Respiratory Therapist Student Blog

( look at the HBO in the back LOL, hyperbaric chamber

A picture that everyone probably found though “respiratory therapist” in google images

I am kind of short of time due to upcoming exams and the only time for me to blog is when I “think” i have time. I read your blogs once in a while. Yes. I read the ones that comment me. I just want to say thank you again for reading and its makes me think that I am NOT wasting my time trying to provide support and information to future or current respiratory therapist, and of course Students. Let me shine some light on http://rtstudentblog.blogspot.com/ . We ARE NOT the same but we do have 2 things in common. Of course the name and we are both students. I really don’t mind having the same name as someone else because the world is full of people of the same name. Go check out his blog and its pretty interesting. Another blog is http://willifordblog.com/ . Same story. Same as a student respiratory therapist.  Another good blogger is http://respiratorytherapycave.blogspot.com/ . This guy is pretty smart when it comes to respiratory therapy. I personally don’t know any of you guys but we are all going through the same thing. Either in school or in the hospitals.

I dedicate this post to bloggers in my blogroll and other people who lurk around looking for information about respiratory therapy.

Rapid Response to the fourth Floor.

Today was an interesting day in clinicals. It was so boring that me, being a student was able to treat all my patients within an hour. The rest of the day I had NOTHING to do. It was so slow that all the RTs just kicked back in the department. In the middle of the day I heard the page over head and people’s pagers ringing “Rapid Response”. WOW! my first Code Blue and I was running up the stairs…4 floors up with a RT. I walked in the room and first thing came to my mind “AMBUBAG!!” I needed a resuscitation bag. You know, the bag that EMTs use in the field for a patient who is not breathing. The RT was already ahead of me and threw me the bag. I opened it and guess what I see?

AMBU BAG WITH NO MASK!!!

I was pissed off and so was everyone else around the patient. I went to the next patients bed to jack one of the masks (i made sure i put another in after the code) The patient was at 2lpm and stopped breathing. Well not completely but the Sat was <70. Pulse was at 60. I didn’t put the mask on but I just did a “blow by” which was just giving oxygen from the ambubag and not sealing it in the patients face. Few mins later vitals were going up and the patient is coming up. I attached a non-rebreather and set it to 15lpm , yes you can also put it on flush. The RT got a ABG as requested by the physician. At first I remembered what my instructors said.

“When you are going to a Code, do not panic and do not try to rush because in the end you will make mistakes”.

Everyone was so calm. It was like they were having picnic under a hot summer day. I can understand that because once all hell breaks loose no one will concentrate. My first code and it was interesting.

To make my day even more interesting there was another patient who had another code. WOW 2 codes in one day and I have had NO CODES for 2 months of my clinical and today was the day. This code was kind of awkward.

We had 3 RTs including me rush into the door. There was like 5 nurses and a physician. Once we walked in, I was handed a bag and this time it had a mask. ALL the nurses walked out. (dont worry i respect “good” nurses as much as I respect “good” RTs. ) WOW…. The physician asked all the RTs what the patients Hx, and what happened and all the information. Well for your information we are “Respiratory Therapist” and dont know anything else about the patient except its pulmonary status. One RN walked back in with a bunch of medications or whatever it was. Make a long story short we did the same thing. Bag > non rebreather. WHEW.. both patients lived.

As a respiratory therapist first thing is first, AIRWAY!

Make sure you have an AMBUBAG with a MASK, non rebreather handy, pulse ox, and your BEST assessment skills.

Breathing is one thing, Having an asthma attack is another. So I met this lady that moved in a room across my house and she has asthma. I realized that I learned about asthma backwards and forwards and general medications for it. Of course the first thing I asked was, how often do you use your inhaler?. She said not that much only when I feel an attack is coming. Obviously her asthma isn’t as bad as others who often use their inhaler. Remember that albuterol or the prescribed bronchodilator, should not be used more than a few times a week or you are just “covering” the problem not solving it.

So here I go again with the questions vs. confidence. I knew so much and I explained so much to her about asthma that she did not know about.  I even surprised myself because I was able to answer every question with details.

Another day in being a student respiratory therapist and another day of teaching people who are having a hard time breathing how to treat their breathing

Today did not go as well as I thought it would. I had my chest assement check off and I thought I was ready. So I did my assement and 1/4 of the way I was not able to answer a few questions and was said to take it again. I was so discouraged from the whole thing that I felt like giving up. I was so mad at everything that I wanted to walk out. However walking out would make things worst so I stayed and tried to stay concentrated as much as possible. This is one of the things EVERY RT student goes through. They go through everything fine and once they are about half way or almost at the home run mark, they fail. I didn’t fail but I just needed more practice. However to me, it WAS FAILURE. I will not take that as an excuse.

