won't affect the HR as much. I also suggest we don't add Atrovent. He nods.

About an hour and 20 minutes later, ER is blowing up my phone again. Another Xopenex .63 x2. (Did I mention the kid took five albuterol treatments at home before coming to the ER? And yes, they're aware of this.) Again, HR goes through the roof. Now the kid is complaining of nausea. Instead of considering that maybe the SVNs are causing this, the doc orders some Phenergan IVP and orders another neb an hour later.

Seriously???

Don't get me wrong, I respect doctors to no end. But wow. How could this have been handled diferently? Just my suggestion:

1. Obtain a CXR

2. Draw an ABG to evaluate the patient's acid-base status (he was, after all, hyperventilating)

3. Steroids? Yes please.

4. Admit to inpatient for observation

Just sayin'.

Big Blue Eyes

noreply@blogger.com (Trauma Junkie) — Sun, 18 Oct 2009 16:42:00 +0000

My first day in the OR practicing intubations was something I had been looking forward to for a long time. The day was going well. I had seen several cases and successfully intubated four people. It was a typically busy Monday for the operating room staff.

Closer to the middle of the afternoon, things started to slow down. I made my way to the breakroom to eat lunch-- leftovers from the night before-- as I heard the pagers go off.

"Prep OR 7 for a trauma!" My anesthesiologist for the day said to one of the scrub techs. "We may get this one. I hope like Hell they make it to OR."

Making it to the OR would mean the patient was still alive. With traumas, it can go either way.

I glanced down at my pager, reading the words on the screen:

911: Level 1 Response-- 4 y/o female, cardiac arrest. CPR in progress. ETA 5 min.

I felt a huge lump form in my throat. My stomach sank. My palms became sweaty.

I made way to the ER, praying the entire time that she would be saved before I got there. Praying the page was somehow a mistake. Hoping, wishing, pleaing, bargaining... anything to save her life.

*********

As the body of a 4-year-old lay limp and lifeless there before me, I'd like to be able to say I was totally caught up in the moment. I'd love...to be able to say that, while performing CPR, I knew nothing but the objective data: Pulseless, apneic, and cool to touch. Asystole without compressions. Cyanotic. Two IV lines established. Size 4.0 ETT, 22 at the lips. Five doses of Epi in. Flail-chest.

But the truth is, when working on a kid, I learned this isn't the case. As much as I'd like to be able to say I was strong and my sole focus were the numbers, the drugs, the vitals, and how many cycles of CPR were given, I made a mistake that day that I always try not to make.

I looked at her innocent face. Her eyes, which were wide open during the entire code, started into me like the deep blue eyes of my own little one who is the same age. For just a brief second, I saw our patient outside at daycare, playing on the playground, laughing and running around freely like kids do so well-- exactly what she was doing shortly before she went down.

I wanted to be able to bring her back more than I've ever wanted to save anyone. I fought like Hell, trying to defy all odds. I begged silently. I prayed. I made amends with God in hopes that this innocent little girl would live to see another day.

I pictured myself in her parent's shoes, and the thought was absolutely horrifying. Just then, they came running down the brightly lit hallway of the emergency department. Security wouldn't let them in the room.

Her young mother was shouting, "Save my baby! Work harder!! Keep trying!" She could barely get a word in without sobbing hysterically. Her husband was trying so hard to console her-- holding her tightly in his arms, whispering something in her ear.

"Janet, let them DO this!" His voice was firm and commanding, but I could hear the pain. He was doing what he knew a husband and father should do. He was trying to stay strong.

I will never forget the screams from the parents or the little one we fought so hard to save. I did compressions for an entire hour, not wanting to let anyone take over.

I reached the point of shear exhaustion. My entire body was sore. I could feel my muscles aching, joints popping. None of that mattered. Eventually, someone grabbed my by the arm and took over. I was too tired to fight them, as much as I wanted to.

I stood in the back of the room and watched them continue to work on her for about another hour. It felt like minutes.

The trauma doc looked up at the clock, and I about wanted to collapse. I knew what was coming. He ordered us to stop CPR and stated the time of death.

Godspeed, little angel. You will be missed.

It wasn't supposed to happen. Her mom and dad kissed her goodbye before she left for school, like any parent would do. It was a normal day, in a normal town, and she was a healthy kid. She didn't deserve to die. It has been on my mind, even weeks later.

I know we did all we could. I do. And pedi codes are never easy. The next one...will be just as bad, just as trying, just as hard. I'll think about it for weeks like I have this one. It's a part of what we do.

We couldn't save her. It was beyond our control. And, as much as we wish she had made it out alive, it doesn't always happen that way.

RIP, babydoll. My heart is with you.

No One is Perfect

noreply@blogger.com (Trauma Junkie) — Tue, 06 Oct 2009 13:40:00 +0000

...but it's important to remember that we're all just human. We're all in this for the same reasons. Epijunky has always reminded us of that, but her latest post really struck a nerve.

Go check it out and send some kind words her way.

For All of My Fellow Students

noreply@blogger.com (Trauma Junkie) — Mon, 05 Oct 2009 22:21:00 +0000

School is stressful. School is hard. If it wasn't worth doing, it would be easy. We all know this. We remind ourselves of this every day. So what do you do when you reach your breaking point? What do you do when you feel like there is nothing you can do but cry or give up?

Keep on going. Hang in there. A year from now, or two years from now, it will all pay off. If there is a concept you can't seem to grasp, or something you can't figure out how to learn, experiment with different methods. Keep on trying.

Remember that there are a lot of people out there willing to help you succeed. Don't ever forget that there are a lot of people rooting for you, a lot of people who have been there before, and a lot of people who just want what is best for you. They're here for you.

Do them proud. Do yourself proud.

When you get to a point that you feel like you can't possibly study anymore in one day, stop. But pick it up again first chance you have the next day. Studying is never easy-- it comes easier for some than others-- but it is never truly easy. As you progress through school, you will find ways to make it a bit easier, or figure out what works for you. But don't ever think you don't know anything. You're brilliant. All of you.

If you're the student who is going to school with no kids and no job, and living off of loan money and your parents, consider yourself fortunate. Don't take advantage of it.

If you're the student who has kids and a full-time job, hang in there. You will make it if you believe in yourself. You will figure out when you can study, when you can read, and when you can spend time with your children. This will come to you along the way.

