How to succeed in life

If you want to succeed in life, then you need to avoid people who are failures.  You need to avoid hanging around people who have negative attitudes.  You need to avoid people who incessantly complain about their work.  Because these people will never succeed.  They will never be better than what they are today.  

If you want to succeed you need to talk to people who have succeeded.  Any person who has succeeded will tell you this.  If you hang around negative people, people who are not happy with their jobs, then that is the attitude that you will pick up.  So if you want to succeed, hang around happy and successful people.  

That's not just something I'm making up, it's true.  If you hang around the failures, you're just going to become negative, and you are going to lose hope, and you are going to become apathetic about your job.  Once apathy sets in, chances of you moving up the ladder will probably be thrown out the door.  

Once you become apathetic and sit around the RT Cave complaining about this or that, or complaining about this person or that person, then you are going to trapped where you are right now.  If you want to succeed, if you want to move up the ladder, for instance, you will have to get away from these people.  You will want to rise above them.  

Don't hang around people who tell you you can't succeed because they didn't, because then you won't succeed.  You don't want to hang around people who are bitter.  Find the successes and learn from them.

If you want to be a writer like I am, you used to have to be ambitious and try to get some newspaper or magazine to like your writing.  One day I was sitting around trying to figure out how I could become a writer, and my wife introduced me to the Blogosphere.  I started writing.  At first I wrote to no one, as I has no audience.  Then people started discovering my blog, and they realized that I had something interesting to say.  

Then one day I received an email from a producer.  She said, "I love your blog.  I love the way you write in a pithy manner, and how you describe your profession accurately, and how you write about asthma.  I love how you write about smart people and stupid people.  I think you are a great writer, and I want you to write for me."  

I responded to this email, and now I have been successfully writing about asthma and COPD since 2008 for healthcentral.com.  I love doing this.  To me, it's not work: it's fun.  I have succeeded.  You can too.  But you will have to take advantage of opportunities, and you'll have to stay away from the complainers, or at least not listen to them. 

I'm not even saying you can't complain, because Lord knows I do.  I'm honest about my job.  However, I talk about it in a generic way, without blasting any person.  I might honestly discuss a situation that isn't going well,  and I might even disagree with doctors and bosses, but never at the expense of respect.  

People do things for a reason.  Doctors order useless breathing treatments because that's what they were taught, and telling them they are "idiots" will not solve anything.  Many doctors even admit that they order 'useless" treatments because they have to in order to get patients admitted.  

You might look at me and say, "You are a small town respiratory therapist and you have a couple blogs, but you are not successful."  To that I say, "It depends how you define success.  I define success by how satisfied I am, and I'm very satisfied." 

The two types of healthcare workers: Over-functioning and Under-functioning

I have observed that there are two types of healthcare workers.  For the case of simplicity we will call them June and Tom.

June manages anxiety at work by over-functioning.  What this means is that when stress hits, she moves in quickly in an over-responsible fashion to take charge and fix the situation.  She walks fast from room to room and patient to patient, and gets her work done as fast as she can.  She takes charge, often telling people what to do  The higher the anxiety, the more she functions harder and harder, and the more she focuses on others who do not (in her eyes) fulfill their responsibilities or accomplish things.

People who are fond of June admire her competence, maturity, and reliability. Those who don't like her call her bossy, strict, overly assertive, and demanding.

Tom manages anxiety and stress by under-functioning.  What this means is that when stress hits, he slows down in a less responsible fashion.  The higher the anxiety, the more calm he becomes.  He tends to take his time, speak less, and gets his job done in a calm demeanor. He heeds orders, even those he doesn't agree with, and just does them to keep the peace. Rather than rushing from room to room in a panicked fashion, he steadily walks, rarely taking charge.

People who like Tom admire his warm, laid-back, charming, and relaxed style. Those who aren't fans of his think he should grow up and become more reliable and thoughtful toward others. They think he appears relaxed and uncaring, which is not the case at all. Chances are, even while he appears calm, he's already working on three things.

June might see in Tom a person who should grow up.  Tom might see in June a person who should calm down and relax.  Yet, as with marriages, the two opposing personality types are essential.

Toms are necessary in order to keep the peace and create an overall calm and peaceful work environment.  Yet too many Toms in one place may result in not enough stress to get all the work done.

Junes are necessary in order to take charge and get the work done in a timely manner.  Yet too many Junes in one place may result in too much stress, which might ultimately make it so even less work is done.

By working together, and with an appropriate combination of the two types of healthcare workers, an ideal environment can be created within a hospital setting.

The secret then is the two types of people learning to get along.  Obviously Tom's friends will side with him when there is a disagreement, and June's friends will side with her.  Yet through it all, there are rarely moments when either is truly at fault for conflict.

There is nothing wrong being a June or a Tom, as they can both be competent workers with many friends.  Yet they are different.

However, when the two get locked into extreme or polarized positions, they begin to operate at a cost to both self and other.  For example, say Tom gets a STAT page to the emergency room, and he calmly walks down.  When he greets the patient he calmly jokes with him as he is doing what the doctor ordered.

June, who happens to be a nurse in the room, thinks Tom is too calm and uncaring.  She sees his coolness as him not caring, and not working hard enough to get the work done.  So she says something to Tom.

Anxiety caused by June's "controlling" statement causes Tom to back away, and he becomes even calmer.  He says nothing to June, and continues to get his work done as he feels comfortable. He continues to jibe with his patient while he whistles while he works.