I talked to the other students and they were the best motivation. They kept saying that they will keep quizzing me until I know it and until I pass the procedure. I also realized that on my Incentive Spirometery Check, it was the hardest thing I done as a student at THE time First semester, first check off and that was so hard. Now I realized, WOW I thought that was hard and this chest assessment is easier because there is less steps and all memorization. Well now that I think about it, I know everything but at the check off it didn’t come out of my mouth because I was too nervous. Well..time to get back and hit the books to gain more of that confidence.

“Show me a successful man, and I’ll show you a failure”

I did my clinicals today and I can say that at this point, I really enjoy it. Sure waking up at 6am really sucks but once I’m doing my rounds and finishing it 3 hours past and I think to myself.. where did the time go?  I am so into it now that I feel so confident about giving treatments. I did one treatment today and the patients daughter was in the room. I did a combination of Atrovent, Xopenex and Mucomyst. That treatment is 30mins+ !! Since I’m a student it doesn’t matter because I don’t have to go around chasing the time and doing multiple treatments at the same time (which you should not do).

So I was talking to the daughter and asked me many questions.

“What is that sulfer smell?”

“Well that is the smell of this drug we are using for your mother which breaks down / thins secretions.”

“is it normal for her to feel nausea?”

The feeling is a side effect of the drug. But at this point it doesn’t seem extreme and it is probably the smell of the “rotten egg”

“Is there other drugs in that container?”

Yes there is because we always need a bronodilator when we use the mucomyst. The bronchodilator which is the xopenex + atrovent prevents the lungs from having a narrow  airway.

There were so many more questions but I was able to answer each of them with a good explanation . I just have to thank my instructors for pounding this information in my head because if they havn’t done that, I would had been really stupid. The patient and daughter thanked me so much that it made my day. It feels good doing the treatments because knowning the fact that somebody is being helped and knowning the fact they are depending on you to help them makes you feel special. I’m sure everyone in the medical field feels this way. This career is so rewarding!!

Now for the EXPERIENCE that every RT will see. I had a patient with thick..i mean very thick secretions. I suction with the yanker (sp?) and OMG this was so thick it was stopping the suction. Next thing you know patient coughs and you see secretions flying across the bed up to his foot. The first time I experienced this I was so amazed and well kind of disgusted. I heard many stories but when you are in the position it is a different perspective. Thank god I was following everyones advice. Suction on the side of the bed so if the patient coughs you will not be hit with sputum.

Funny advice from an instructor  

What if a patient asks “how many times have you done this ABG?”

If this is your first time do you know what to say? Just say “I HAVN’T MESSED UP YET”

Well this next thing I WILL say is

Thank you guys for reading my blogs. I’m getting some traffic and viewers. I appreciate the COMMENTS and feedbacks.  I know it may not seem like it but I just can’t find the time to comment your guys’s blogs back. But I am always happy to see people posting comments. Everyone knows that if you are a RT student it is very hard to find time to do what you want to do. Once again THANK YOU FOR READING and I hope this inspires people or get a simple laugh from a blog I make. If any students or future students are reading this make sure you show others so they can figure out how much RT students go through… Signing out…..

-rtstudentblog admin, S.R.T. 

So I was with this one RT and i had to admit she was really cool and was very knowledgeable. I had 8 patients to do  and every RT would know that mornings are a drag. All your Q6s + Q4s are all in the same time. I did all the patients and treatments in about 3 hours. That is probably long but hey students lag so much. I didn’t mind doing all this work because I learned so much. I actually felt as if I was really working in the hospital. She was always next to be observing and helped a few times. But about 80% of the time I did all the work. I’m not complaining because this helped me realize one thing

Can I really do this for my career?

I simply answered myself with . YES.

The work is time consuming but time flyes by so fast. The 8 hour shift felt like only 2 hours. They said don’t let the RT give you all the work load but for the first time I accepted it to see if I can really do it. I loved it! But I know ill get sick and tired of it when I realize I’m working for free. LOL. I gave a Tx to this one patient. For the first time I gave a SVN for TOBI

What is tobramycin?

Tobramycin is an antibiotic. It fights bacteria in the body.

Tobramycin inhalation is inhaled into the lungs using a nebulizer. Tobramycin inhalation is used to treat lung infections in patients with cystic fibrosis.