For some of you, this is a second career choice. Some of you, your first. Either way, be passionate about it in all aspects of your daily life. The passion that you have for what you do will help you to move through the obstacles.

When life with school becomes too much, don't be afraid to take the time to chill out and relax. It won't hurt anything, just keep school in the back of your mind. If anything, remember all the good experiences you've had thus far-- that first time you intubated a patient, the first test you passed, etc. Remembering the good experiences and knowing that you will have many more in the future will help you out greatly.

You never know what life will bring you, but you can know that you are making a positive choice.

Keep your chin up.

Sound Advice

noreply@blogger.com (Trauma Junkie) — Wed, 23 Sep 2009 20:12:00 +0000

This was given to me this afternoon by one of my clinical instructors. Seeing as how he has been an RT almost 40 years and is one of the smartest people I know, I figured it was worth sharing. Here are his keys to success:

1. Be honest in money matters. Real success will never come to a dishonest person who has compromised himself.

2. Work harder than you are required to do. A successful leader will always do a little more work than he is paid to do. An underachiever will always do a little less. The difference in effort is small. The difference in success will be great.

3. Make up your mind to accomplish your goals. Determination is undoubtedly the most important characteristic of a successful person. Visual the successful end results of your efforts before you start. Write down specific goals. Don't take your eyes off of them.

4. Be positive -- not negative. Approach all things with enthusiasm. Being positive is an attitude. You can decide. It is a conscious state of mind.

5. Dress yourself a little better than the occasion calls for. You'll receive better attention, acceptance, and a response wherever you go. You'll be much more influential if people think you care about yourself and take yourself seriously. If in doubt, overdress.

6. Take special pride in your personal experience, home, and automobile. It's more important than ever to project a clean, organized image to others.

7. Make those who report to you feel successful and good about themselves. Be generous and compassionate with those individuals. You'll achieve tremendous success if you make those who report to you feel successful. It will also give you greater influence.

8. Keep on good terms with all business associates, neighbors, and family. It takes two uncommitted people to be enemies or adversaries. Don't participate. Life is too short. Keep the harmony. Do more than your part in your relationships.

9. Be eager to please your customers (patients), your employees, your co-workers, and your boss. You must be eager to please.

10. Don't burden yourself with debt. Do without.

11. Enjoy yourself. Get a hobby. Laugh some, especially at yourself.

Sometimes, if we are deficient in even one of these areas, we suffer as if we failed them all.

I may just be a student, but...

noreply@blogger.com (Trauma Junkie) — Tue, 22 Sep 2009 19:47:00 +0000

Dear ICU nurse,

You're right about one thing-- I am a student. You're wrong about the other-- this doesn't mean I don't know what I'm talking about when it comes to the respiratory care of a patient (I mean, there is a reason we're called RESPIRATORY therapists, respiratory therapy students).

When I told you that increasing the FIO2 on your long-time COPDer in bed 7 would knock out her drive to breathe, I'm sorry you weren't satisfied with my knowledge. I am just a student, but not only have I read about, I've seen it happen. 88% is, in fact, an acceptable to SpO2 for this patient, and as she wasn't in distress and her blood gases were within normal limits for the typical COPD patient, there was no reason for alarm.

But I'm just a student. You didn't buy what I had to say.

When I told you I didn't think it was a good idea, in my opinion, to increase her FIO2, you did it anyway. You were shocked when her sats dropped from 88% to 82% and her respiratory rate slowed severely. Again, calmly and professionally, I tried to explain this to you.

Finally, it reached a point where it was time to do something before your patient coded. You started screaming for BiPAP. I explained that since her respiratory drive was no longer stable, she wasn't a candidate for BiPAP, coupled with the fact that she had *severe* anxiety and was extremely claustrophobic.

I suggested we intubate your patient, instead, before matters became worse. You know, give her a break, allow her to resume a normal breathing pattern. I'm ALL for BiPAP to avoid intubation, but BiPAP wasn't indicated anymore.

Well, you went ahead and did it anyway. You called the hospitalist, instead of the pulmonary doctor, and got an order and placed the patient on BiPAP. She crashed harder. She damn near coded. A few minutes later, here comes the pulmonologist with the intubation kit.

Your patient is now intubated. Her gases are awful. I'm just a student, but she will have to be tubed for a lot longer than she would have if you could have had a little faith in me.

I don't try to piddle in nursing things. Don't piddle with respiratory.

Kthxbai.

Much Love,

TJ

Always Remember

noreply@blogger.com (Trauma Junkie) — Tue, 15 Sep 2009 15:29:00 +0000

The thing I love about respiratory therapy is that I'm always learning new things. A lot of these things are learned in the classroom, but a lot of them are things they just can't teach you in school. Some of them, hard lessons. Some of them, just things you pick up on. Just as important as it is to have textbook knowledge and common sense, it's also important to pay attention to these type of lessons, as well.

The most recent thing I've learned is that, in Respiratory Therapy, you have to find a balance. If you want to be good at what you do, and do it for a long time, remember that it isn't about saving lives. Remember that you aren't just there to make people better. Remember, above all, that your purpose is to make a difference, however you can do so. In the past week, I've:

Watched three people die
Saw one patient go from bad to worse
Seen a brilliant classmate and good friend kicked out of the RT program due to illicit drug use (I had no idea...)
Watched a patient improve significantly o--ver the course of a day, then fall back to critical condition even quicker
Treated two MIs, three MVCs, and four people in respiratory arrest.

A difficult conclusion for me to come to, although it seems so obvious, is that working in healthcare isn't all about glory days. Real life is nothing like TV. You don't go home happy every day, and not every single one of your patients will walk out of the hospital. Some will go home, some to the nursing home, and some to Heaven.

At the same time, in the past week or so, I've:

Witnessed my first "successful" code-- I didn't work it, but still.
Weaned and extubated 3 patients who are now saturating just fine on room air
Placed a patient on BiPAP, avoiding intubation (they were since weaned from BiPAP and doing fine on 2L NC)
Received a few "thank yous" for the care I've given
Terminally extubated a patient (sometimes called "pulling the plug"), at the wishes of the family/Power of Attorney, who ended up living following removal of the tube.

It's not all about the glory days, but hold on to them when they happen.

