Spiga


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.

This is JEOPARDY!



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

The Category:

INITIAL TREATMENT OF
METABOLIC ACIDOSIS

Here's your clue:

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



BUUUZZZZZZZZZZ!

What is...intubation, Alex?!




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

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





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

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

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

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

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

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

The doctor? Yes, the doctor.

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

Let me paint a scenario for you:

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

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

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

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

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


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


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

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

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




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

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

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

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

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

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


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

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

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

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

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



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

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

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

The contents of my pockets. Can you tell I'm an RT student? on TwitPic
(My pocket contents at clinicals the other day.)

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


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

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

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

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

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



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

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

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


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


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

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




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

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

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

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

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

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











Technical Difficulties

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

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

Let's make this a big deal

From Inspiration


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

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

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

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

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

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

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

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

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


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

In Lieu of My Own Quality Content...

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



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

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

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

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



That is all.

No pressure, right?

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

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

No pressure, right?!