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.