Added to the Blogroll

noreply@blogger.com (Trauma Junkie) — Tue, 15 Sep 2009 15:20:00 +0000

A couple of recent editions to the Blogroll--

Medic 7 For those of you that don't know Medic 7, he is actually a lot like my good friend Epijunky. M7 shares a passion for what he does that rivals most people. He's sharp, caring, and at times pretty witty. If you don't follow his blog, I'd definitely consider adding it to your "must read daily" list. I have.
Fat Fireman JS is a good friend of mine. He's a firefighter and EMT from up north who has a lot good posts to read. From his bio, hobbies include shooting and SCUBA diving. What's cooler than that???

Stop by their blogs and give a shoutout when you have time.

A Heart-Warming Story

noreply@blogger.com (Trauma Junkie) — Sun, 13 Sep 2009 18:12:00 +0000

It took me way longer to write this post than it should have, but sometimes you just can't find the right words.

I love a good heart-warming story. A good, true heart-warming story.

Somewhere out there, a girl is living the dream. Her dream. And she's doing it because others see great things in her-- potential, passion, determination, and a commitment to helping others.

Epijunky is my best friend. One day this past January, we added each other on Twitter and started talking through IMs and phone calls. Right off the bat, from that first conversation we had, I found a friend-- a true friend...and we all know how true friends are hard to come by.

Seeing as Epi has always been there for me when I needed help with any number of things, when I got a phone call one day this past August saying she was throwing in the towel on attending Medic school due to financial issues, I decided it was time for me to step up and pay it forward. I made a phone call to Bernice, a fellow medblogger and EMT. We knew we needed to do something. Life really is all about paying it forward, yanno.

Between the two of us, we came up with the idea to set up a Paypal fund-- think, the medical blogosphere's largest tip jar. Later that night, Bernice wrote a post challenging everyone to three fives: "Give her five dollars, tell five friends, and take five minutes to stop by Epi's blog and give her some words of encouragement." Simple enough, right? Sometimes simple favors are the most appreciated.

In the past month, Epi has been absolutely rocking it in Medic school. In her time of need, everyone came together to help one of their own-- a girl with a passion for what she does that is clear in her writing. People started chiming in to help. People she knew, people she didn't. People who know her only through her blog.

We all know what it's like to be faced with challenges in life. We know how it is when life gets in the way of helping us do what we really want. Sometimes things are beyond our control, but sometimes all it takes is a little help from others.

Today, I'm giving you a challenge a lot like Bernice did. Help a girl out. Stop by Bernice's blog, give any amount you can, big or small, to help someone who wants to be a Paramedic more than anything. Then stop by Epi's blog, and send some kind words her way. In doing so, you'll know that you hold a permanent place in one EMT's heart. What can be more gratifying than this?

Go Forth and Ventilate: Initiation

noreply@blogger.com (Trauma Junkie) — Fri, 11 Sep 2009 15:19:00 +0000

Look at this thing. Pretty intimidating, right?

When it finally reached the point that we started covering ventilators in RT school, I was a mix of emotions. Excited, nervous, intimidated, and confident all at the same time. Okay, well maybe not confident. But I am now.

You see, when it comes to ventilators, you can't be intimidated. Yes, the machine is breathing for your patient, and yes, you are the one to apply the settings and make the changes to benefit the patient, but you have to take a deep breath. Don't let it scare you.

Some of the best advice I've heard about ventilators came from an RT student who recently graduated. "Don't fear the vent. You can always bag your patient. The vent changes don't take effect until you apply them."

Since we are covering initiation of mechanical ventilation in lab this week, I'd like to share with all of you some tips/tricks I've found to help make this a bit easier. For the purposes of this post, I'm going to describe setting up a vent in Volume Control, Assist/Control mode (VC/AC).

1. When setting the ventilator controls without prescribed settings from the physician, always remember the "rule of 10s":

Preliminary settings:
-Respiratory rate (f) of 10-12
-FIO₂ at 1.0 or 100% in emergency situations (cardiac arrest, etc.), or 40-50% for post-op/overdose. See? Intervals of 10.
-Tidal volume (V_T) at 10-12 mL/kg of the patient's ideal body weight (IBW)

IBW male= [(height in inches - 60) x 2.3)] + 50

IBW female= [(height in inches - 60 x2.3) +45.

Note: Once the IBW is determined, set the tidal volume in intervals of 50. Say your patient has an IBW of 66kg, so the V_T at 10 mL/kg, would be 660. Set it at 650 to make it easier.

-Peak Flow: Set at 40-60 L/min (again, intervals of 10) to achieve an appropriate inspiratory:expiratory ratio (I:E ratio), which is typically 1:2. (10/10=1. See?)
-Sensitivity: For patient-triggered sensitivity, set at 1.5-2. For flow-triggered sensitivity, set at 2-3. Okay, this has nothing to do with the rule of 10...but work with me here.
-PEEP of 5. (10/2=what?)

Preliminary alarms:

-Normal pressure limit (also called peak pressure, P_peak, peak inspiratory pressure, or PIP) at 50 cmH₂O
-Respiratory rate high limit at 10-15 bpm > set respiratory rate
-Low exhaled volume at 10-15% < set or targeted minute volume or 5 L/min (1/2 of 10 is 5. Remember that.)
-Low exhaled minute volume at 100 mL < set tidal volume. Again with the intervals of 10.
-Apnea alarm at 20 seconds (10 x 2=20. Woo!)

Still with me? Okay.

So you now have the ventilator set up and the patient arrives to the ICU. It's time to place them on the vent. (Don't forget your humidifier, if needed! Remember 30-35°C for the temp.) Next, it's time to adjust the alarms after connection to the patient so the blasted thing isn't screaming at you every two minutes for something that isn't important. This part is simple enough. As easy as A, B, and C. (Get it? Airway, breathing, and circulation?).

A. Determine the peak inspiratory pressure or PIP.
B. Set the low inspiratory pressure alarm at 5-15 cmH₂O < PIP. (Still with the rule of 10s? Just remember 5, 10, 15.)
C. Set the low PEEP alarm at 3-5 cmH₂O < set PEEP. This one still follows the rule of 10, because a good place to set the PEEP is 5 to begin with, so 5-3=2. 10/5=2. See? See?