The patient likes the way June is taking the necessary actions to help him feel better, although he might agree that she is being a bit harsh to Tom.  He also likes Tom, because he makes him feel comfortable and easy in an otherwise stressful environment.

Many times Tom might approach the patient in a manner that June feels is late and too slow, although she says nothing.  Yet the tension in the room is so thick that anyone else in the room can feel it.  After the patient is fixed June will be on the phone calling Tom's supervisor to let her know how irresponsible and immature Tom was, and how worried she was about his influence on the patient.  June has all but lost her ability to focus on and relate to Tom's competence as a healthcare worker.

Tom, of course, did his full share to keep the intensity going.  Not only did he know exactly how to push June's buttons and keep her involved (like not stopping joking with the patient), but he was also highly reactive to June.  For example, when his boss came to him telling him that he was too relaxed in an urgent situation, Tom might say, "What do you want me to do, stop on the way to ER to wipe water on my face so I appear more stressed?"

June might want the two to get together to work out their differences.  Tom might see this as her trying to control him even more.  So the drama continues.

Ultimately June doesn't change and neither does Tom.  Despite any therapy or counseling that might take place, June will continue to over-function when under stress, and Tom to over-function.

Of course Tom and June may support each other, and learn to work together, for the benefit of the patient.  They may even be good friends under normal circumstances.  Yet there will be times when the two will not see eye to eye. That's just the way it is.

The benefit of down time

One of the neat things about working for a small town hospital is you will have plenty of down time. During this down time I have seen nurses and respiratory therapists do an array of activities, such as play games, surf the net, Facebook, read, blog, and you name it.

Some people frown upon this and think that if you are on the job you should be working.  For instance, when you work for a restaurant and there is down time, you are expected to have a rag in your hand wiping down tables.

I don't see it that way.  I see down time as a benefit to the job.  I see down time as an opportunity to rest and prepare for those moments when you have to bust your but to get your work done.  I see it the same as I see health insurance and other benefits to working at a hospital.

Of course, the rule of thumb here is that you have to have all your work done before you can play.  Likewise, you cannot become so rapt in your play that you forget to check on patients who need checking on.  You must also not get so rapt in your work that you leave work for your replacement.

Still, I think of down time as good.  How bosses perceive down time varies from boss to boss.  Some are totally fine with down time, and they are fine with you taking advantage of it.  Others hate it and are always trying to find things for you to do.  Some are about half and half, okay with it but would prefer you find something to do.

This is one of the advantages of working night shift, because, so long as you get your work done, you can do whatever you want in your down time.  I have worked at some hospitals where the night shift workers take naps.  I'm not a fan of naps, although mainly because I like to be industrious with my time.

I think that's one of the main reasons I started writing medical blogs.  Here I am able to do something health related, something industrious, something useful.  Of course there are others who simply walk around and gossip or try to sell some kind of tonic to make your hair grow to their coworkers.

How to give a good report

I get quite a few questions about how to give a good report, particularly by RT Students.  Here is my pity answer.

Report should not be hard.  What kind of report may depend on who you are giving report to.  If it's the same person you got it from, then you might be able to get away with simply giving the time the treatment was done.  But if it's a different person, you should give more detail.  

Here's what I like in a report for those patients receiving only basic respiratory care (i.e. treatments).

1. Name of patient
2. Age
3. Lung sounds
4. Vitals (HR, RR, SpO2)
5. Oxygen (room air, 2lpm, 50%vm, etc.)
6. Level of alertness (awake, orientated, lethargic, coma)
7. Anything else that might effect how patient is approached (i.e. hard of hearing, blind, mentally challenged, dementia, depressed, Alzheimer's, nice, mean, laconic, loquacious, etc.)
8. Why were they admitted (i.e. COPD, Asthma, bowel obstruct, hernia, broken leg, etc.)
9. Why they are getting treatments (if different from diagnosis (i.e. admitted for heart failure or anemia or bowel obstruction, getting treatments due to asthma history or COPD history)
10. Are they on oxygen (if so how much and why)
11. Is the patient stable. This information is helpful in prioritizing what to do first.
12. Any other pertinent information (going for a bronch today, coughing up yellow or bloody sputum, pertinent lab values, x-ray results, etc. 

What you give in report starts in the report you receive. Write down what you learn.  Check the patient's chart and review doctor notes, lab values, ABGs, x-ray, for anything significant.  Write down what you learn. If the patient has a disease you don't know, look it up on Google.  

Give a pithy report on each patient.  If you are asked a question you can't answer, don't fret.  Most established RTs don't have all the answers either.

How to deal with a bad teacher

Unfortunately they do exist -- bad teachers that is.  They are a rare breed, although, as with any apple tree, there is an occasional bad apple.  So, that said, how do you deal with terribly bad teachers?

First of all, it must be noted here that most teachers are good or excellent.  If such teachers are perceived to be bad, it is mostly the result of poor study skills by the student and not the fault of the teacher.  That said, even the best teachers have bad moments.

But some teachers are simply bad.  Whether it is because they write poor questions, give bad lectures, have poor control of students, or are simply unfair, they are a problem that must be dealt with.

Unfortunately, once a teacher develops tenure it's nearly impossible to get rid of them.  So what is tenure?

According to the American Association of University Professors (AAUP), Tenure is defined as...

"...an arrangement whereby faculty members, after successful completion of a period of probationary service, can be dismissed only for adequate cause or other possible circumstances and only after a hearing before a faculty committee.