Tobramycin may also be used for purposes other than those listed here.

http://www.drugs.com/mtm/tobi-inhalation.html

Anyways I was in the room for 30mins!!! I was like this takes soooo long just like Xopenex and Atrovent. Well I put the LPM to 7 and OMG it took so long. Well that was a day in clinical. There was also a Code but when I go their ( was in the middle of a SXN) I watched all the physicians for 30mins after I did my Tx because the Pt had a heart block. I didn’t know that people can still be conscious with a blood pressure of 30 ( i never learned about it ) . The physician injected him like 6+ times while I was there and they said they needed to put something but couldn’t find the artery. I didn’t get much detail because I didn’t want to ask a lot while they were rushing to get this patient back up. I had to leave with the RT because another RT told her to take her lunch and he can take over. She said the physician should have not tried putting the needle in that many times on that same area. Either call someone else or don’t attempt at all. Well whatever I dont deal with what doctors do because I have no idea what they do in codes.

I learned a valuable lesson today. No i did not get yelled at in clinicals and I hope I never do as a student because it might discourage me. So the RT I was with earlier told a story about a Physician yelling at him across the hall. He said that the doctor ordered the RT (him) to change the settings because the patient was really in bad shape. I don’t know much about Physican’s order and the ventilators since we have not gotten over it in class yet. But I can pretty much sum everything up. So the RT went in and changed the settings. A few mins later the Physician calls him and asks him why he changed it and the physician was yelling at him over the phone. Well the RT said “you told me to change it”. So the physician got quiet and said well your settings are all wrong. The physician changed it while the RT was next to him. The RT told me the physician went in and changed his settings but it was the same exact one as it was earlier.

Basically the RT got yelled at for following orders. While he was telling me this, other RTs in the room added their experiences.So I finally found out that every single RT in the dept got yelled at by that same physican. Even the Manager and Team Leaders. The Physician has anger issues. I don’t know what the RTs dept. has done with the physician since it might be an on going case.

The RTs told me good advice. They said if you get yelled at by the Physician either, Remain passive and tell him if he does not calm down the conversation will go no where. Or ignore everything and DON’T EVER take anything personally and walk away and talk to someone above you. Well they told me a whole bunch of advice and now I have something to watch out for. I guess in every basket of apples there is always a rotten one. The RTs said I will get yelled at, at least a few times in my career if not more but NEVER EVER take it personally and reason is because you were doing your job . As long as it is a benefit to the patient you are doing a good job

I understand why physicians would get mad and yell for endangering their patients lives, but if they get mad for stupid reasons it is no excuse to yell at someone.

I hope i DO NOT get yelled at as a student but after I am a graduate yell at me all you want because I should have sufficient knowledge of what I am doing and I have a better ground to stand in with confidence.

BTW CHECK OUT MY NEW PAGE I CREATED ON THE RIGHT SIDE!! 

So I was going through my clinicals today and I did the most dumbest mistake. A patient was having a hard time breathing and he was also about to be intubated. So while the physicians and nurses and everyone else talked in the room about what to do, they had me put him on a NRB so he can get more oxygen.He had a NC @ 3LPM w. humidity. His SpO2 was 92% and they wanted him on 100% because he was having SOB. He was also DNR status but I guess the family changed their mind.

I went on putting the NRB @ 10lpm + and I looked at the bag and it was inflate/deflate at the normal range. So I said ok. Few seconds later the RT I was following said “what is wrong here?”. I thought for a second..uhh..”nothing” HE said “look at the connection you made.

1) Gas Source : Oxygen

2) LPM : 10 (good)

3)All connections secured.

So he said “You never humidify with a NRB “ .AHHHHH i didn’t take out the humidifier!! I feel so stupid now. I mastered this concept last semester and now I made a really stupid simple mistake… O well that just means I have to relearn everything! So that goes out for everyone.. keep in mind that 1st semester easy stuff can be easily made wrong. However I do know that many RTs or students have made this same mistake 100x or a mistake worst than mine. ( wasn’t there on the news that a Doctor gave 10,000mg of some drug to a pt and died?) The only thing know is learn from your mistakes

O well I think about it this way. It would had been so much humiliation if I was already a RT and this happened to me. The Student Umbrella Saved me!

Something Random , RT ruins hollywood movies

I was watching an old movie a few weeks back. I don’t recall what movie it was but the situation was a patient was in because he was in a car accident. This movie has nothing to do with medical but at one scene there was this.

A doctor was going to suction and talking to the patients family but the situation ( storyline of the movie) He grabbed the suction catheter without sterilizing hisself and with ordinary gloves, he suctions! WHAT!? You can’t do that. haha yea that was my reaction and my friend was like “i dont get it” O well… there goes all the movies I’m going to watch with all the medical scene.

Also I’m not much of a RAP music fan anymore but I was on my ipod the other day and a song from 50 cent -Patiently Waiting. He raps and since hes talking about people dying there is this audio sound of a patient in the OR and sounds like hes on a Vent and on a cardiac monitor. If you listen closly all you hear is inhaltion and a beep. I actually counted how fast it was and at this rate his RR (respiratory rate is 48) hahah.