Have you made it this far? Good. We're ALMOST done with initiating mechanical ventilation. (I swear!)

Next, assure the patient's airway. This is the simplest part, to me. 4 steps:
1. Note placement of the ET tube (it's easier if you document at the teeth). 23cm at the teeth, etc.)
2. Check the cuff pressure (18-27 is ideal, but you'll do okay if you still want to go with the rule of 10s and remember 20-30.)
3. Make sure there are no cuff leaks by auscultation. While you're at, auscultate to make sure you have good bilateral breath sounds.
4. Assess the patient for oral secretions and suction as needed. (Most of the time, it WILL be needed, so have that Yankeur ready at bedside). By the way, for an adult, you can use the rule of 10 to set the vacuum pressure. A good vacuum pressure is about 120 inHg (forgive me if I've got the wrong unit of measurement here, but just look for 120 on the dial). 10 x 12= 120. Yep.

Last step-- chart it. A few pieces of advice from fellow RTs, nurses, and others to remember when charting (I'm sure you've heard them all before):
If it wasn't documented, it was never done.
Always, always CYA (cover your ass).
Chart consistently so that if it comes back to you in the future, you'll remember doing it.

That being said, here are the things to chart, in no particular order:
1. Date/Time of initiation
2. Ventilator parameters
3. Airway placement/cuff pressure
4. Adequacy of ventilation (breath sounds)
5. Patient complaints
6. Anything else that you feel is pertinent.

Remember, chart in the same order every time. It doesn't matter how you fit all of this in your documentation, as long it is documented. Here's an example of how I always chart vent setup:

"09/05/09 mechanical vent initiated at 1310 with Draeger Evita 4, ETT at 23cm at teeth, cuff pressure 22cmH₂O, vent settings as prescribed on orders. BBS auscultated in all ant. lobes/bases. Ventilator/alarms functioning properly. Pt sedated with bil wrist restraints in place and no s/sx of distress noted. "

Well, ladies and gentlemen, there you have it.

Go forth and ventilate.

Finding the Balance

noreply@blogger.com (Trauma Junkie) — Thu, 10 Sep 2009 16:28:00 +0000

My friends, and humble readers, I'm having a problem.

What do you do when the ER goes from this...

...to this?

What do you do at the end of your shift, after you've spent the day doing nothing but working codes, treating chest pains, and applying oxygen to people who don't respond to it? When it's time to go home and relax and all you can do is thinking about treating patients and helping them get better?

I'm having a hard time dealing with something, and I'm not sure if the problem is separating work from home, or something simpler.

Recently, I've started following a lot of EMT blogs, and paying more attention to blogs of ER nurses, ER physicians, and the like. I'm starting to realize that a lot of us face common problems in this line of work, and that often we can help each other out. Just as we care about our patients, we care about each other...we're in this together.

So what do you do? Do you listen to hard rock music on the way home to keep the rush going a little longer? Do you mellow out, take deep breaths, and try to relax? Perhaps play a little classical music?

Do you do things on your day off to get your adrenaline going? Extreme sports? Or simply take pleasure in the simple things in order to find a balance between the stress of working in emergency medicine and trying to live a normal life outside of work?

I'm asking what works for you. I love trauma, I love emergency med, and I love nothing more than working a code (besides my family, friends, daughter, and significant other). Once the rush starts at the beginning of a shift/clinical, I never want it to end, but I know it always does.

Help me find a common ground. And thank you.

Warning: Graphic

noreply@blogger.com (Trauma Junkie) — Thu, 10 Sep 2009 00:57:00 +0000

You may think this isn't relevant to what we do for a living. I don't care.

This video is so real, and so tragic, that it holds a place in my heart. H/T Epijunky for putting this up on her blog.

If you text and drive, please stop. I don't want you to end up in the ER while I'm doing clinicals needing an artificial airway because of something you could have prevented. Be safe out there, guys.

The Number 1 Sign You're Burned Out on School

noreply@blogger.com (Trauma Junkie) — Wed, 09 Sep 2009 00:23:00 +0000

One classmate to another this afternoon during Mechanical Ventilation class,

"Umm. I'm so tired and so lost. What is he talking about now?"

"I don't know, I'm sure it has something to do with breathing. AGAIN."

Maybe I'm a bit hysterical myself, or maybe I've hit a bit of burn out, but I laughed so hard.

Share your quotes, if you have any.

Unexpected

noreply@blogger.com (Trauma Junkie) — Sun, 06 Sep 2009 04:27:00 +0000

Stacks of blue charts lined my desk. A vast amount of paperwork was scattered in every direction, joined by a few ink pens, highlighters, and a pencil. The phone was ringing constantly, in competition with the tones from the call light system to my left. A few visitors gathered in front of me, wanting to know what room their father was admitted to earlier this morning. While trying to direct them to the room, I was approached by nurses who had questions on orders I had checked off. The stack of charts wasn’t becoming any smaller, as completing one chart simply meant a new one was added to my stack.

Amidst all the chaos and calamity, behind that desk sat someone who appeared calm and collected. I’ve learned that even during the busiest moments, losing your cool will not help matters. I kept reminding myself that it was just another day at work. Not all days are like this. Eventually, things will slow down. Eventually.

In what seemed like an ordinary shift, in any ordinary hospital, the operator came over the PA system and spoke those words that no one ever wanted to hear:

“Your attention, please…”
Dear God, please let it be something else. A fire drill? Someone who left their lights on in the parking lot? Dr. Brown, please call extension 4394? If only its not--

“Code Blue, room 4-5-1. Code Blue, room 4-5-1. Code Blue, room 4-5-1.”

In the blink of an eye, everyone stopped what they were doing. I bolted for the Crash Cart as another co-worker grabbed the portable Oxygen tank. Someone lifted the dusty LifePak off the shelf, and we hauled ass to room 451.

In my mind, I’m recalling key points from school:
-Four minutes without oxygen before brain death.
-15:2, compressions to breaths
-Bag at 12 breaths per minute, or a breath about every five seconds. It is okay to count to yourself, no one will notice.

I push the Crash Cart into the room and step outside the door. I’ve been working in hospitals long enough to know that CNAs and Unit Clerks don’t’ have much of a role in a cardiac arrest situation.

