Surviving RT School

My Resume/CV

noreply@blogger.com (Jared) — Thu, 09 Jun 2011 22:09:00 +0000

So I'm a writer, and as a technical writer by practice, I'm writing resumes for a nominal fee. Below is a link to mine. Feel free to comment and send me a message if you'd like a resume written.

Resume/CV

Visit my OTHER blog...

noreply@blogger.com (Jared) — Tue, 17 May 2011 17:36:00 +0000

http://threesixtyfivein2010.blogspot.com/

PTSD, you're a bitch. Thanks.

noreply@blogger.com (Jared) — Mon, 09 May 2011 04:33:00 +0000

Who would have known? PTSD exists. I'm a man, and I don't like admitting I suffer from it.

Remember the post about the the 4 y/o? CPR? Yeah, it still fucks with me. Some days I can't deal.

Every time I see a kid.

Every time I hear an ambo or firetruck going code 3.

Every time I sleep.

Sometimes when I'm awake.

Sometimes when I'm short of breath.

Sometimes (all the time) when I see an AED.

It wakes me up. I'll find myself doing CPR on my matress. Cold, clammy, sweaty. Dyspneic.

Help me. I'm six feet from the fucking edge and I'm falling.

Your Best Weapon

noreply@blogger.com (Jared) — Sat, 24 Jul 2010 04:50:00 +0000

Here's a riddle:

-A little bit goes a long way
-It's not a Basic skill, or a Paramedic skill
-Anyone is capable of it, even with no advanced training or education.

What is it?

Compassion.

Compassion is your best weapon to treat your patients, and is often your last resort. But it should always be your first.

Compassion is greater than any drug or therapy. It has the power to mend hearts and give hope. And the best thing about it? Compassion inspires compassion. It's a vicious circle, and a vicious cycle. Do you set the example?

I don't know how many of you have ever heard the old adage, "A little oxygen, a warm blanket and a few kind words can go a long way." This couldn't be any more true.

I can't count the number of lives I've saved using invasive procedures or complex therapies. I have no tally for the number of patients I've seen die, or the number that have lived. But I can count the number of times my company has helped better a patient (or family member's) day, because I use it with every patient.

Compassion is funny. Sometimes you see the results, and sometimes you don't. Like all therapies, not all patients are accepting of it. Sometimes, compassion doesn't work. But more often than not, it does.

And the good thing about compassion is that you can pay it forward. Doing a simple favor such as refilling your patient's water pitcher or holding their hand, can come back to you ten-fold in the future. You do a good deed, and you get one in return.

Every day, new therapies and new medications are developed. Advances in treatment are made. But the one thing that has been around since the beginning is sure to work in your favor. Remember that.

Technology is great, but in the mix of numbers and values, we often forget that we are treating a person. A human being like you and I. Treat the patient, not the numbers.

I promise you that if you try it today, you will be a better provider. So what are you waiting for?

EMS Today, Part II: All about the memories

noreply@blogger.com (Jared) — Tue, 16 Mar 2010 21:16:00 +0000

(To read the first part of this post, click here.)

As I sit down to write part two of my experiences at EMS Today, I realize that I have a lot to say, but it is difficult to put my emotions and feelings to words. As I have been a blogger for almost two years now, that's not something I'm used to dealing with.

I tried for a while to figure out why I was having this dilemna...why I couldn't share the sheer epicness with my readers. Then it hit me.

For the past few years, I've made friends with some of the coolest people I know. Friendships, networking, and connections were all made via blogging, Twitter, or other forms of social media. Any time I found myself struggling with school, I reached out to this amazing community of people. People...that I've never met. Until I was in Baltimore.

(L to R: Justin Schorr, Myself, Meris, Ted Setla, Mark Glencourse, and Chris Eldridge)

People my own age, who are just as passionate about EMS as I am:

(Nate Malecki)

(Meris)

And being able to sit face-to-face with those who inspire us:

(Meris, Justin, and Mark)

These were people from all different age groups, different walks of life, different beliefs, and different outlooks. As friends have, we've probably all had outs with each other from time to time. But, we share one thing in common:

(L to R: Kelly Grayson, Mike Ward [@Fossilmedic], Mark Glencourse, Stephanie, Epijunky)

From states, and even entire countries apart, we share a love for EMS. A tie that binds us, if you will.