While surely professors love tenure, I personally believe it's an excuse to keep incompetent teachers.  Yet according to the AAUP, it's necessary to "protect academic freedom."

Tenure is usually granted to teachers after a certain amount of time in probation, which in many cases is about five years.

We all know what a good teacher is.  So are bad teachers?  They are teachers who fail to follow good teaching practice, or who fail to manage a classroom effectively.

When you get a truly bad teacher, what can you do?

I believe the appropriate steps to take in dealing with this type of problem is:

1. Study your butt off and know the material upside down and backwards 
2. Approach the teacher in an appropriate manner to discuss the situation. 
3. If a problem continues, or you believe the teacher continues to be unreasonable, take it to the next level, which is usually the dean. 
4. Drop the class (a last resort)

I certainly would hope you wouldn't resort to #3, although I know of many who have. If you do #1 and the teacher write such poor questions that you cannot possibly answer correctly, then it's time to resort to 2, 3, and (hopefully not) 4.

Is respiratory therapy a good career?

Your Question:  Is respiratory therapy a good career?

My answer:  Technically speaking, yes it's a good career, and it's been good to me.  I think if you are in a position in life where you need a job as I was when I went to RT school, and you enjoy working with people as I do, and you enjoy a challenge, this is a good field.

However, while I see this profession as better than working in a factory, or flipping burgers, or stocking shelves at a Walmart, it is still considered a bottom feeder job in the hospital.  I think if you are a person starting a family and you need a job with benefits, then this profession might be great for you for all eternity.

If you are a senior in high school thinking about going to respiratory therapy school, I would say "Go for it!"  However, I would recommend that you not stop there.  This profession will fill you mind with knowledge about respiratory therapy and healthcare in general that you will never receive by any other profession.  So it's an ideal stepping stone job.

In the past I have had three coworkers who have used the RT profession as a stepping stone to better jobs.  The first used it to become a hospital administrator, the second used it to become a nurse anesthetist, and the third is currently working on becoming a physician's assistant. Al three of these careers are well respected jobs that pay well.

For more information check out our RT Basics page.

16 tips to help you get hired as a respiratory therapist

I keep getting emails from respiratory therapy students on how to get a job as a respiratory therapist.  Or they might be something like, "What questions should I expect to be asked?"

My answer is usually something like this: When I was being interviewed most of the questions centered on the theme: will this person fit into our team? Does he have the right personality fit? Does he have potential? Is he teachable?

In other words, how to get a job as an RT is no different than for any other profession.  Here are some other tips:

1. Put in your application
2. Don't wait to be called.  Wait about a week and then call them.
3. Be courteous on the phone and in person
4. Be especially courteous to the secretary
5. Dress nice.  You do not need to wear a suit and tie, although nice pants and a dress shirt would be nice. A general rule is to dress about one level above what you would wear to work.  If you're applying for an executive position, then you'll want to wear a suit and tie. But since you'll just be wearing scrubs, you don't have to go to that level.  In fact, you might not fit in if you did dress that well. 
6. Be courteous, especially to secretaries.  The reason here is because I've heard of secretaries getting people hired.
7. Speak good English
8. Don't wear a bunch of piercings on your face.
9. Don't wear too much makeup or perfume
10. Be a good listener
11. Know the company that wants to hire you
12. Be on time, which means be about 10 minutes early
13. Know the name of the interviewer.  You can learn this by checking out the hospital's website, or by calling and asking.
14. Bring a copy of your resume, even if you already sent it
15. Practice your answers to basic questions, such as:
1. What are your strengths?
2. What are your weaknesses?
3. Why do you want to work here?
4. Where do you expect to be in five years? 
5. What do you do in your free time?
6. Tell me about yourself?
16. Ask questions.  This shows you are not all knowing, and are willing to listen and learn. 
17. Be honest.  Don't make yourself out to be what you are not.  If you're personality fits the milieu of the hospital, you will make it to the top of the hire list.  If your personality doesn't fit, there will be other jobs. 

Bottom line: Any hiring person will know that you have no experience, and that there will be a lot for you to learn.  So, this means that your two best selling points are how you present yourself, and that you are capable of being molded into the type of respiratory therapist the institution requires. 

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Respiratory therapists are eubiquitous

Respiratory therapists are ubiquitous; seeming to be everywhere at the same time.  This is the nature of our game.  Wherever we are needed, that's where we appear.

Where might you find your respiratory therapist? The following is a typical day at a hospital near you.  You will find your RT:

1. Walking into the front doors with a cup of coffee in one hand and a lunchbox in the next
2. Punching in
3. Greeting his coworkers with "I'm doing great today!  How are you?"
4. Placing his keys in his locker, and lunch in the refrigerator
5. Taking report in the RT cave
6. Answering the phone at the secretary's desk
7. Reading yesterday's newspaper in the RT charting room
8. Discussing a new idea for a protocol in his boss's office
9. Bantering with a visitor in the waiting room
10. Guiding a lost visitor to the room his mother is in
11. Guiding a second patient to the front back lobby
12. Grimacing as his beeper goes off for the first time for the day
13. Running through the hallway on the way to the emergency department
14. Bagging a patient in the Emergency room, and then setting up a ventilator
15. Washing his hands behind the ER nursing station
16. Running through the hallway on the way to critical care
17. Assisting with an intubation in the critical care, and then setting up another ventilator
18. Walking through the hallway on the way back to the RT Cave
19. Grabbing a clipboard in the RT Cave
20. Washing his hands in the bathroom near the cave
21. Walking through the hallway on the way to do breathing treatments
22. Walking into a room, saying, "Well, are you ready for your med-day peacepipe?"
23. Giving an albuterol breathing treatment in a patient room, and bantering just as well
24. Giving an epinephrine treatment in recovery
25. Attending a code in the front lobby
26. Performing EKG or PFT on an outpatient
27. Assisting a physician do a stress test
28. Washing his hands once again
29. Grabbing his lunch box from the RT Cave
30. Gobbling his lunch in the cafeteria
31. Grimacing as his lunch is interrupted by his beeper going off
32. Trudging down the hall on the way back down to ER
33. Rushing room to room in ER doing several EKGs
34. Washing his hands by the ER nurses station
35. Pikcing up some medicine in pharmacy
36. Rushing back down to the emergency room
37. Trudging room to room in the ER doing breathing treatments and more EKGs
38. Setting up a holter monitor in the emergency room
39. Rushing up the stairs
40. Grabbing incentive spirometers from one of many satellite stock rooms
41. Walking room to room teaching patients how to do incentive spirometry
42. Instructing a middle aged woman on methods for quitting smoking
43. Grumbling as his beeper goes off, once again
44. Taking an patient on a ventilator to CT
45. Setting up on oxyhood in OB
46. Running a blood gas in the laboratory
47. Watching monitors in the sleep study lab
48. Checking on a BiPAP set up in critical care
49. Joking with a critical care nurse
50. Giving a breathing treatment and watching the Detroit Tigers with a COPD patient
51. Watching telemetry while the monitor tech takes a break
52. Eating lunch in the hospital cafeteria.  Whew!  A much needed break. 
53. Watching a C-section in surgery
54. Watching Matlock while giving a breathing treatment to an elderly lady
55. High fiving a happy, young child with down syndrome
56. Cheering up a child with stickers after the lab tech drew his blood
57. Rushing past the unit secretary on his way to the stairway
58. Trudging through the surgical doors, and down a long hallway
59. Searching for an EKG machine that was not put away
60. Smiling when he discovers the EKG machine is right where he left it
61. Doing a STAT EKG on a pre-operative patient
62. Joking around with the nurses in recovery
63. Talking with a volunteer on the way up the stairs
64. Talking in the break room with a nurse
65. Meeting in the doctor's lounge with a hospitalist
66. Attending doctor's rounds in the critical care
67. Searching for an old EKG in medical records
68. Watching a football game in the break room, at least until his beeper goes off
69. Grabbing stock from the basement stockroom
70. Grabbing a new oxygen tank on the way through the tank room
71. Enjoying the fresh outdoor breeze while taking a break on the loading dock
72. Surfing the Internet in the Computer room
73. Attending a meeting in the classrooms
74. Talking with the CEO in the administration building
75. Assisting a nurse boost up a patient in bed
76. Attending a Keystone meeting in the boardroom
77. Extubating a patient in the critical care
78. Watching telemetry as a DNR patient's heart decides to go flat line
79. Taking a dead body to the morgue
80. Walking some epaper work to a doctor's office
81. Walking through OB on the way back to the RT Cave
82. Stopping on a dime as his beeper goes off
83. Rushing to check on a ventilator that "won't stop beeping."
84. Suctioning a ventilator patient in the critical care
85. Washing his hands in the patient's bathroom
86. Walking through the hallway
87. Eating dinner in the break room
88. Discussing the end of the day plan with his coworker
89. Rushing room to room doing breathing treatments
90. Standing in the doorway of a patient room saying, "Well, if I see you again, I hope it's at Walmart or a Bar or sometihng."  
91. Touching a little old lady on the shoulder, and noting how she smiles
92. Standing in the doorway of the same room, listening to one old lady say to the next, "What a fine young man he is."
93. Returning to the RT cave
94. Leaning back on his chair an dputting his feet up on the desk
95. Placing the keyboard on his lap and charting his daily work
96. Giving report to his replacement RT
97. Bantering with his fellow RTs in the RT Cave
98. Standing by the time-clock watching the last minutes tick away
99. Punching out
100. Saying "have a wonderful night" to the folks working at the front desk
101. Walking to his car after a long day

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Respect for respiratory therapists

I would like to revisit for a moment the issue of respect for respiratory therapists. For those of you new to this blog, you can read my opinion about respect for the profession here.

There is no less respect for the respiratory therapist as there is for any other profession in the medical industry.  There is no less respect for the respiratory therapists than there is for doctors or nurses or nurses aides or EMTs.

I had to bring this up again because I'm asked quite often by high school students aspiring to become RTs whether or not RTs are respected.  They say they want to take care of people with breathing trouble, but the RTs they talk to say there is no respect for this profession: don't do it.

I would like to contend that if you like people, if you have the skills necessary to make a difference to someone who has trouble breathing, then you should become a respiratory therapist; this is the right job for you.

Do not, I say, do not NOT go into this profession because people in the profession complain about it.  I say this because people in every profession get burned out and apathetic, and complain about their profession.  It happens especially among professionals who work with people.

When I was in high school I wanted to be a teacher.  I had a burning desire to teach, and I would have made a great teacher.  However, I asked two of my favorite teachers, and both told me teaching is a terrible profession, that the pay is terrible, and I should seek another career path.

So instead of going into teaching out of high school I became a journalist, and only later (after failing as a journalist) I chose another profession I really wanted to do: respiratory therapy.