As I’m standing outside the room, I can’t help but look inside. Expecting to see an 80-year-old man, someone with children and grandchildren, and his hysterical wife at the bedside, yelling at the staff to save her husband, I’m absolutely shocked at the scene before me. I shake my head a few times to make sure I’m not imagining things, then reality hits.

My stomach sinks. I feel a large lump begin to form in my throat. My palms become sweaty, and I hold back my tears. While staying completely focused on the situation, I try to imagine myself anywhere but here, anywhere but now.

Her long, blonde hair is brushed away from her face by the anesthesiologist who is preparing to intubate. A pulse oximeter was in place over her right index finger-- it didn’t match her other fingers, freshly manicured the night before surgery. I’m thinking over our census in my head. Since I wasn’t doing patient care on this particular day, I knew nothing about this patient. Just then, it hit me--

Jesus Christ. She arrived to our floor earlier this morning following a very simple and very common surgical procedure, a lap chole. A few hours ago, the nurse was working on her discharge papers. The patient decided they wanted to eat lunch before they went home. That is the only reason she was still in the hospital.

She was all of 25 years young, and a nursing student, a semester shy of graduation. Amy had a beautiful daughter who was but a year old, as I’d later learned.

Her father swooped their daughter up and carried her out of the room as more and more people entered to work on his wife.

I can’t imagine what it must have felt like to be in his position. His young wife was being coded, and he hurried down the hall and into the waiting room, placing all of his trust in the medical staff. I remember seeing the look on their daughter’s face. She was terrified and had no idea what was happening. As I stood there outside of her room, I couldn’t help but think of my own daughter, just a year older in a similar situation. It was horrifying and gut-wrenching.

I’ve found myself in this situation more times than I can count. I continued to stand outside the room, feeling completely helpless as nurses and doctors certified in ACLS did everything they could to save Amy’s life. Sure, I’m certified in Basic Life Support, but that was already being done. I remember this being one of the major reasons I wanted to go to school.

I wanted to do more. I wanted to help save a life. I wanted to try. I wanted it more than anything. I was kicking myself that I didn’t go sooner. I was kicking myself for being a first year and working in the capacity of a unit secretary that particular day. Not that I could I could do more than all the fine medical staff, but I still wanted to help.

After a while, I realized the situation was being handled in Amy’s room. I realized there were 3 or 4 other people standing by next to me if the doctor needed them to grab supplies or someone needed relief from chest compressions for a bit. And my thoughts instantly went back to their little girl.

I thought about it for a second longer, then I stopped thinking. Yes, there were patients calling on the call light because their infusion pumps were beeping. A patient next door to Amy wanted someone to give her a sip of water. This was my job during a code. But amongst all the commotion, all of the staff take on different roles…and I figured out what my role was this day.

I walked past the rooms, to the nurses’ station. I continued down the hall, passing the kitchen and the supply room. I walked, and kept walking, all the way to the waiting room. I made eye contact with Amy’s husband, trying to tell him anything without saying a word.

It’s going to be okay? No, that wasn’t appropriate. She’ll make it? No, I couldn’t’ say that either. And before I could think, I opened my mouth.

“Hey, baby girl, what’s your name?”

She didn’t answer. I wasn’t sure that she was talking yet. But I kept talking to her. I was a slight distraction at the most needed moment, as Amy’s husband was completely losing it…and I can’t even blame him. He walked over to the opposite side of the waiting room, looked me directly in the eyes, and whispered the softest “Thank you.”

All I could do was nod. I love kids, and I kept putting myself in his position. I knew I’d want some alone time to process what was happening, and I knew that he was in that waiting room with his little girl, trying to pretend like nothing was wrong. He was trying to distract his daughter, but he needed the distraction more than anyone.

As the baby and I sat there playing on the floor of the waiting room, I could see him praying in the background. He was whispering and I can’t even imagine what he was saying. Begging. Pleaing. Making ammends. Anything for Amy, I imagined him saying at one point.

Not a single code I’ve ever seen has ended well. I try not to think about that. I try to think that everything will be okay, and how much this little one needs her mother. I even caught myself praying silently at one point.

About 15 minutes later, an ICU nurse walked into the waiting room. She pulled Amy’s husband aside.

Oh, no… Oh, no… I can’t do this job. I quit. I can’t. I remember thinking this before she delivered the news. I could only imagine the worst. I could only assume that Amy didn’t make it.

And just then, on that day, something amazing happened. The husband of a 25 year old nursing student followed the charge nurse to the intensive care unit. For some reason, I went along with them. I can’t recall why now.

I stood for a second outside of Amy’s room in ICU. Just a second. Long enough to know that she was intubated. Long enough to know that she was in Sinus Tach. Long enough to know, that she was already breathing against the machine. She had spontaneous respirations.

Long enough to hear the doctor talk to Kevin, Amy’s husband.

“It’s always very rare that someone recovers fully after their heart stops beating and they stop breathing, and it’s still a waiting game at this point, but I anticipate that, if things keep going as they are now, she’ll be off of that breathing machine in anywhere up to a week. We’ll work with her. I think we may have made it there just in the knick of time.”

And with that, I made my way back to my unit. I shuffled around the papers on my desk and started to work through my charts again. This time, I had a smile on my face.
I know I didn’t save a life. I know it was a combination of a huge effort on behalf of every single person working in this hospital that responded to the page. I know that I’m just a CNA.

But I also know that Amy will be okay. And thank God for that.

As the 02 Flows...

noreply@blogger.com (Trauma Junkie) — Fri, 04 Sep 2009 16:54:00 +0000

At the end of the first year of RT school, I remember several things:

Some of these things, very basic, but very important:

-Never withold oxygen from a patient who needs it

-Bronchodilators are intended to treat bronchospasm/bronchoconstriction

-Normal respiratory rate is 12-20bpm, normal heart rate is 60-100, normal B/P is 95-145/50-80

-Always wash your hands

-Central cyanosis, hemo-/hydro-/pneumo- thorax, and pulmonary emboli are very serious and require immediate intervention

Some of these things, slightly humorous, but slightly irritating:

-Patients who tell you they know how to properly use their inhalers and nebulizers (you know, they have been doing them at home for years), in fact prove to you that they cannot demonstrate the proper way to do them

-Almost everyone who is admitted with a respiratory problem, such as pneumonia, will have bronchodilators scheduled, even if they have no indication for this therapy (they aren't "wheezing" and have no history of asthma or reactive airways)

-Doctors, especially residents, don't always know how or when to properly order a neb treatment, including frequency and dosage ("Albuterol 4mg per neb TID and q1h PRN SOB," anyone?)