So, looking back on EMS Today 2010, what was the best part of entire gathering? There is no one thing that made it so great. It wasn't simply seeing all the latest products relevant to the field at the exhibit hall, it wasn't just what I learned as a new EMT student and very much a rookie in EMS, nor was it solely being able to put a name and face to someone's Twitter handle.

It was all about the memories. Being able to look back almost two weeks later and say,

(On EMS Garage LIVE with Chris Kaiser, Jamie Davis, and Chris Montera)

"Holy crap, I was a part of THAT?"

Realistically, I should be able to look back and say I made a lot of new friends and colleagues. But the fact of the matter is, we already knew each other. And in meeting most of these people for the first time, albeit an amazing experience, I feel as though I had known them all already.

Therefore, I can't say I made new friends. But the memories? Those will last a lifetime.

EMS Today, Part I

noreply@blogger.com (Jared) — Fri, 12 Mar 2010 18:13:00 +0000

I started blogging in July of 2008 and joined Twitter in November of that same year.

In retrospect, it really wasn't that long ago, but looking at where I've come and the things I've done since I wrote that first post, appropriately titled "The Beginning...of a Never-Ending Journey?", I am both extremely humbled and amazed to see where life has taken me.

As many of you know, I'm still in RT School, but partly due to several inspiring, supportive, and wonderful people I met through online connections (@Epi_Junky, @MsParamedic, @Medic61, @ScottTheMedic, @theHappyMedic, @UKmedic999, and @setla), I began classes for my EMT-B certification this past January.

So far, it's been a ride (no pun intended), but that's another post for another time.

My rambling has a point, I promise. Due to nothing but social media connections, friendships across the United States and even the world, this past weekend, March 5th-7th, I had the absolute pleasure of attending the EMS Today Conference and Exhibition in Baltimore, MD. I meant to write about this time sooner, but to be honest, my mind is still a bit blown by the entire excursion.

If you can grasp your head around the idea of meeting several people that you've known, looked up to, and sought advice from for a long time, but never met, well...that's the whole idea.

**********

After a 3 hour flight, I arrived to Baltimore-Washington International Airport on Friday, picked up by Epijunky and Stephanie. Shortly after, we met Tony Olivero who is actually from the area and was able to get us to The Nest, where we all met for an early dinner with Nate Malecki (@NateEMT_B). Sitting downstairs, at a table that was entirely to packed for us to cram ourselves around, we saw the infamous Kelly Grayson, published author and blogger of A Day in the Life of an Ambulance Driver, and several others (TOTWTYTR and Old NFO to name a few.) At this point I was already so overwhelmed by the entire experience that I don't think I even met any of that crew at the restaurant.

Friday night, the real experience began. Many of you RT types may not know about Chronicles of EMS, but it is a project (if you will) that I have been following very closely since the end of 2009, and quite simply, a reality series by and about paramedics and EMS professionals. I'd consider it the forefront of EMS 2.0, best described as, "...the product of every EMT and paramedic who has ever looked at what [we] do and thought of how we could do it better." That evening, we arrived at the Chronicles tweetup, where I had the joy of meeting several highly influential EMS bloggers/tweeps, and the Chronicles "crew":

