Mixed Week

This week has been a week of acute and diagnostics and continued care all thrown into one. I went from the ICU to a care facility to Sleep. It was an alright week, but I kinda felt like I was all over the place because I literally was. I got a few more competencies checked off but know I have lots to learn and fully understand. I am also thinking I may need a sleep study done on myself as I tend to feel tired when I should be fully alert. Maybe I am actually tired from lack of sleep or maybe I am just less interested in the non-acute side of respiratory therapy?
The people I have worked with have been really friendly and show varying interest in my learning by the way they preceptor me. Some just let me do whatever I want, some ask questions first to see what I am thinking before doing something.Some preceptors just ask me on the spot with the patient "So, you set them up on the vent. Are you happy with these settings? what are you going to do now?" and such. Some preceptors do things for me, which I don't really enjoy them doing that much. I want to learn and be competent at doing the entire shift. If I am going to take a blood gas please do not enter it into the computer for me. Although that is extremely nice and would be deemed helpful if we were colleagues, I want to be able to perform the entire task enough times that I can feel 100% competent at it.
Discussing patients care with doctors at first was kind of intimidating, but the doctors at this hospital are friendly and create a good work and learning environment that makes it alot easier.
I have now seen future options and different directions I can take with my career if I get tired or for some reason can not handle the acute side. For right now, I want to be in the acute side but things may change as I get older and priorities change.
One thing that hasn't changed and will never change is that there is always something to learn. Everyday there is something new or something to review. And it is not just because I am new to RT. There are always advancements and different ways to do things as well as getting another view point on something you thought you understood completely.I enjoy continued learning.

First week in Emerg

So I just completed my first week in the ER. I was expecting it to sort of be a cluster f*ck of everything from traumas, copd exacerbations, psych admits,seizures, cardiac arrests, broken bones, etc. I thought I was going to be running around the ER like a chicken with my head cut off. Not so much.I did send see the exacerbations, concious sedations, siezures, psychs, fluid overloads but it was more controlled then what I was expecting. We even had a lot of free time to help out on the wards and see patients there. That is one of the great things about this Hospital and it's RT department. Everyone gets along and helps each other out. It seems to be a good group here.

I got calls to see pediatric patients, elderly patients and patients that looked like we might have to call a code on them. But with a little bit of bipap and some lasix, these patients were off the machine and sitting up and smiling and joking around an hour later. It is kind of amazing what a little intervention and therapy can do. I got to give some ventolin and atrovent by nebulizer quite a few times as well as by MDI. I set up some high flow systems and did a lot of blood gases. Got to interpret a few CXR's and auscultated a lot. Auscultating an actual patient sounds a little different then auscultating the machine we listened to in lab and got tested on. People come in all shapes and sizes and you need to listen all over and compare side to side. Some peoples fat blocks the sound,others heart beat or stomach sounds are louder than their breath sounds. Getting patients to take deep breaths and NOT talk when you auscultate them is the key.It is also easier if they tend to stay somewhat still. It makes it just a bit harder if they are moving/rocking back and forth and for one reason or another you can't get them to settle and move less.

All in all I liked my ER rotation. You never know what the paramedics are going to wheel through those doors. Those same paramedics are also interested in learning and where asking me questions and possibilities of what could have caused the patients illness and what types of therapies we would be providing. I also learned something kind of important in the ER. Make sure you move the sat probe to a new finger every once in a while. Sometimes a patient can sweat a little and you look at the waveform and it looks normal and their SpO2 is 93%. You trial them off the high flow face mask and see their SpO2 drop to 88% so you put them back on and up their FiO2 to get their sats up. Later on the nurse comes by and during their routine check ups changes the sat probe and you find the patient SpO2 to be 98-99% and the nurse informs you there was a lot of sweat on the finger where the probe initially was. Sweat will give you incorrect SpO2 measurements.

Pulmonary Function

So this was my first week in the PF lab and out of acute. I kind of missed acute as there were no codes, and the patients coming in were not even close to being as sick as the patients in acute.I got to tell patients to blow and test their lung functions. Also learned  a few words in an other language. Did a few methacoline challenge tests for possible asthmatics as well as cardiac stress tests.The group of RT's in the PF lab are pretty laid back but the loudness and sharpness of their voices is strong. They have the experience to get the patients to blow when they want them to. I also found out that I do not have asthma. Lucky me. I seemed to be the only RT there that didn't have asthma. I noticed I haven't been posting too much in this blog and when I do it is short and doesn't have very much to actually get anyone to read this. Well, too bad. That is the way it is going to be. I am usually kind of tired when I remember to post on here.

First Week on the Wards

So I just completed my first week on the wards. I did a lot of trach care and vent monitoring. Learned quite a few new techniques as every RT has their own methods and way of doing things that works for them. Had some exposure to Bipap and high flow devices. A few codes were also called this week.I also got my first blood gas puncture this week. Although it was a femoral and not a radial but at least I got it first try. The RT's here tend to help one another as per the workload. If anyone needs help, the others help out. This week went well. Learned what the set up was like to administer mucomyst via nebulizer on a trach patient. Also went on an external transportin an ambulance with a patient. Getting more exposure and experience. Got to see the different types of tubes and got more exposure to trach care.