-Patients do not know why they take their breathing treatments, they don't help, but they just do it and have never asked why

-Some of the therapists you work with in clinicals will tell you all the wrong ways to do things

Some of these things, don't just apply to respiratory therapy:

-Everything that can and will go wrong, usually does (a variation of Murphy's Law)
-If you've got time to sit, sit. (An EMS thang)
-People live against all odds, people die with no odds against them
-Sometimes, all you can do is hold their hand
-Experience matters, but not always
-You will say things that make you sound totally stupid, and sometimes you'll catch yourself, but sometimes you won't (I once came to the "conclusion" that Sp02 could *ALWAYS* be calculated by adding 30 to the Pa02 on a pt's blood gas [if their Pa02 is 85, then this would make their Sp02 115%.] Yeah, laugh it up.)
-Sometimes, you know more than you give yourself credit for knowing. Sometimes you will surprise yourself, and sometimes you'll feel like you don't know enough
-You will question what you're doing with your life at least once during the course of your formal education
-Some days, you will know that you have chosen the right career field, and other days, you will find yourself wondering if you've made the right choice
-It is, in fact, okay to not know the answer. It is, however, never okay to not ask or seek out the answer in another way
-Some people are there to help you, others will try to hurt you
-You can't fix everyone, but you can sure try like hell

They say that the first year of RT school is the toughest. You learn basic concepts, formulas, laws, and equations that you will carry with you for your entire career as a therapist. The second year just consists of building on these concepts.

I have a wide base of readers for my blog. Some of you are new grad RTs, some of you have been practicing a while. Some of you are potential students, and some of you are right where I'm at in school. Some of you are nurses, doctors, and other health professionals. Some of you, are members of the general public.

I just wanted to take the time to thank all of you for sticking by me through my bouts of writer's block, stress, many questions and sporadic posting. I started my second year three weeks ago, and I'm in the home stretch. I've met a lot of great people, and even my significant other, through blogging and reading other blogs.

You have all been most excellent, and there is something about each of you that I either see in myself or would like to be like. I have one more year, then I can rock the RRT to my fullest potential.

It is my ultimate hope that I have at least helped one of you as much as you have helped me. Life really is all about paying it forward.

-

EMS: My Observations

noreply@blogger.com (Trauma Junkie) — Fri, 28 Aug 2009 15:51:00 +0000

As I've called myself a trauma junkie from time to time, many of you have probably wondered why I chose Respiratory Therapy as opposed to Paramedicine. The answer? I honestly don't know.

Nothing is more gratifying to me than managing a patient's airway. It has been said a time or two that, "If you aren't breathing, you aren't doing anything else." I love what I do as a student RT, but I have another love, a new found love, and that is EMS.

Recently, I had the pleasure of doing two separate 3rd rides with a well-known blogger, Epijunky. For those of you who don't know much about EMS, a third ride is basically where you ride along for a day on a truck with two certified Emergency Medical Technicians and observe for a certain amount of time.

Let me tell you-- my experiences on these two separate days were amazing. The first day I rode was basically uneventful. We were working a racetrack and posted outfield in case anything went wrong in the stands. There were no emergencies and no accidents this day, but it allowed me to see what EMS is like on "slower" days. Through working at a hospital for the past 5 years, I've come to realize that slow days can sometimes be just as rough as the busy days-- and if you can handle the slow days where you want to shoot yourself, you know you can do the job.

The second day I rode with Epi and her partner went a little something like this:

1040: Arrived at the station 20 minutes early for the shift.
1045: Truck inspection. We made sure the truck was stocked properly to handle any variety of runs we could take. Checked mileage, fuel level, and made sure the battery and lights were working. Realized we were out of nasal cannulas and C-collars. This would mean a trip to the main station to grab some supplies.
1100: Called dispatch to tell them the truck was in service, but that we'd be swinging by to pick up a few supplies before they gave us a run.
1110: Arrived at main station to restock. Epi and I run upstairs to talk to the boss for some reason, while her partner for the day heads to the supply room. Before she could tell them anything, they blurt out an address. "1157 Main Street. County run. " We run out the door, her partner with supplies in hand. He tosses them into the back of the truck and the doors slam. Trauma Junkie was on his way to his first run ever.
1118: We arrive at the scene, a private residence. The patient is already outside on a stretcher, and the local fire department proceeds to give us report on an elderly patient who fell in his bedroom. He feels dizzy. No history of CVA or TIA, but has chronic back pain. He is boarded and collared. We get him transferred to our stretcher and into the back of the ambulance.
1127: We drop the patient off at the ER. Give report to the nurses, grab a facesheet, and I learn how to make a stretcher. (P.S.- Never unfold the sheet all the way. This complicates things. Don't try to pretend like you know what you're doing to impress a certain girl EMT.)
1130: We're sitting out in the ambulance bay of the ER. Epi's partner is finishing his run report, and I'm drinking a soda. Epi proceeds to make towel rolls. I tell her that looks easy, try to do one, and fail. She laughs at me. "Let me do that." I can't do anything but agree at this point.
1140ish: Back in service. Head back to the station where we first started for the day. I listen as Epi and partner try to make sure they have everything done. Run report? Check. Facesheet? Check. Signatures? Check. Sunglasses? Check. You know...
1150: Arrive back at our station for the day. There's absolutely nothing to do at this point but wait to be called for a run. We turn on the TV and some guy is cooking bacon. They don't get many channels.
1230: Still nothing interesting on TV. I'm tired due to not much sleep the night before, but in no way am I brave enough to try to nap right now. (Yes, you can nap in EMS. Good luck finding time, but you can.)
1315: Spend some time walking around outside the station and checking the TV again. I play on my cell phone for a while. Quiet partner guy is on Facebook and checking prices for Macs. Epi and I both decide we'd like a Mac, but we're broke students, so we will stay Windows people for now. I try to crack a Macintosh joke, but it's really not all that funny. Silence ensues.
1400: I know they run their asses off most days and they're probably enjoying the slow pace of the day, but are we EVER gonna get another run? I think this in my head. I'm wise enough not to say it out loud, because that is when all hell breaks loose.
1430ish: We decide to grab a bite to eat. Before doing this, Epijunky has to call dispatch to ask if they have anything scheduled for us or if it is okay if we go "mobile" for a while. We find out there is a transfer scheduled for 1530, and decide to do it early. We'll eat later...maybe.
1500: Arrive at the hospital. Patient is being taken to a nursing home nearby. We come across your typical, run of the mill, type situation. The family wants to keep the patient alive and in the hospital although there is no medical reason for the patient to remain in the hospital. Etc, etc, etc.
1540: A decision is finally reached and we arrive at the nursing home with the patient.
1545: Back in service. Another transfer-- this time hospital to a hospice facility.
The next two hours and a half hours are spent without returning to the station. All of the runs are transfers, and we keep getting the runs the second we jump back in the truck after dropping the patient off. It's all kind of a blur, but I'd say we did about six runs in this time period.
1800: We finally catch a break. The shift ends at 1900 and we're about 30 minutes from the station. Can it be? Will we get to leave on time?
1802: A dispatcher calls on the radio. They have another transfer and it's out of district for our truck. The other trucks are on runs and are going to be for a while. The transfer is actually scheduled for 1830, but dispatch begs. "If you can get there early, I'm sure you'll still get off on time." I laugh. I've worked in healthcare long enough to know that means we will be getting off late.
1810: We arrive at the patient's home. She's to be transferred to hospice for comfort care. Her daughter is on the phone. The patient is resting in bed, wearing O2. She has a lot of belongings and things. Family wasn't expecting us early, so they are still sorta trying to ready her for her trip.
1845: The patient is in the truck. We proceed to the hospice home. We find construction, rain, and rush hour traffic. A family member is following behind us in their vehicle.
1900: At Hospice. We get the patient situated in bed, find her nurse, and say our goodbyes. Epi and I are both exhausted at this point, and I'm pretty sure her partner is too. We sprint to the truck. It's about 25 minutes back to the station.
1930ish: There are no more runs. We check to make sure everything is in order and that all the paperwork is done. FREEDOM!