Chris Kaiser, @Ckemtp, author of Life Under the Lights, who is very cool, easy to talk to, and a bit crazy. He later learned not to leave his smartphone unattended as he hit the loo. I know, I'm hilarrrrioussss.
Chris Montera, @geekymedic, and host of the EMS Garage Podcast. He really is THAT short (sorry, Chris). But on a serious note, it was a pleasure to meet this guy. I love EMS Garage and listen weekly. If you haven't, I recommend you check it out.
Tom Bouthillet, @EMS12Lead and @tbouthillet on Twitter, author of one of my favorite blogs of all time, Prehospital 12-Lead ECG. Seeing as I'm an absolute and total cardiac geek, you can only imagine how unreal it was to meet this guy.
Rhett Freitz, @firecritic, co-host of the Firefighter Netcast, author of The Fire Critic blog. This man right here is about the most chill person I know, and very intelligent regarding Firefighting and several other subjects.
Rhett's partner in crime, John Mitchell (@firedaily), author of the blog with the same name as his twitter handle, and second host of the FFNetcast.
Jamie Davis, AKA the Podmedic, absolutely awesome podcaster and host of the MedicCast, which reached its 500th episode near the beginning of this year. Jamie has always been a huge inspiration for me as a student, and he was excellent about spreading word of GenMed, my own attempt at EMS 2.0, co-hosted with Scott (@scottthemedic, Meris (@medic61), and Natalie (@MsParamedic).
Ted Setla, @setla, founder of Chronicles of EMS. Ted is the man with the plan, an awesome paramedic, director, and inspirational filmmaker. Words can't describe how cool it was to finally put a face to the name.
Justin Schorr, @theHappyMedic, author of The Happy Medic, and co-star of Chronicles of EMS who is ruggedly handsome, in case you haven't heard.
Mark Glencourse, @UKmedic999, author of 999 Medic, and the other (equally important) star of Chronicles. Of all the people I met, I was honestly looking forward to meeting Mark the most. The fact that this gentleman was able to travel to Baltimore from the United Kingdom is mind-blowing.
Carissa O'Brien, @carissao, social media MAVEN (to say the least), author of Baseline Vitals, who is much cooler than Chris Kaiser and I figured she would be in person (no worries, much love to Carissa, it's just a little joke we had).
Chris Eldridge, @thedridge, an epic cameraman who works closely with Setla and the Chronicles team. (Thanks again for letting Meris and I use your Zune to record the interview!)
Mike Ward,@fossilmedic, who is a veteran in EMS and had tons of amazing stories and advice to share.
Jake, @medicthoughts, a person whom I recently began following on Twitter who has plenty of worthy stuff to say. Jake was very amiable and easy to talk to.
Kevin, @NJDiveMedic, who has an awesome job in the EMS field. Kevin was totally relaxed and probably just as overwhelmed by the entire event as I was, but it was a blast to meet this guy and I made a good friend. We actually realized we have a lot in common because a lot of what I learn in RT school, he had to learn to be a dive medic.

I met many, many other people that night that I have known solely through Twitter or the blogosphere, and I apologize tremendously if I left your name off the list, but my mind is still in a bit of a fog at the moment. Rest assured that if I didn't list you above, it's not because I don't remember meeting you, but simply because I met so many new people that I am certain I'm forgetting a small handful. (I urge you to leave me a comment or shoot me an e-mail at jared [at] genmedshow [dot] com with your name and info if I've left you out and I'll come back and edit later.)

As I said, the Chronicles tweetup was an epic experience for a young blogger and EMT student like myself. Never in a million years would I have considered that I'd be able to socialize in a face-to-face setting with such a large number of people from different parts of the country, and even the world. I'm utterly humbled at this experience and looking forward to doing this again in the future!

On Saturday morning, I woke up and hit the Exhibit Hall at EMS Today, and saw many of the people mentioned above, in addition to meeting Bill Schumm (@firegeezer), co-author of FireGeezer with Mike Ward (see above). It was a pleasure to meet Bill, as part of me has always been drawn to firefighting, and I consider this guy a highly popular person in the field.

After making my way around the exhibition floor, scoring tons of free gear, and learning about many arising technologies in both the firefighting and EMS fields, I made my way back to the stage where the live podcasts are recorded from the event. I ran into Jamie Davis, Chris Montera, and Chris Kaiser, just before EMS Garage was recording their final live 'cast from EMS Today. Much to my surprise, Chris Montera put me on the panel of the show with himself, Kasier, and Jamie. And let me tell you, the experience was UNREAL.

Instead of continuing this post any further, I've decided it will be best to break my time spent at EMS Today into a series of posts. Tomorrow, head back to read about mine and Meris's interview with Mark, Justin, and Ted about Chronicles of EMS, pictures, and more detailed description of the meetings posted above!

Respiratory and Ventilation Books for EMS Professionals (or other non-RTs in healthcare)

noreply@blogger.com (Jared) — Thu, 18 Feb 2010 17:51:00 +0000

As an EMT student, I have come to realize that we are taught very simple life-saving techniques: ABC’s. Airway, breathing, and circulation.Two of these (airway and breathing) fall directly within the same body system– the respiratory system– and as my time in Respiratory Therapy schooling has shown, EMS providers are not taught nearly enough to fully understand the respiratory system and its more complex disease processes and concepts that medics and EMTs run calls on all the time.

Because of this, I would like to use my knowledge as an RT student and share with my fellow EMS providers some excellent respiratory reading material.

Respiratory Disease: a case study approach to patient care

An important part of an EMT or Paramedic’s assessment is obtaining the . For some patients, respiratory diseases are often a part of their past medical history. Wilkins’ Respiratory Disease gives an in-depth explanation of a number of respiratory diseases that are only briefly covered in EMS education programs, such as Chronic Bronchitis, Emphysema, Interstitial Lung Disease, Cystic Fibrosis, Asthma, and Bronchiectasis.

