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Sunday, January 15, 2023

Changes Coming To The RT Cave

If you do what you enjoy doing, and you do it well, good things will come of it. That is what I learned from this blog. I created this blog while working the night shift on October 7, 2007. I remember, just before I created it, pacing around the hospital thinking of a name for my new blog. 

At one point in the night I was in the critical care unit hanging out with the nurses there. And we had a very nice discussion. After a while I decided to get up and walk back to the respiratory therapy department. I said, "Well, I'm going back to the cave!" 

That's IT!!!  I thought. That's what I am going to call my blog: Respiratory Therapy Cave. I proceeded to create my blog on And I wrote my first blog post, a silly post about my beeper. As I go back and look at this old blog post I'm reminded of how green my writing was. I have grown so much as a writer since then. 

I decided I was going to write and publish a post for my blog every day. And this was quite the challenge, as some days I couldn't think of anything. Although, once I got started writing, I was soon writing not just one but two or three or many blog posts per day. Although, I only wanted to publish one post per day. I decided it would be overwhelming for any potential readers of my blog if I published too much too fast. 

Then I learned that I could write as many posts that I wanted on blogger. And I could submit them to be published on any date of my choosing. This was a major revelation that occurred after about a year of publishing one post per day. 

A did a lot of Googling back at this time. I Googled how to improve your blog. I learned in this way how to add things to my blog that made it look cool. I even learned how to go to the back side of my blog and make changes to the html. And, I also Googled other respiratory therapy, COPD, and asthma bloggers. I became friends with all these other bloggers. 

I would place all my blogger friend's blogs in my contacts link. And they would do the same for me. Sometimes we would write guest blog posts on each other's blogs. And, in this way, we helped each other draw people to our blogs 

I did not know this, but I created my blog right as the blogging bubble was taking off. This, along with the help of my new friends, helped me obtain a good following really fast. Within a year or so I had a following of over a million people. This included respiratory therapists, respiratory therapy students, asthmatics, and people with COPD. This also included people of other diseases. It also included high school students were were thinking about becoming respiratory therapists. 

I was well aware of who was going to my blog. I was well aware of what people were typing into search engines that caused them to land on my blog. So, I quickly learned to cater my blog posts to these particular groups. I had a plan. On Mondays I would write articles for asthmatics. On Tuesday I would write posts for COPDers. ON Wednesday I would write articles for students. On Thursday I would write articles for respiratory therapists. On Friday I would have fun and write something humorous. On Saturday I was free to write on any topics I wanted. And on Sunday I wrote something religious or philosophical 

That was the plan on my blog. That is what I did during the hey day of the RT Cave. And I developed an even larger following. Then I discovered Facebook and Twitter and promoted my blog through pages I created on social media. 

Then something amazing happened. And this segues back to where I started: 

If you do what you enjoy doing, and you do it well, good things will come of it.

I received an email: "I love your blog." And I ignored it because I thought it was spam. I think we are all familiar with spam today. Back then it was something I had to deal with all the time, both in my emails and on my blog. And so, I thought this email was spam. But, thankfully, the person sending it to me was persistent. And she wrote me a second email: "I love your blog." 

And this gave birth to my Freelance business. I had always wanted to be a writer. I kept a journal since I was in my teens (remind me I should probably throw them away). I kept a journal until I started this blog. Since then all my writing goes here. A neat thing about this blog is it gave me an audience. So, rather than just writing to write, I started writing for an audience. 

So I continued doing this blog. But I was also writing a weekly blog about asthma for (now it is I was dedicated about this job, and wrote one post every week. I would also answer any questions people had about asthma on the site, and I got paid for this too. 

In 2015 I was sent a similar email as the "I love your blog" email. This one I also ignored for about six months. I ignored it until one of my asthma blogger friends said, "John, did you get an invite to write for" And, of course, this inspired me to recheck my old emails. And, within a short time, I was hired as a freelance blogger and moderator for and soon thereafter 

So, this is a nice side gig. I turned a hobby into a good paying business. And this respiratory therapy cave blog kind of went to the way side. I have spent little time updating it over the past ten years. I still have continued to write a post now and again. And sometimes I get on a roll and write a post for a few weeks. And then I get busy and forget for a couple months. 