Okay, so we didn't get to ride Code 3. There were no traumas. We never flipped the lights or sirens on. There were no chest compressions, no splinting of extremities, no bandaging wounds. So what made it so great?

Well, EMS is like family. In the short period of time that I got to work with Epi's partner, we became good friends. We talked about life, school, relationships, and other things. We were relaxed. Epi made me feel at home. There wasn't a lot I could do as a 3rd rider, basically nothing, but I did get the chance to do a few things, which only further convinced me that I love EMS.

Even when the day began to get stressful, we all kept each other grounded. If short partner guy wasn't cracking a joke when things got tense, I was. If Epi wasn't doing something goofy to keep us from becoming stressed, her partner was. I left my shift that day knowing that I made a difference.

I held hands with an elderly lady who was afraid. I made small talk with an older man who needed the distraction. I spoke to a guy who couldn't speak back, but I knew he could hear what I was saying. I made friends with a few nurses at a few hospitals. I reassured a patient that she was in good hands. I made people smile.

I'm attracted to EMS for the adrenaline rush that comes with coding a patient at 80 miles an hour on the freeway. I'm addicted to trauma. I absolutely love the fact that a 911 run can and sometimes will, challenge everything you know. I love being forced with making a split second decision that could save a life. I love the entire idea of this.

But, you know what? Sometimes it's not about blood and guts. Sometimes, it is about holding hands and reassuring your patient. Sometimes its about talking about the weather. It takes skills to perform during a trauma, but it takes a certain kind of person to have compassion and people skills.

I know that one day I will ride again and I'll see my fair share of emergencies. But, for now, I have seen a different side of EMS. A side I love almost as much.

There are a lot of things I want to do in my future. But after RT school, medic school is next. Maybe I'll work as an RT for a while before I go for my paramedic cert. Or maybe I'll go straight into school for medic after I graduate respiratory school. I may work as both, or I may do one or the other.

Whatever happens, I know that EMS has touched me. And I will touch EMS one day.

Thank you, Epijunky.

Survey Saturday

noreply@blogger.com (Trauma Junkie) — Sat, 08 Aug 2009 14:39:00 +0000

Yes, it's that bad. I'm bored, was going through a serious spell of blogger's block, combined with a ton of drama lately that has kept me from blogging. So, without further adeu, a meme--

Have I:

Gone on a blind date: Depends. I knew the person through IMs, pictures, and phone calls for about six months before we ever met. But as far as going on a date with someone I've never seen or spoken to, nope.

Skipped school: I skipped way more days than I should have my senior year of high school. In college, it's a different story. I have intentionally skipped a few times, but only if I knew it wasn't an important lecture or a test day or anything. I am really way more responsible with college than I was in HS.

Watched someone die: Yes. My grandpa and more patients than I can count. There were several moments growing up that got me interested in health care, but watching the hospice nurses and aides take care of my grandfather was one of the more defining moments.

Been to Canada: No, but I would love to one day. Hopefully soon.

Been on a plane: I have, and I prefer it to driving if the place I'm going to is more than say, 8 hours away. I hate to stop overnight on a drive, so I usually end up very sleep deprived by the time I get there.

Been lost: All the damn time. I'm directionally challenged and I'll be the first to admit it!

Been on the opposite side of the country: Yes. Minnesota and Ohio on separate occasions. I absolutely loved Minnesota. I'd like to visit and hopefully make a home in Seattle one day.

Swam in the ocean: I've been out in the Atlantic on a boat, but the closest I've come to swimming in an ocean was in the Gulf of Mexico, about five miles from the Texas coastline.

Had your booze taken away by the cops: Nope, to my surprise a few times.

Cried yourself to sleep: Not that I can remember.

Recently colored with crayons: Yep. There was downtime at work yesterday and I was just bored enough to do it. :)

Sang Karaoke: Quite a few times. My dad has a complete karaoke setup at home with over 15, 000 songs.

Paid for a meal with coins only: Every now and then when I forget my wallet or it's close to payday I've been known to use the ashtray change for dollar menu stuff. Lol.

Cheated on an exam: I’ve never cheated on an exam.

Laughed until some kind of beverage came out of your nose: I honestly can't say I ever have...