Now, I love where I am at in my life, and I love being a respiratory therapist, but I would have made a great teacher.  I'm just saying.  I suppose, in a way, that's exactly what I've been doing right here on this blog the past six years.

My 15-year-old son wanted to be a dentist until a couple dentists we talked to said that it's not such a great profession, and there is a high suicide rate.  So my son said he didn't want to be a dentist any more.

I explained to him that he doesn't have to be a statistic.  If he really wants to be a dentist, he should do it.  He should not let a few negative people impact the most important decision he'll ever make.

I have a pharmacist friend who said pharmacy is a terrible profession.  He said you have doctors rushing you all the time, and you have patients who want you to get their prescription ready right now.  She said she'd switch professions, but she invested too much time and money, and has a lot of student loans to pay.  She said she's trapped.

I have an engineering friend who says he loves his job, but he's very burned out and apathetic even about that.  So, no matter what profession you go into, there's going to be burnout and apathy.  There's going to be complaining and negativism. It's just a part of life.

If you think you have the skills and personality that would make you a good respiratory therapist, then become a respiratory therapist.  If there are things you don't like about the profession, you can work to improve it, or you can use your experience and move up the ladder.

You also might find that you love this profession.

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Stand your ground

I'm fine with you guys disagreeing with me.  However, I'm going to say things on this blog that are considered by some to be "controversial."  I could just keep my ideas to myself, but what fun would that be.  And if Rene Laennec kept his ideas to himself, we wouldn't have the stethoscope.

Did you know that?  Rene Laennec was probably not the first person to use a tube to listen to lung sounds.  I mean, history says he was, but I think more accurately it was probably done before just the person (or persons) who did it were afraid to face a stubborn and proud medical community.

I don't mean to say that in a negative way, but it is true.  Most historians agree with me on this one.  In the 1920s the medical community was introduced to the stethoscope, and the basic response was, "You want to carry what? I'm a doctor, I don't carry stuff with me?"

The same rejection came when John Floyer invented the pulse watch.  Physicians said, "You want me to carry what?  I'm a doctor, I don't carry stuff with me?  Man, I could make a long list of things that were initially rejected by the medical community.  You'd probably be surprised.

I can make an extemporaneous list right here.  Things initially rejected by the medical community (unofficial list):

1. Stethoscope
2. Pulse Watch
3. Germ Theory
4. Bronchospasm theory of asthma
5. The Hypoxic drive theory is a hoax

Okay, I added in the last one to prove my point.  I truly do not believe in the hypoxic drive theory, and now there are physicians (not because of me, I don't want you to think this has anything to do with me) who support that the hypoxic drive theory is a hoax, and I interviewed one of them when I wrote my post: Hypoxic Drive: A history of the myth.  

I'm also a proponent with Albuterol being available over the counter, and I'm fine with you guys rejecting that idea.  I'm fine with doctors getting so mad at me they refuse to speak to me for months, as one of our physicians did.  I just mentioned it in jest, and we had a fun discussion (no sweat, no tears), and he walked off all mad.  

I can't help myself.  It's kind of the same as about ten years back I drew a blood gas on a homeless man that no doctor wanted to take care of because the man didn't take care of himself.  He came in with maggots in his leg wounds and stunk so bad we had to dunk him in the tub, took 10 of us to do it, to get the maggots off and the smell out.  

So three weeks later this patient is still admitted, and he's supposed to be going home.  So I do a blood gas because he doesn't look right to me.  I called his doctor who didn't want to do anything.  So I get the nurse to back me up, and we called the critical care nurse and supervisor.  We did this only on a gut feeling, and we decided together we had to do something even if the doctor didn't want to  

The nursing supervisor said, "Why did you call me?"  I said, "Because this guy doesn't look right to me and I decided we ought to do something.  Just because he's a poor homeless guy doesn't mean we can blow him off.  Look at him!"  I took the fall for the nurse, who was afraid of getting in trouble.  

I already had my blood gas kit, and I put the needle into the arm of the non-responsive patient. Blood oozed from the site and dripped down the arm and onto the sheets even as the needle was in.  This never happens, folks.  This guy, I could tell right then, was in DIC and he was in Sepsis and he was probably also in ARDS.  

The ABG showed a pH of 6.01.  Yes, that confirmed my suspicion.  By now the ER doctor shows up, and I give him the ABG results.  He says, "Oh, this must be a venous poke.  Do it again!"

"No, I said, "It's not venous.  And even if it is, that pH is still bad."

"Draw it again."  

So I do, and the result is the same.  The man was moved to the critical care with the diagnosis of DIC, Sepsis, and ARDS.  He died two days later on a ventilator.  

Later I talked to the medical director, and he said, "You did the right thing.  A person doesn't just go into spontaneous ARDS.  That person must have been showing signs long before you called, and what you did was heroic."  

Now I'm not trying to toot my own horn here, I'm just trying to make a point:  Stand your ground. If you have a gut feeling about something, if you have an idea, don't be afraid to go with it.  The automatic reaction of many people is to reject anything new.  The medical profession is a proud profession, and it is definitely no exception.  

And I mean no disrespect to the medical community either, because in the end it generally does the right thing.  The medical profession is no different than a peaceful phlegmatic person who gets comfortable and is resistant to change.  

I also believe that many of the procedures we do that aren't really medically indicated occur because we let it happen.  It happens because most RTs don't stand their ground because they are afraid.  They are afraid of the unknown.  