Check out the rest of this post over at Everyday EMS Tips. Special thanks for Greg Friese for allowing me to post this on his site.

Stand for the Change You'd Like to See

noreply@blogger.com (Jared) — Tue, 19 Jan 2010 20:45:00 +0000

As we steadily move into the new year and a new decade, we've already seen many changes in the face of medicine. But the changes that are to come, the ones we as providers control, are the changes that will be most defining for our profession.

Keep in mind that I'm both an EMT student and a respiratory student, so this post may be geared toward one profession or the other at times, but in a nutshell-- it's all health care, and here is my small contribution.

What can we do to bring about change? There are several things:

Be a diagnostician, not a technician

In RT school, one of my favorite instructors of all time often told us that we should think like therapists, not technicians. In EMT school, I have learned that BLS skills are crucial, but aside from Basic assessment, decision-making skills are key.

We like to follow a simple model for patient care in both professions: Assessment -> Decision Making/Critical thinking -> Intervention -> Follow-up. Often times, this is overlooked in practice. So many providers are used to doing a very focused assessment based on the complaints the patient presents and immediately moving to the protocol/standing orders or phoning the physician for advice with their initial (and very simple) findings. Following this, a decision is often made for treatment hastily and without regard to other possible causes.

It is important for both RTs and EMS providers to remember that while we aren't physicians, we are taught this process for a reason. Many of us would like more autonomy and a larger part in the overall care of our patients, but in order to do so, we must act and think critically, not as if we are working out of a cookbook or basing everything we do off of an algorithm.

I can't speak on behalf of EMTs yet, but I know in recent years that respiratory therapists have made a move toward being a more crucial part of the team. Professional organizations (the AARC, NBRC, etc.) are working for us as professionals, but it is our duty to show everyone what we are truly capable of doing.

Don't settle for being a neb jockey or a button pusher. If something doesn't seem right, question it in a professional manner. Be prepared to offer an alternative method or treatment to the physician, but also be prepared to defend your case with proven research, which brings me to my next point.

Never stop learning

As either an EMT, Paramedic, or Respiratory Therapist, we have an obligation to our patients to never stop learning. Every day, new modalities, new drugs, and new equipment are in the making. You may have went through the toughest program in the United States, graduated with flying colors, and passed your boards the first time around, but it doesn't stop there. Trust me.

I'm not talking about just meeting the required number of CEU's that you need to renew your license or certification. I'm talking about taking an active role in educating yourself for the benefit of your patients, as well as being able to share this knowledge with your co-workers.

As well all know, the internet is an amazing thing. Use it as a tool to learn about current trends

so that you can be the best provider you can be. Stay-up-to date on your knowledge and skills. This will take you a long way, and eventually, you will be able to make great strides in your field.

But also, remember to stay humble. Some of the best advice can't be found in a research article, a textbook, or a policy manual. This is why we must...

Never stop listening

You are never too good at what you do, nor will you ever have seen and done so much, that taking a moment to listen to another, more experienced (or even less experienced) co-worker's stories or advice will ever be beyond you. It is safe to say that we have all experienced moments in our careers that we haven't known how to react to a situation. Emotional situations often come to mind.

Again, absorb it all. Listen to your partner's story about a rough call he had, and listen from an outside perspective. Often times, the best providers have an even better colleague that they look up to.

Social media is wonderful. Twitter, podcasts and blogging can easily revolutionize medicine as we know it. Read and listen to all that you can. (That's another post for another time, I promise.)

And last but not least?

Be the change you want to see

Everyone has their own ideas for how we can reform the health professions. We're all individuals, and while we see eye-t0-eye on the issues that require change, we may envision going about these changes different-- and that is completely fine.

Your job is to be the change that you want to see. Go about this change how you want to go about it. Bounce your ideas off of your fellow health care workers, your supervisors, and others in the medical community. One person can make a difference, but all in all, many people are required to enact a change.

Support your own efforts and the efforts of others. In 2010, and in years to come, we can improve health care.

Are you in?

How 2009 Changed Me

noreply@blogger.com (Jared) — Sun, 03 Jan 2010 20:22:00 +0000

...alternatively titled "How I Became a Better Caregiver and a Better Person in '09."

Dear 2009,

You have changed me. It's true. You were a hard and sometimes trying year, but I have no regrets and I'm glad you were a part of my life.