I do want to keep this blog going. I want to keep it going because this is my baby. This blog is what lead to my business. And so, I have decided to spend some time updating this blog. You will see some changes to this blog. You will also see, coming soon, that my blog will have a new domain. That is something I am working on. You see, like I did in the early days, I'm back on Google trying to find ways to make my blog better, cooler. 

And, most important, I plan on updating my content. I plan to write lots of articles on a regular basis. My focus will be on respiratory therapy. My focus will be on asthma. Those are the two things I am passionate about. 

But first I have to get this new domain thing going. Thanks for hanging out here in the RT cave. John. 

Monday, January 9, 2023

If You Smoked once you automatically have COPD

Studies show that about 15% of smokers will eventually develop COPD. Sure, there are a few studies where that number is 50%. Although, the general consensus is that it is 15%. 

(Note: a consensus is not science. But, since since we are humans and not God, we must resort to debating the studies, and that's why we usually talk about consensus's.)

But, if you are admitted to the hospital, and you note that you smoked, you are automatically diagnosed with COPD. 

And if you are diagnosed with COPD, you automatically need Duoneb QID. 

This is true even if the patient never had a pulmonary function test (phooey on the GLOBAL COPD Guidelines). And this is true even if the patient did have a PFT done and it was normal. None of those things mattered. We are covering our bases. If you smoked, you get treated as though you are a COPDer. 

And you can go ahead and DC the order per protocol. The doctor will just reorder it. 

Friday, January 6, 2023

Wearing A Mask On Your Chin As Effective As Wearing One Over Your Nose and Mouth, Study Shows

A cohort study was done. And cohort studies are the best studies. They are studies that take all the results of all the studies and study them. And these are are way better than looking at one study, because they are studies of all the studies. So they are the most accurate studied. 

And the study went something like this. 

20 studies were reviewed. The studies reviewed were studies that studied masks on either the mouth and nose or just the chin. So, this study involved 10,000 healthcare workers. And the conclusion drawn by the review of studies (cohort study) was that there was no difference in the rate of virus transmission between those who wore the mask over their nose and mouth for a 12 hour shift compared to those who wore one over their chin. 

For that reason, you will see many more nurses and respiratory therapists wearing masks over their chins instead of their mouths and noses. 

Head of the study, Dr. Ven Tolon, said that, "Yes, we think that there are pores surrounding your chin, and covering them up sets up a force field effect that prevents viruses from being inhaled. We are thinking this may be a good explanation explaining the explanation of this study of studies."


Wednesday, January 4, 2023

Things You Don't Want To Hear

T'here are some (many) things we RTs do not want to hear. Here are some examples. 

1. "Please come to critical care stat. The oxygen is low." And you get there to learn the sat is 89%. 

2. "The patients CO2 is high. I'm ordering Q4 breathing treatments." 

3.  "224 is short of breath. Can you give her a breathing treatment?" Well, I will come assess her to determine if there is a need for the treatment. 

4.  "The patient is coughing up blood. I called the doctor and requested breathing treatments, EKG, ABG, and tons of other stuff. None of it has been ordered yet. But I need you to come and check on the patient." And you check on the patient to learn the sat is 92% and the patient is not short of breath. The patient says, "Get that nurse out of here. She's driving me nuts. 

5. "STAT treatment post op." And you drop what you are doing, rush to do the treatment, and learn the patient is not wheezing: the patient is snoring away. 

6.  "The patient's sats are 89%. We need a stat ABG."

7.  "I looked into the patient's room and heard an audible wheeze. So I thought, 'If I didn't order breathing treatments I'd be a horrible doctor." Said the doctor you thought was smart. And you think: "If a patient is having bronchospasm type wheezes, they are deep in the lungs are would not be audible. But, oh well. You give the treatments anyway and just DC later on per protocol. 

These are some things I could think of at this sitting. I'm sure as the day goes on I'll think of some more. Actually, I really don't need to think much about this as I just write things down here as they happen in real time. If you have some to add to this list please do so in the comments below. 