I wrote a post a while ago that I believe Albuterol has no effect on pnuemonia.  One doctor got so mad at me he wrote me to tell me he will never again recommend a patient to my blog.  I was actually honored, because I never expected a doctor would ever recommend my blog in the first place, let alone come here.

Yet it goes to show the dogmatic profession in full swing.  All I did was propose a theory based on empiric evidence.  I opposed their theory, that is based on skimpy evidence, if any evidence at all. Lord knows, the hypoxic drive theory was postulated based on a study of only four patients, and disproved 3534 times since then. So this is proof that while the medical profession pretends to push order sets based on "best practice medicine," they don't means "based on best scientifically proven to work medicine."

So keep this in mind the next time you come across an idea.  And keep this in mind the next time your humble RT comes up with an idea and shares it on his blog.  In no way am I trying to anger people: it's all about education.

Humility and Respect make good RTs

I recently had a fellow RT email me with the following comment: 

"I'm positive you have heard this a thousand times. Great site!  Though I have been an Rt for a few short years, I feel like I'm still putting things together. I'm embarrassed at some of the things I don't remember and sometimes afraid to speak cause it may show my ignorance. I'm quietly confident, never a know it all."

I think this pretty much describes most respiratory therapists, and it's a good thing.  I often have moments when I'm afraid to speak up and I've been an RT for over 15 years.  It used to bother me, yet after confiding with a wise old RT with this once, she said, "Rick, this is normal.  It's a sign of humility. It's a sign that you are not an arrogant know it all."

It kind of reminds me of when I started out as an RT.  In RT school I studied about as hard as anyone could study because I wanted to learn as much as I could.  This paid off because in those testy situations I always had, as the author of the above comment notes, a plethora of wisdom to fall back on.

Yet when I first started as an RT I'd often find myself doubting even my own self, and I would take a moment to stop and check my cheat sheets, or books.  Sometimes I'd even take the time to call the wise old coworker I referred to above.  She was always available even in the wee hours of the morning.I found myself doing this often.

Several years later I talked to a doctor who had to wait a long time for me to set up a ventilator on a certain patient because I had to make one of my infamous phone calls.  I said, "You probably thought I was stupid."

He said, "Exactly the opposite.  It was you doing that that made me respect you almost right away.  There are a lot of RTs who think they know everything and yet they know so little.  It's those RTs who act before thinking who end up hurting patients.  Your taking the time to call to get help is a sign of humility."

So this doctor pretty much summed up the words of the wise old RT.

As time went by I found myself doing the opposite as well: not speaking because I didn't want the doctor to be aware of HIS ignorance.  Sometimes I hold off all my wisdom to a patient as well because I don't want the patient to think the doctor is ignorant, even when I know the doctor is.  

I'm told is a sign of respect. 

The worse part of being an RT

Your question:  What is the worse part of being an RT?

My answer:  Politics.  I hate it when you have to tell your boss, "Sorry, I will never do it again."  I think that is the most political BS I've ever heard, yet I find myself saying it all the time just so my boss thinks I care, and to prevent myself from going on the defense.  Because, as I've stated many times, if you resort to defending yourself, the assumption is you are guilty.  I use that all the time with my kids, and bosses are no different than pseudo parents.  Bosses control you. Bosses are your gods. So you have to use whatever politics necessary to stay on the up with them, even if it means lying your little pants off.  Thus, this is politics, and I hate it.  I hate that kind of politics, anyway.  I'd prefer to speak the truth, such as, "Oh, that's not a big deal. You guys are making a big to do of nothing."  Truthfully, that's often the case.

How can you prepare for RT school?

Your humble question:  What classes are necessary to take in high school in preparation for this career?

My humble answer:   Rather than taking particular classes, I think what's important for you to do in high school is to learn how to discipline yourself to do good in school and get good grades.  From my experience the people who fail this program are those who lack discipline.  Other than that, some basic classes you can take in high school that will help you get through this program are basic physics, chemistry, math, and any health related classes.  Another thing I'd recommend is participating in a shadow program if your school offers such a thing.  Where I live the local high school has a healthcare shadow program where you participate in a class to learn the basics of healthcare, and then you shadow the various medical professionals in the hospital such as respiratory therapy, nursing, x-ray techs, lab techs, pharmacy, etc.  Any of the above will prepare you for RT School.

What do respiratory therapists do?

Respiratory Therapists (RTs) are professionals who work alongside nurses and doctors in caring for patients. The scope of patients we treat, and the scope of what we do, is almost too great to expound upon in one simple blog post, although I'm going to try here.

This profession started in the 1940s when taking care of oxygen equipment became too much work for nurses. The profession of inhalation therapy was slowly taking hold.  Most of the first inhalation therapists were nursing assistants (mainly men) who's job it was to haul tanks into patient's rooms.  In essence, they were oxygen jockeys.

In the 1950s oxygen was piped into patient rooms, and the need for oxygen jockeys was slowly eliminated.  Yet also in this decade aerosolized medicine therapy was revolutionized.  In 1952 the first metered dose inhalers hit the market.  It was also in this decade that the first effective and marketable glass nebulizers hit the market.  So now the task of RT shifted from oxygen jockeys to nebulizer jockeys.

The medicine aerosilized in nebulizers in the 1950s was epinephrine and isoproteronol, with the later being a refined version of epinepherine.  These were medicines that relaxed muscles wrapping around the air passages of the lungs, and thus made breathing instantly easier for asthmatic and chronic bronchitis patients.  It was our job to give this medicine, and to assess the patient before and after treatments.