For all of my readers, here's a quick recap of my year, as far as school goes:

Spring 2009
-Respiratory Care Fundamentals II
-Cardiopulmonary Disease Processes: A Case Study Approach
-Respiratory Care Fundamentals II Lab
-Clinical I: Respiratory Therapy Tech
As this was my first semester of clinicals, I learned two important lessons: Regarding patient care, you should always trust yourself, and always ask questions. Becoming a good caregiver is a combination of both of these. If you are ever unsure of yourself, or your knowledge on a certain topic, don't be afraid to ask. No one will look down on you for asking.

Summer 2009
-Respiratory Care Procedures II
-Clinical II: Respiratory Therapy Tech
-Respiratory Care Procedures II Lab
Summer was a trying semester. None of us wanted to be there in the first place (What?! No break AT ALL???) and we covered a lot of ground. We learned some non-invasive procedures (CPAP, BiPAP), but it was also in this semester that everything really tied together and we learned some of the more complex things.

It wasn't long after being signed off on intubation in school that I lost my virginity, and since then I've successfully dropped almost 25 ETT's, only missing once (I went back in a 2nd time and got it.) I grew a lot this semester, as a lot of pressure was placed upon the students. (Read more on what I'm talking about here.)

Fall 2009
-Mechanical Ventilation
-Pulmonary Diagnostics
-Advanced Respiratory Patient Assessment
-Mechanical Ventilation Lab
-Clinical III: Respiratory Therapy Tech
Fall semester of 2009, you kicked my butt. However, it was also in this semester that I learned to find support in the people who care about you the most-- one of the more valuable lessons learned during my course of schooling thus far.

I witnessed my first pediatric code, and I learned that it's okay to be emotional. I also learned that you have to be able to find a balance between the stresses of your job and "real life." As much as it is okay to be raw and let your emotions show, you can't let the things you see burden you.

But the most important lesson learned in Fall of 2009? Working in this field isn't about being a hero, or about saving lives...not all the time. More-so, it is about being there for your patient and their family. Sometimes you don't bring them back, and sometimes you don't even have the chance. At many times in such a career, you are going to be faced with doing things that are extremely difficult for you...but you have to remember that you're in it for the patient.

As many of you know, though, school isn't my life, and my life isn't school. Outside of school, I have a job as a CNA/telemetry tech/Unit Clerk at the local hospital. I learned a lot on the job this year:

I realized when I first became a trauma junkie, and why I love what I do. If you don't love what you're doing, you should be doing something else...and I spent a great part of 2009 trying to figure out why healthcare is the right job for me.

I witnessed my first save, and learned that cardiac arrests don't always end badly. It was also in this same day that I discovered how important it is to truly connect with your patient's family. Medicine is fascinating, and the advances are great, but if you don't have bedside manner, you won't get far...and bedside manner doesn't stop at the bedside.

Outside of work and school, other important things were learned along the way:

-I learned to keep your friends close. Good friends are hard to come by, and when you find them, you should cherish the friendship completely. Never take what you have for granted.

-I learned to find comfort in silence. When everything is so busy and you feel so incredibly weighted down from the events in your life, I learned how to turn it off. I learned how to relax and make time for myself. Sometimes, clearing your mind is just as important as checking off everything on your to-do list for the day...and both should be something you do daily.

-I learned to be my own person. Seems simple enough, but it was a difficult lesson to learn. You don't have to be perfect, nor do you have to embrace everything that everyone thinks you should do. You don't always need the support of others, especially if you know in heart that what you are doing is what is best for you.

So, here's to 2010. A belated Happy New Year to all of my readers!

I intended to write this post with resolutions on what I plan to change in the New Year, but I don't make any promises at this point. 2009 has taught me a lot, and I guess my main goal for the New Year is to relax and expand on the lessons learned in 2009...to continue to grow, and become better at all aspects of my life, one step at a time.

I'm certain 2010 is full of many exciting changes and new chapters in my life, but I don't know what those are just yet, and that's okay.

One breath at a time, right?

The Ballad of Edward and Marie: Part II

noreply@blogger.com (Jared) — Mon, 21 Dec 2009 20:11:00 +0000

(In case you missed it, read part I here)

As time slowly passed...seconds into minutes, minutes in hours, and hours into days, we'd all love to be able to say that Edward finally came to grips with the passing of his beloved Marie. We'd love to be able to say the healing process began, but the truth was, it never really did.