Monday, January 2, 2023

PTSD For Work

How did it go with that patient the other day? Said the nursing assistant. 

Horrible. I have PTSD from taking care of him. Said the nurse. 

They never should have given him to me two days in a row. She added. 

I have PTSD from work as a result. She added. 

We can all relate. 

Friday, December 23, 2022

No Phlebotomist Tonight

So, I caved and decided to work a night shift. 

"Hi, I'm stuck in the UP. Would you be able to work for me on Friday night? We are supposed to be getting a blizzard, and we didn't want to get stuck driving in that just to get to work." 

"Yes!" I said. "You stay safe!" 

So here I am on that night shift. For those who have followed my blog since the beginning in 2007, you know that I loved working nights. I worked 15 years as a night shift therapist here at Shoreline Medical Center. It was a tough decision to shift to day shift. And now I have been a day shift person for ten years now. 

Still, occasionally I volunteer to work a night shift. It just so happens that this is my first night shift since before COVID. 

And, interestingly, I walked through the ER and a nurse said to me, "Are you going home too tonight?" 

"Oh no!" I said. "I volunteered to work the entire night. You are fortunate to have me." 

"Yes we are!" he said. "So, if you do decide to go home, can you show me how to run a ventilator before you go." 

"Sure, I will. But I have no plans on leaving" 

"Good. I was just asking because we have no security tonight. And we have no phlebotomist." He pointed to all the phlebotmy stuff he had sitting on the table by the ER nurses station. "See, we have all this stuff ready to roll. Since we don't have a phlebotomist, we had to be trained to do this ourselves tonight. So, I just figured if you left, we could do our own ventilators too." 

"Sure, I'll give you a quick lesson before I take my nap tonight." 

We both laughed at that. 

Security I can see not having. I mean, it's a blizzard outside tonight. And the doors are locked. But, no phlebotomist? I think this is a first. 

Friday, November 4, 2022

Instant Pneumonia: An Illness Doctors Just Made Up

The following is an update to the Real Doctor's Creed. We have come upon this top secret (shared only with the medical community) information. We will continue to share these as we gain access to them. At the present time we have several spies in the medical community, making it possible to publish the Creed right here on the RT Cave. 

Doctor's Creed: Update 10/1/2022

Add the following to the pneumonia section of your booklets. Please do not publish online, as we do not want respiratory therapists to have an opportunity to hack into our esoteric wisdom. 

So, we know what pneumonia is. It is a condition caused by a virus or (usually) a bacteria. Walls of alveoli become inflamed. And this causes puss and fluid to fill alveoli. This renders the affected air exchange units less effective. And a may result here is soreness (especially with a deep breath), shortness of breath, and lowered oxygen levels. And, if severe and untreated, potential death. 

Now there is a new type of pneumonia. And it results from aspirating large doses of stomach contents. It is generally not caused by aspirating small amounts of stomach contents over time, as that would be diagnosed as GERD. But, if you aspirate large amounts of stomach contents (such as due to a drug overdose), then this is referred to as aspiration. 

A new study, one never performed by the fake left leaning scientific community, has now determined that aspiration INSTANTLY results in pneumonia. And this would help explain why we doctors are now able to diagnose patients with "Aspiration Pneumonia" instantly following aspiration. 

Respiratory therapists have often said things like: "Now, how the hell can someone develop instant pneumnonia? It usually takes time for alveolar walls to become inflamed." Or they say things like, "It should be called 'aspiration' not 'aspiration pneumonia'"

We in the medical community know better! We understand that unwanted fluid in the lungs from aspiration is "automatic" and "instant" pneumonia. Sure, there may be no inflammation right away. But, still, the aspirated contents fill alveoli meeting our definition of pneumonia. 

Besides, a consensus of doctors agrees with this author. And therefore it must be true. 

Also, insurance people love pneumonia and are willing to fully reimburse hospitals for pneumonia. So, adding the term "pneumonia" to the term "aspiration" shall guarantee the highest reimbursement potential for your patients admission.