Bronchoscopy

I had a week in the bronchoscopy suite which also included being a float when not having a bronch to be part of. The Doctors performing the bronchs were nice and relaxed and provided a good environment for learning. One of the Dr's actually allowed me to take control of the bronch and move it around in the patients airway. It's interesting to see the lungs from inside a patient and how to prep a patient for a bronch. We took tissue samples, washes, brushes all to see if the patients had carcinoma or TB/ etc.  I also had exposure to the wards where there are trach changes to be done andthe charting is different than in the ICU. There were a few codes called this week. Overall it was a good experience and I learned a lot.

ICU week 2

           So I have finished my second week in the ICU. This week I actually had 12 hour shifts.The time flies when you are busy. Hours go by extremely fast. When things are slow time sort of slows down but there is always something to be done to keep busy or something new to see/learn. I have seen a lot of things not talked about during classroom teaching and heard terms that I have no idea what they mean. Its always good and OK to look up something you do not know or do not understand. Do not try to pretend you know something you do not. Just be honest. I have gone to codes, assisted Dr's intubating, transported patients, administered medications, taking blood gases, did patient planning, performed CPR, suctioned patients, analysed x-rays, checked lab values, adjusted ventilation settings as per blood gas results, discussed patients plans with Doctors, set up otpi-flow, did trach care, watched seminars, wrote reports, charted correctly, signed arrest reports, and a whole lot of other things while continuously being quizzed by preceptors, csc's, doctors. 

           When I was told by previous student RT's that clinical makes you feel stupid and it's like hell because you don't really have a life while in clinical may turn out to be right and may not. During the week it is tough as you work from 7-7. Having to be up by 5-5:30 and leaving for work by 6am. Then leaving work around 7:15pm and getting home around 8pm. If you want 8 hours of sleep you need to be asleep at 9pm. That would give you 1 hour to have a life/study/do homework. This is why us clinical students do not get the recommended 8 hours of sleep and probably get on average 4-5 hours of sleep during the week. Going out for dinner saves you time on making it and you can go with friends/family. But you also need to make your lunch and break meals for the next day as well. There is always the weekends to catch up on things such as sleep, friends, studying, homework, normal everyday things. Some of that weekend time gets taken away if you work during clinical year like I do. But it is always good to have some money coming in because school costs money and so does living.

Good Day in the ICU

So, I finished a 12 hour shift in the ICU today. Still have tons of energy and did not feel tired at all throughout the day. Learning a lot and getting to see new things and different approaches to doing certain tasks. All the patients I saw today survived. Not one death on my shift today! The Oath of all health care professionals is " primum non nocere". I will always follow this.

ICU Week 1 over

Today was the last day of my first week in the ICU. After orientation and mock patients/rounds I finally got my own patient to provide care for the day. Presenting the patient at rounds was a little nerve racking as we first present our patients to the other RT's in the ICU and then go see the patients and monitor them. It is a bit intimidating because all the RT's know so much more than I do and have done rounds millions of times while it is my first time ever doing this. Anyways, rounds went well and I went on my way to monitor my patient. The best part about this hospital is how nice the nurses and doctors are in the ICU. They really work well together along with the RT's and the RT's here get a lot of respect from both. I did my monitoring, suctioning,charting,etc and also remeasured the patient and calculated the IBW. Since it was my first time I was kind of slow and by the time I was finished and asked a few questions and what not it was time for break.

Coming back from break and find that the Dr's rounds are just finishing up on my patient and as discussed within the rounds with just the other RT's we decided along with the doctor to switch modes on the ventilator to allow the patient to make their own efforts. Along with an RRT we switched the patient over and talked about the theory behind the new mode and how it works (PAV). We noticed that the resistance was a little higher then it has been so I administered 8 puffs of ventolin and 8 puffs of ipratropium to dilate and increase the radius to decrease the resistance. Just as I finished we hear " Code blue.........." Which is just in the care unit adjacent to the ICU. We rush over. I bagged. I did compressions. The doctors,nurses and RRTs did what we could but we could not save the patient. We brought them back for a short while, but it did not last.

I came back and monitored my patient again and help/follow my preceptor with their patients to learn and get as much experience as I can. A new patient arrives and I ask if I can go recieve the patient with the RRT thats section of the ICU the patient is arriving in. It turns out this patient already had a code blue in Emerg and came to ICU. The Dr. stopped by and all we could get was a weak pulse and couldn't get an ABG. The prognosis for this patient according to the physician was "Very poor" and we were maintaining them until family arrived. It was now time for lunch.

After lunch I come back and monitor my patient. I talk to my preceptor about things I have questions about and then take a blood gas from one of their patients as it needed to be done. I walk back to my patient and find out the family has made the decision to withdraw care as the prognosis of my patient was extremely poor.

That was the end of my day. I did what I could, but it seems like I did not do enough. Not a good day.

First day in ICU

So today was my first day in the ICU and was just an ICU orientation with a lot of quizzing. Even with studying the drugs, dosages, waveforms, disease processes, lab values, charting, different ventilators and their settings, all the equipment, the policies and procedures, everything from first and second year of respiratory therapy school I learned one thing today. I don't know anything. Maybe I should become a nurse.

First Week = Done

So, first week of clinical came to a close on Thursday and what a week it was. Orientation went well as did the multitude of tests that we needed to write daily. As the hospital atmosphere is new to us students, the information given during the week long orientation can be quite overwhelming.  We were reminded that this year of clinical is essentially a year long interview. Now that we are done orientation, the fun starts Monday when we begin seeing patients.I am looking forward to this and am excited and scared at the same time.