There have only been a few times in my career that I've given my personal cell phone number to a patient's family-- this was one of those times. Each day I'd hear from either Edward or his family. First, it was Edward more. He'd call me to tell me how much he missed her. He called about funeral date and times. We talked about the Cowboys and photography and other random things to try to clear his mind. Sometimes it worked, sometimes it didn't.

Eventually, I received a call from Edward's family that I had hoped I would never get. Even in his near perfect health, now it was him who was in the hospital not even two months after she passed.

Little did any of us know (not even the family), Edward stopped taking care of himself the day Marie died. No longer was he working out each morning, eating healthy, and taking his medications. Some call this failure to thrive. That next day at work, Edward was transferred to my floor.

As I went in to take his vital signs at the beginning of my shift, I didn't recognize him. He was rail thin, and very weak sounding. I don't think he recognized me either.

"Hello, Edward...how are you feeling today?" I asked, being polite, although the sight before me said enough.

"Not good, sir. I just don't have anything left in me. I hurt all over, and I can't eat."

The doctors had spoke with Edward and his family about inserting a PEG tube or starting IV fluids to renourish him. Edward didn't want any of that. Unlike Marie, he wasn't a candidate for Hospice because technically, he didn't have a terminal illness. So we were treating him for "comfort measures" only.

Edward was only with us for a few more weeks. He never signed DNR paperwork, so the day we coded Edward was tough for all of us. Although each and every one of us in that room were professionals and didn't have any true attachment to him, it was one of the harder times I've had to work a code.

Imagine coding your grandfather. Or your best friend. Or even someone you know as a bit of an acquaintance. Imagine knowing the person behind the pale face. That's the only way I can describe it.

At 3:59pm, we lost a good man. A man of his country, of God, and someone with a gentle and caring nature. But most of all, we lost a man who loved a woman for sixty years.

More often than not, we are witnesses to tragedy. We aren't always healers, heroes, or even life-savers. A lot of what we do can't be measured in moments of happiness.

I can only hope that Edward joined his Marie in Heaven that day. It may not have been his plan, but someone had that in store for him. The doctor's never diagnosed Edward. There was no medical reason for his death, aside from Cardiac Arrest. He had no health problems, no heart conditions, and was fit and healthy, until his wife passed away.

I'm no doctor, but I'd say he died of a broken heart. It's entirely possible.

The Ballad of Edward and Marie: Part I

noreply@blogger.com (Jared) — Sat, 19 Dec 2009 21:13:00 +0000

"Marie, would pass me that stupid remote already? I promise I won't accidentally call the nurse this time, but my Cowboys are playing on TV."

"In a MINUTE, Edward. You know 'Days of Our Lives' reruns on Sunday."

"Hmph...Days of Our Lives. If that was anything like real life...," Edward said mockingly, stopping mid-sentence as he noticed I was in the room.

As I stood there in the room trying to take Marie's vital signs, I listened to their spat. They were both pushing 90, so it was almost adorable in a sense to hear them bicker like cats and dogs, because in some strange way you could hear the love behind their words. Sure, they fought, but it was never ugly. They were the couple you looked at and knew they were soulmates.

Edward and Marie were high school sweethearts. Shortly after graduating, like most men of his age during the time, Edward was drafted into the service. He spent two years in Germany and loved it, but it was the hardest part of Marie's life, as she'd tell any complete stranger who was willing to listen.

Edward returned home in the fall of 1950, somewhat a changed man. But his new outlook on life and his increased maturity never changed his feelings for "his Marie." They married a month later.

"Mrs. Connolly, I need to check your blood pressure and your temperature," I said, speaking up softly during a pause in their little conversation.

"Oh please dear, I'm Marie to you guys." Her voice was so pleasant, so calm, for someone in her situation. Years of smoking had finally taken its toll on Marie. She was in with stage IV lung cancer that had, unfortunately, metastasized to her brain. A sad, but very real, reality of working in healthcare is that you see truly good people pass away, and it can often be the demise of their own lifestyle choices.

She knew this as well as we all did. She preached to every single one of us about not smoking, and even convinced her grandson to quit. Prior to being diagnosed with the big C, Mrs. Connolly was the healthiest person I've ever known. I was convinced in a lot of ways that she was in better health that I am, and she had a good seventy years on me. Edward was the same way.