Alright for you new students like me…everything respiratory turns into an assement from your view

If you are going to ask me, waking up at 6am to go to clinical is such a hassle and nothing to look forward to. Today I woke up and got to clincal right on time. Next thing you know it was already 10:00 and I done 4 Tx. WOW time flyes by fast. So I learned a lot today. I learned how to give a med with a patient in a trache. At first I blanked out. I saw the trache and I’m like uh-oh what do I do? I can’t give him a U.D of Albuterol. I suddenly started to think. I got his vitals and now I’m like how do I do this?

My head went back to first semester when we did this in lab. I remembered! Just remove the Large Bore tubing and attach the Flex Tube with SVN (HHN) HAHA success!. Sometimes when you are not used to the normal Tx you start to panic. All you have to do is slow down and think back to your teacher’s lecture. I was happy that I was able to treat him. This Tx takes about 10mins and in that 10mins I was smiling like ” i know what I’m doing!”. So the RN walks in and says “oh you are from respiratory, I have a question”. At this point I’m like “oh man” where is that RT who I am following. Well the RT I was with was doing another Tx across the hall and before I was able to say “wait im a student ” she says ” how much oxygen is he on?” My head went straight to ” are you serious!? how can you not know”. So I said in my nice voice “well its not 6LPM for sure because hes on a cool aerosol”. The RN looked at me like “uhh,,what did you say?”. I further explained and I was able to teach a RN something

It does not matter if he is at 6LPM or 10LPM. Look at that knob right there. You can change the FioO2. He hes on 28% oxygen. If you wanted 40% you can change it through the knob but in this case he is just on 28%. The air is “entrained by the jet inside”

The RN was happy and said “wow I never knew that thank you”. I’m not bringing down RNs because the stuff they do I also have no clue. But as a student, teaching someone who is already working in the hospital, felt good to help.

She looks at my badge and says “you are a student?, good job keep up the good work.”

I just smiled.

I am so inspired just as a student that I am not just able to help patients but help RNs understand better things for their patients.

I had another patient who was very talkative and alert. I was able to communicate with her pretty well and everything I learned in the books came in handy. She was wondering why I gave her the Tx via Mask. I gave my speech like this

“Well sometimes if the patient is not able to tolerate using the mouth piece we give them the mask. It is easier for the patient to wear the mask and also easy for the RT. However sometimes if not most of the time the RT uses the Mask more often because of how much rounds they are doing. There is also a difference. The mask does not give as much medication as the mouth piece (i point). I’m not saying its bad but its better if they use the mouth piece. Some patients don’t even use the mask and we use something called blow by which is disconnecting the mask and spreading the medication around their mouth. If you wish to use the mouthpiece instead just like the RT know that you want to use it and if I see you again I will let you use the mouthpiece”

The patient was so happy and I could tell by the look in her eyes that shes thinking “wow this RT knows his stuff”  I hope I got that little speech right because it caught me off guard but my brain just kept giving me information to spit out.

I also had another patient who also had a trache and needed SUCTIONING. The RT made me suction and mind you, I NEVER learned how. We are not that far yet from the course so I don’t even know where to start. I put my head up and was taught exactly what to do while I was doing it. Kind of scary but I think I got the hang of it. I probably just need to do a few more suctioning and I can be master like how I feel so confident giving SVNs (HHDs).

THINGS I NEED HELP ON FOR SUCTIONING : STERILE TECHNIQUE

It took me 2 times to get the sterile technique down. Unwrap gloves DONT TOUCH ANYTHING that is not sterile is all I can give as advice. It only takes <.1 sec to touch a non sterile surface for a microrganism to contaminate the gloves

Todays clinical I was able to prove to myself that everything I do , I know it backwards and forwards.

ADVICE FOR STUDENTS FROM A STUDENT

When the instructor says “know this know that” just study it well that you are able to explain it to someone else. When you hit clinical, patients / Nurses will ask you questions and if you know it you can sound really smart. Your instructor might want you to know EVERY SINGLE DETAIL of something , and you will be like “wow thats too much to study”. BUT when you are in the clinical state it will save your BUTT!!! Some instructors will pick on you for not knowning it and it can be embarassing in front of the whole class if you give the wrong answer. If you ask him

“I’d rather be embarassed in front of my fellow RT students then look really STUPID in front of a patient or nurse”

But one good thing about a student is.. if you don’t know the answer just say “I’m just a student” and it will save your BUTT but don’t abuse the power.

“As a student you still have an umbrella under the rain to save you”