Since then most aerosolized has been refined so much that it works better and side effects are negligible. Because of this it is prescribed by doctors for pretty much any patient with a breathing problem or with  a wheeze.  So being a neb jockey remains to this day part of the RT profession.

Some hospitals allow RTs flexibility in determining who gets aerosols by means of protocols, although some hospitals don't have protocols.  So the degree that an RT is allowed to use skills learned at school and through experience differs from one institution to the next.

Another thing that happened in the 1950s that greatly influenced the RT profession was the polio epidemic. Some patients with polio became so weak they couldn't breathe and required artificial respirations in order to stay alive.  This was a time when the iron lung became popular in hospitals.  These were large, bulky machines that were a lot of work for nurses.  So managing them became the job of inhalation therapists.

In the 1960s the name was slowly morphed into respiratory therapy.  Likewise, the iron lung was phased out in favor of smaller and yet more complex positive pressure ventilators.  To run these machines required a lot of math and science and common sense.  To benefit the patient RTs and doctors had to participate in critical thinking.

One of the main problems with this profession was that while nursing was recognized by the government, respiratory was not.  So in order to improve respect for this profession the National Board of Respiratory Care was created to improve education for RTs and to create tests that must be passed in order to become a certified or registered respiratory therapist.

Originally these tests were oral and, so I'm told, quite challenging.  The reason for this was because the NBRC wanted to make sure all RTs were well rounded critical thinkers as well as people who could perform a task.  RTs were now trained perhaps even more than doctors on how to manage the airway, and would be assistants to physicians more so than just jockeys who do tasks.

So as you can see, this profession is still growing.  There are many tasks we do, which include:

• Electgrocardiograms (EKGs):  This is a quick five minute test where the RT (or EKG tech) hooks the patient up to a machine that records the electrical activity of the heart.  It's a great test to see if there is any abnormality.  It's a great tool to help doctors assess and treat patients.
• Stress Testing:  This is an outpatient procedure whereby the patient runs on a treadmill and their heart is stressed. A rhythm strip of the heart and blood pressure is monitored by the RT and physician to determine if the heart is healthy.  Depending the specific test ordered, the procedure can last anywhere from 30 minutes to an hour and a half.
• Breathing treatments:  You put liquid medicine into a nebulizer cup and the patient inhales the mist created.  A typical treatment lasts 5-10 minutes.  The majority of these treatments are given to asthmatic and  chronic bronchitis patients who have breathing trouble.  
• Assessing patients:  This is generally done before, during and after breathing treatments.  If a patient is having trouble we are one of the first called to the scene to provide our excellent lung assessing skills.
• Oxygen therapy:  This involves deciding who needs supplemental oxygen, setting it up, and monitoring it.  There is a variety of equipment available to help patients get oxygen from the simple nasal cannula to big equipment such as ventilators.  
• Pulmonary function tests (PFTs):  This is a series of breathing tests to help a doctor diagnose lung diseases.  
• Arterial Blood Gases (ABGs):  This is an invasive blood draw.  Yes, you get to draw blood to.  This is where you draw blood from the artery (usually from the wrist area). The blood is tested to see oxygen, CO2, and bicarb levels.  The results may help you and the doctor decide how much oxygen to give patients, and whether they need (and how much) assistance with their breathing.  
• Suctioning:  Some patients have trouble bringing up secretions and need our assistance.  This is kind of like when you go to the dentist and they suck spit from your mouth, only we often go a little deeper.  It's an invasive procedure, and it's often rewarding for us when we can make something complex an uncomfortable for the patient as easy as possible.
• Managing the airway:  We pretty much do anything that has to do with the airway.  We suction, we  use an array of equipment and machines to breathe for some patients, we do breathing treatments, we clean and suction tracheotomies.  
• Intubating and/or assisting with intubating:  When a patient is having trouble breathing, or when he stops breathing, we often insert a tube through their vocal cords and into their lungs.  This way we can breathe for them using Ambu-Bags and ventilators.  
• Setting up Ventilators:  Once a patient is intubated we have to determine what ventilator to use and then we must set it up.  You and the doctor must use your experience to determine what buttons to push and where to set them at to benefit the patient.
• Managing Ventilators:  This is where your math and science come into play.  You use your education and skills to determine what settings are best for the patient and then you titrate these settings until the patient is ready to be extubated (take the tube out of his lungs).  Here you'll need to use your critical thinking skills (see below).
• Protocols:  These are policies that allow the RT to use his skills to determine at the bedside what is best for the patient.  You'll need to use your assessment and critical thinking skills.  
• Critical Thinking:  Here's where all your education and training come to the test.  Usually a patient shows signs he's going to fail, can you notice them?  Can you think of what might be needed to help a patient?  Can you use your skills to diagnose and come up with ideas to help the doctor help the patient?  Can you see the big picture?  Do you know how to manage a ventilator?  Do you know when a patient can come off a ventilator?  This, in my opinion, is the greatest part of the job.  

These are the main tasks that we do.  What makes it even more interesting and challenging is we have to do this for all age groups, and we work the entire hospital.  In this way, you have to keep up on our skills and education.  You'll be on your feet a lot.  It can be fun too. 

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RTs: Here's an update on credentials

So we used to be inhalation therapists and then respiratory therapists and now the preferred term is respiratory care practitioner.  Like the name of our profession, so too has the credentialing changed over the years.  If you're like me a quick refresher may be beneficial.