Reality never quite hit Edward as it had Marie and the rest of the family. Even the words "terminal cancer," coupled with the fact that his beloved was placed on Hospice for palliative care, never quite seemed to phase him. You see, to Edward, Marie was a Superwoman of sorts. He'd jokingly say things like, "Hell, she raised five kids and worked two jobs just because she enjoyed being busy. This is nothing she can't overcome." Until one night in particular...

Slowly but surely, Marie's health did in fact steadily decline. Day by day, her labs were looking worse and she was becoming paler, frailer, and less vibrant. On a bleak and dreary night, mid-October, Marie took a turn for the worst.

Likely the result of the fact that she wasn't eating, wasn't drinking fluids, and refusing her medications (I can't blame her...they made her sicker than a dog), Marie called us into the room. She looked intently at Edward, then at the nurses, CNAs, and myself.

"My babies, I think it is time soon. I don't have the fight left in me."

Oddly enough, by the next morning, Marie was nonverbal and unresponsive to any sort of stimuli. She was still breathing, but every single breath she took, we were convinced it would be her last. She was struggling, and blatantly miserable. Edward didn't know what to do. He was her rock, her guidance, and her hope...now all he could talk about was how he was losing it too.

I pulled Edward aside for a brief moment. It was one of the hardest moments I've ever had in the short time I spent as a CNA with hospice. I placed my hand on his shoulder, exhaling deeply, trying to put my words together. Without much thought, I spoke to him from my heart.

"Mr. Connolly, erm...Edward? You are doing all that you can, and so are we. I don't want you to let go, but she wants to hear something from you. At her core, she wants to know that you will be okay."

I thought about how ridiculous I was sounding. I stopped for a second to recollect my thoughts. I knew it in my mind to be the truth, but I didn't want to seem like a know-it-all or a mind-reader, because this just wasn't the case. I was all of 21 years young, but I've been on this side of the dying process for years, and have seen it more times than I can count.

Much to my surprise, Edward nodded, his voice trembling as he spoke: "I know, son. I really do. But she's my Marie..."

There were no words that could make this any better for him. Instead, I nodded in understanding and let him know with my eyes that I was there for the both of them. As Edward walked back into the room, he gently motioned for us to leave. As I walked slowly out the door, I saw him reach for her hand.

None of us know what Edward said to his wife on that day, nor will we ever. When the nurse and I re-entered the room about an hour later to round on Mrs. Connolly, we found her with no pulse, no longer struggling to breathe. Edward said it just happened seconds ago. He wasn't struggling to fight back tears, nor was he trying to be tough. He was being real.

And this is one of the more difficult parts of a career in medicine. Good people die, and you carry them with you. You touch their lives just as they have touched yours. There's a "Marie" inside each of us that work in this field.

Edward returned home to an empty house for the first time in almost sixty years. His family told us he was oddly calm, or that maybe it just hadn't hit him yet. But we knew he'd be okay. Or so we hoped...

Announcing GenMed

noreply@blogger.com (Jared) — Thu, 10 Dec 2009 03:06:00 +0000

When I first began blogging and Twitter back in June of 2008, I set out with a simple mission: To express my opinions and share my knowledge and experience with other students, health care professionals, and members of the general public. I wanted to offer an "inside view" at what I deal with on a daily basis. Simple enough, right?

Well, shortly after I joined Twitter, I found out my true mission. My passion, if you will. As time progressed and I met and spoke to some amazing people with a similar goal in mind, I realized that not only did I want to touch other people through my writings, but that I wanted to make an impact on the entire health care field. (Dream big, right?)

Working in health care has opened many doors for me and taught me many things. It helped me to put my own life into perspective, while doing what I love the most-- helping other people.

All of this in mind, what happens when a group of four young people with similar goals and interests in mind, get together and brainstorm?

We call it GenMed (short for GenerationMedicine). What started as somewhat of a joke by the infamous MsParamedic (@MsParamedic on Twitter) on a Skype call was followed by a long pause and then a, "Hey, we can do this! Yes?" One thing led to another, and for the past few weeks the four of us have been planning our contribution to health 2.0, if you will.

So, what is GenMed? GenMed is podcast geared toward young health care professionals and students. We call it Generation Medicine because we are the "young blood" in the field and we're hoping to improve and revamp the entire system, while helping people in our age group at the same time. Basically, we'll be tackling hot issues and conflicts with our own viewpoints, and using the current research.

GenMed has four hosts. Scott (@scottthemedic) is an emergency responder and paramedicine student in Canada. Meris (@medic61) is an EMT/FF and nursing student from Virginia. Natalie (@MsParamedic) is a critical care paramedic, preceptor, and pre-med student from Louisiana. And last but not least, yours truly, the CNA and RT student from Texas.

