Trau·ma  Junk· ie  ( 'trau-m&  'j&[ng]-kE) n. Slang
  1. One who has an insatiable interest, devotion or addiction to responding and assisting people with serious injury or shock to the body, as from violence or an accident.

On RT School and Hitting a Plateau

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

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

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

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

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

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

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

Well, this particular patient had Pneumocystitis jiroveci pneumonia.

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

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

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

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

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

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

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

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

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

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

Challenge yourself. Often.

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