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Sunday, May 10, 2009

RT Cave Rule #35: Wise Dr.s, Humble RTs

Wicked busy here at the RT Cave. I suppose it wouldn't be so hard if there were two of us here at night, but since it's just little old me all by myself trying to waddle between 17 patients, it makes for a strenuous night.

The short of breath patients, the critical patients in the ER, the one's who need BiPAP, the ventilated patients, and the one's who require a certain degree of RT expertise and critical thinking are the patients who bring joy and pride to the RT. They are the reason most of us chose this profession.

The frustration comes from the other 80% of the job. The frustration comes from the 16 patients who have no need for a bronchodilator every 4-6 hours around the clock. And once our feet are burning from trudging room to room trying to get all these done in a timely manner, the emergency calls us down for a lady in respiratory distress.

"Oh, come on!" The Rt grumbles. Yet he reminds himself that it is not this lady in respiratory distress, the one who requires his time and expertise for the next two hours, that he is mad at. She is the reason he loves his job. It's the critical thinking he does that saves her life that brings him joy.

And, yes, when the doctor wanted to intubate the patient, and the RT thought to say to the wise doctor: "How about if we try BiPAP first?"

But the BiPAP didn't make that CO2 of 89 drop. In fact, the CO2 actually rose to 92. The doctor called and asked to talk with the RT. He said, "If we can't get that CO2 down we will have to intubate. Do you have any ideas?"

The RT was impressed with the doctor. It's not very often a doctor utilizes the wisdom of the RT. And, seizing the moment, the RT knew exactly what to say: "We could increase the IPAP in an attempt to raise her tital volume and blow off the excess CO2."

"Go for it!" the doctor said.

An hour after the the humble RT called in the repeat blood gases to the doctor. The RT said, "Look, here's what I did. I increased the IPAP from 10 to 16 in an attempt to increase the tital volume and blow off CO2. The patient is now getting an estimated tidal volume of 550-600, which fit into the hospital tidal volume protocol of 6-10cc/kg ideal body weight.

"Then," the RT continued, "since the PO2 was fine with the last gas, I decreased the epap from 5 to 4 to get a pressure support of 12 and a little extra tidal volume. That said, the CO2 is down from 90 to 86, the pH is up from 7.29 to 7.31. Aside from that, the patient is awake and alert and orientated on or off the BiPAP. She is not longer in respiratory distress and states she actually feels great now. Oh, and she's also joking with us."

The good doctor said, "Good job! I think we averted a ventilator for now."

The RT's ego jumped from zero to one. But the humble RT had no time to savor the moment, as another page to the ER meant another treatment for a CHF patient. And, hence is the life and times of an RT.

Ego = +1. But the ego of the RT doesn't matter. A doctor being wise and admitting he needed the education, training and wisdom of his RT for a change does not matter. What matters is neither the doctor nor the RT panicked and needlessly intubated the patient.

This is a perfect example of what good can come from all the medical staff working together. And, since we haven't done this in a while, it's time for RT Cave Rule #35.


RT Cave Rule #35: A wise doctor admits when he is to the limits of his medical wisdom and seeks the education, experience and wisdom of RTs. A wise RT will be ready with a veritable option for the doctor, and stay humble if he is right.

Regardless: ego = +1. Current ego status = 1.

2 comments:

Trauma Junkie said...

Thank you for sharing this.

It truly is because of nights like you describe that I have decided to go to RT school. I realize that a lot of the job is tedious and pointless at times, but there are those moments when you can step up to the plate and make a difference.

Trauma Junkie said...

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