Caught a snowflake on your tongue: Yes.

Danced in the rain: Nope. But it's something I'd like to do.

Written a letter to Santa Claus: Yup.

Been kissed under the mistletoe: Hmmm. No, actually.

Watched the sunrise with someone you care about: Well I thought I cared about her at the time.

Been arrested: Like handcuffed and put in a cop car? Negative. But I have came extremely close a *few* times. That's another post for another day.

Blown bubbles: All the time when I was younger and now all the time with my little girl. She loves it!

Gone ice-skating: It’s been awhile… But I can count how many times on two hands. I loved it, but there isn't really a place to do it around where I live. Have to drive to Dallas.

Been skinny dipping outdoors: I have.

Favorite drink? Diet Pepsi or coffee

Tattoos? One on my right upper arm. I want several more, but am still trying to decide what I want to get.

Piercings? Right now just my ears. At one time I had my lip pierced, but I had to take it out for a job interview and it closed up.

How much do you love your job? There are those days and those patients that make it worthwhile. There are also those days and those patients that make you feel you should do something different with your life. But for the most part, I love it.

Birthplace? Waco, Texas

Favorite vacation spot? That’s a tough one. Orlando, FL or St Paul, Minnesota.

Ever been to Africa? Nope, but I have a few friends who are nurses on mission trips there right now.

Ever been on TV? In the background of a few news stories.

Ever been in a car accident? Uhmmm. Yeah. More than I'd like to admit. But I've never been seriously hurt or hurt anyone else, and only one was my fault.

Favorite movie? Forrest Gump, Shawshank Redemption, The Green Mile...too many to pick just one.

Favorite holiday? Christmas. Hands down.

Favorite food? Steak baby. T-Bone, Sirloin, NY Strip. Medium or medium rare.

Favorite flower? Never really thought about it, but I like to look at Easter Lillies.

Favorite smells? This is a tough one. The smell of my significant other. The smell you get after it rains. My daughter's hair after a bath. Fresh brewed french vanilla coffee. Salty air near the beach. Clean sheets.

What do you do to relax? Read a good book, write, sit outdoors in a quiet place, or call a good friend.

How do you see yourself in 10 years? I honestly don't know for sure. Obviously, I'll be a Respiratory Therapist by then. But the next move? It's a toss up between paramedic, RN, and medical school. Hell, I may do all three.

Ever been given an engagement ring? Nope, actually. And I was married at one point.

Longest relationship? Just short of five years.

Last gift you received? Guinness pint glasses.

Ever dropped a cell phone? About three million times give or take a million.

When’s the last time you worked out? Yesterday.

First thing you notice about the opposite sex?
If she’s up close I notice her eyes (I’m a total sucker for brown eyes) and her smile. From a distance I notice how she carries herself. Also, I have a thing for tall girls.

One favorite song?
Anything but Mine by Kenny Chesney

Favorite mall store:
Depends on what I’m shopping for. I'm fond of Pac Sun and Journey.

Longest job you’ve had:
My current job, as a CNA/unit clerk, which I've had for about 5 years.

Biggest lie you’ve ever heard:
In response to “How much have you had to drink?” “Just a litttleee bit."

Favorite place to eat with friends?
Ninfa's or Applebees.

Can you cook?
I can cook. I've heard quite well.

Best kiss:
From that certain person...

Last time you cried?:
Sometime this past week.

Most disliked foods:
Artichoke, brussel sprouts, and tomatoes.

Thing you like most about yourself:
I'm a veritable plethora of knowledge, compassion, and determination. Pffffttt.

Thing you dislike most about yourself:
I’m an insomniac. And when I’m tired but can’t sleep, and it’s late my mind tends to run away on me.

Longest shift you’ve worked at a job?:
20 hours straight. NEVER EVER AGAIN, at least not in a hospital.

Can you sing?
Depends on who you ask. I don’t think I’m all that great but some of my biased friends say I am.

Last concert you attended?
Cruefest in Dallas around this time last year.

Last movie rented:
The Haunting

One thing you never leave the house without:
Cell phone(s).

Laptop or Desktop?
I prefer my laptop to my desktop.

Favorite comedian? Carlos Mencia. I LOVE Carlos Mencia.

Do long distance relationships work?:
I'd have to say they can. Forever? I don't think so. But for say...a year or so until both people can be in the same place, yes, it's possible.

How many times have you been pulled over by the police??
Five or six times

How do you like your eggs?
Over medium with wheat or sourdough toast.

Number of pillows?:
Three

Can you play pool?:
I think I can. People say I can. I can't honestly answer because I don't think I've ever played completely sober, but I know I've won quite a bit of money playing a time or two.

Favorite season?
Fall

Best thing about winter?
Cooler temperatures.

Name of your first pet?:
Red, a doberman.

Birthday?
March 8th

What do you want to be?
I’m not sure I know anymore.

Smiling right now?:
Sorta. I'm listening to a male coworker educate a female nurse about why she shouldn't get married...for the fifth time in like the last 6 years.

Do you miss somebody right now?
Very, very much so.

If you could go anywhere in the world where would you go?
Definitely up north.

Are you in high school?:
Thank God no.

Do you have a harmless crush on anyone?
What's the chick's name from The Notebook? I was forced to watch it once.

Ever been on a cruise?:
Nope... would love to though!

What jewelry are you wearing?
Just my watch.

What are you going to do after this questionnaire??
Probably go take a break from work (LOL) or go find something to do.

Whew. I went there. A meme. Now you know a little bit more about me. I realize it's not the most interesting thing ever, and that most of you are here to read about RT school and other med-related stuff, but gimme a break. I'm exercising my poetic license, and trying to shift the focus of my blog off such serious topics 24/7.

If you're still out there and reading my blog, shoot me a comment and let me know.

Take a Break with This

noreply@blogger.com (Trauma Junkie) — Sat, 04 Jul 2009 11:00:00 +0000

In lieu of actual content about ventilators and whatever else I'm learning about right now, I present to you the winner of the CSRT's video contest.

Gave him some oxygen, put the breathing tube right in...

I know the video is a bit weird, but what do you expect? They are, after all, Canadians. Like they dont' say the the same thing about us Americans! (Much love to RT Scribe, The Frozen RT, and the rest of you helping people breathe up in the Great White North).

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.