So, what can you do to help? Be sure to follow the show on Twitter (@genmedshow); this is probably the easiest way to find updates about progress of upcoming shows, etc. Once the website/blog for the show are up and running, I'll be sure to drop a link here. The main thing here is FEEDBACK. Did I say feedback? Yeah, feedback. We want to hear from you, about anything from opinions, questions, upcoming guest spots on the show...whatever is on your mind. (Contact us at genmedshow@gmail.com.) Also, as most of you know, social media is an excellent means of spreading word on what is new on the horizon. So, help us out with retweets, mentions, and tell your friend, your cousin, and your uncle Bob.

Due to schedule conflicts, we're not yet certain the date of the first podcast, but we figure it will be up sometime within the next month, so keep your eyes and ears open!

On a side note, for those of you who would like to know a little more about the show, I will be appearing tomorrow night, 12/10/09, as guest on the Doctor Anonymous Show on BlogTalkRadio at 8pm CST/9 PST. Come over and join us, will you?

Thanks for the support! You guys are awesome! Feel free to contact us at the email address above, on any of our twitter account, or as a comment on our blogs.

Lately...

noreply@blogger.com (Jared) — Sat, 21 Nov 2009 18:00:00 +0000

I apologize for the lack of posts lately.

Life has been kinda hectic for me. A lot of it I can't go into for one reason or another, but just know that I've been stressed to the max most days.

Yep, that's right. To quote my best friend, "I'm fried." Crispy, even. It's a feeling I never really understood until I experienced it myself.

School is kicking my butt. As we're nearing the end of the semester, it's a little less challenging, but finals are coming up soon, and I fully intend on rocking them. It's just going to take a little work.

So what's been going on this semester? Well, as I posted a while back, it's the start of my second year of RT school. It's been pretty busy. We're building on concepts we learned first year, and learning a lot of interesting things.

Here are the classes that have been occupying my time:

1. Pulmonary Diagnostics
More than you could ever want to know about sleep studies, capnography, flow-volume loops, pulmonary function studies, bronchoscopies, lung/chest imaging techniques, and the like. Interesting stuff, folks. I'm slowly finding out that next to good assessment skils, diagnostic skills are key.

2. Advanced Respiratory Care Patient Assessment
By far, my favorite class. I may or may not have talked before about how much I enjoy using my assessment skills to troubleshoot and treat my patients. Without these skills, there wouldn't really be a need for respiratory therapists. It's this particular class that helps me realize that we truly are specialists in the health care field and that we have a lot of good knowledge we should put to use. EKG interpretation, analysis of serum and urine chemistry, auscultation of heart sounds, and so on and so forth. Fun times.

3. Mechanical Ventilation
VC/AC, PC/AC, SIMV, PRVC, bilevel, APRV, VC+...say whaaaa? That's right. Homeboy knows his way around a vent now. This was, without a doubt, the most difficult class I have ever taken in my entire college experience. And believe me, coming from the guy who didn't know what he wanted to do with his life and has all the pre-requisites finished for four different degrees, that speaks volumes (Volumes? Yeah, I guess I still have ventilators on my brain). I remember when we first started working with vented patients and I was so intimidated, but now I have the confidence I need to be able to perform my job well.

As far as reading material goes?

Waugh, et al. Rapid Interpretation of Ventilator Waveforms, 2^nd Ed.

Ruppel, Manual of Pulmonary Function Testing, 9^th Ed.

Cairo and Pillbeam, Mosby's Respiratory Care Equipment, 7^th Ed.

Wilkins, et al. Egan's Fundamentals of Respiratory Care, 9^th Ed.

Chang, Clinical Applications of Mechanical Ventilation, 3^rd Ed.

So, there you have it. Add a precious three-year-old into the mix and such has been my life for the past 4-5 months.

I promise I'm working on a few posts that I have saved in my drafts folder. Bare with me as I get through this (I *can* get through this, right?), and I promise great things will be coming soon.

How's your life been lately?

One Last Breath.

noreply@blogger.com (Jared) — 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 (Jared) — 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 (Jared) — 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 (Jared) — 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 (Jared) — 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 (Jared) — 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 (Jared) — 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 (Jared) — 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 (Jared) — 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 (Jared) — 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 (Jared) — 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 (Jared) — 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.