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Sunday, August 31, 2008

A good feeling for a humble RT

On the technical side of being an RT, one of the greatest joys is when you intubate a patient, and set up a vent based on your protocol and experience and common sense, and then you tell the doctor what you did and why.

"That sounds great," the doctor says. "Just try to keep the EtCO2 around 30."

Awesome, I think. So I titrate the rate and title volume a bit until that EtCO2 is just where the doctor wants it, and then turn down the FiO2 until the SpO2 is no longer 100%.

This is how it should be. This is awesome.

Tonight when I learned that a bad baby was coming to our ER, and the nurse told me how much the baby weighed, I grabbed my little cheat sheet and knew, based on our protocol, that I needed a 3.5 ETT and that it should be positioned approximately about 9-10 at the lip.

Once the doctor was done intubating, I said, "I think it should be 9-10 at the lip."

"No, I want it at 12," she said.

I listened for lung sounds and told her lung sounds were diminished on the left. She pulled it back to 11. "I don't want to pull out any further," she said. "Let's secure it right here."

Later, after we had secured that little tube with tons of sticky tape, the doc looked at the x-ray results. "Well, I think we need to pull it back to 9 or 10," she said.

I couldn't help but smile. She knew I was right.

A good feeling for a humble RT.

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