One of the reasons I chose to become an RT is I knew I could start working as an RT as soon as I completed the first year and passed the  Certified Respiratory Therapy Technician (CRTT) test.  No more is this option available.

The CRTT was created when RTs were in high demand.  Now that the field is saturated the CRTT has been eliminated in favor of the Certified Respiratory Therapist.  To qualify for the test you now have to complete an associates degree in a credentialled respiratory therapy program. 

Generally speaking, the CRT credential simply means you meet basic requirements to be an RT.  You understand and know how to operate basic respiratory therapy equipment and are compitent at basic assessment skills.  CRTs are qualified to obtain licensure in most states.

Most RTs do not stop at CRT and move right on to become a Registered Respiratory Therapist (RRT). While some states allow you to stop there, most require you to earn your license.  Requirements to obtain your license differ from state to state.

The CRT and RRT credentials were necessary prior to licensing because they proved you met criteria and were competent to be a respiratory therapist.  After your name you would write your credentials to show the level of training and competency you earned. 

Example:  Rick Frea, RRT

However, once you have a licence you no longer have to use your credentials.  If you have a license all you have to do is write "LRT" after your name, because writing this pretty much denotes that you have your CRT and RRT credentials.

Example:  Rick Frea, LRT

If you have a specialty you may also include these after your name.  For example, if you passed the Certified Pulmonary Function Technologist you may write CPFT after your name.  If you took the Advanced Pulmonary Function Technologist you may write APFT after your name.  (To see what other credentials you can earn click here.) 

Example:  Rick Frea, LRT, CPFT

If it makes you feel better, or if it's required at your place of employment, you can also write your name followed by all your credentials.

Example:  Rick Frea, RRT, LRT, CPFT

To  verify your license or the license of another person you can click here.

25 Reasons your coworkers don't like you

If you're like me you sometimes wonder what your coworkers think of you.  Surely it seems like they like you because they're nice to you, but what do they really think.  According to studies, there are a variety of bad habits that often determine what people think of you. 

The following are some of the things that if you do them, your coworkers may hate you for:

1.  Sucking up to the boss at the expense of your coworkers.  One example is pointing out mistakes of your coworkers so you look good and your coworkers look bad.  Then of course you mingle with your coworkers like you're innocent.  You can also call this All kissing or Brown nosing

2.  Taking work from your colleagues:  I had a coworker once who tried to make herself look like the hotshot by every time there was a critical patient she'd jump to the head of the bed and take over management of the patient.  It made me feel like an idiot.  Then she'd say, "Oh, I hope I'm not stepping on your toes."

3.  Taking too much credit:  You and your coworkers work hard to save a life, and your boss credits you.  Instead of sharing credit, you take it all for yourself. 

4.  Not willing to help out:  Are you sitting around on the Internet playing games while your coworkers are running a code in the emergency department?  Are you willing to take an extra load to help out?

5.  Unable to manage your own workload:  Some people simply can't prioritize, and can't get their own simple tasks done without calling for help.  There's nothing worse than a co-worker who leaves work for other people to do or finish.  Get your work done!  Do it right!  Get it done on time!

6.  Too much gossiping:  Like, I've heard enough about Dr. Blabbermouth's brother's sister's aunt's affair with Dr. Sassapants.  Enough already. Stop talking about other people.

7.  Too much complaining:  The person who complains to much about the boss is often seen as the negative, pessimistic person no one wants to hang around

8.  Being too loud:  Every office has one coworker who talks way to loud.  It's hard to concentrate when someone is yapping.  I don't want to hear any more about your golf game.  Shut your mouth!

9.  Being too messy:  You may see your cluttered workstation as a sign that you're busy or creative, yet your coworkers may see it as you being lazy.

10.  Noisy chewing:  Whether eating or chewing gum, excessive chomping is annoying. 

11.  Too much texting:  Are you texting during a meeting or when you're supposed to be taking care of patients? 

12.  Too much talking on phone:  Are you talking on the phone with your friends when you should be taking care of patients?

13.  Selling stuff:  It's fine to sell your home products during down times or during breaks, but some people spend their entire shifts trying to sell their products, and this gets annoying.  No one wants to feel "like they are expected to buy something," or "feel guilty for not buying something."

14.  Swearing:  Bad language is annoying.  Period. 

15.  Leaving too many notes:  It's nice for someone to leave a few notes around the office to maintain order, but that person who puts a note above or on every compliance is an annoying bugger. 

16.  Too much judging:  Yes I know I'm a screwup already.  I don't have to know everyone of my faults and every one of my bosses faults for that matter either.

17.  Selling out:  You are major supporter of an RT protocol, yet as soon as Dr. Scrubbin starts complaining about it you are the first to jump ship.  You think kissing the ass of your bosses and the doctors is more important that what some silly RTs want. 

18.  Leaving old food in fridge:  It's been a week.  Get your Sh...junk out of the fridge.  It stinks!

19.  Unwilling to work your hours:  You're sick all the time.  You can't be relied upon. 

20.  Tardiness:  Again, you can't be relied upon.  It may be okay to be late once in a while, but every day????  Come on!

21.  Procrastination:  Playing games when your work needs to be done. 

22.  Not taking advantage of leeway:  If you have a half hour leeway to do a breathing treatment, don't do it a half hour late because you were playing Zuma Blitz and got called to ER.  Do your treatment a half hour early, and if you get called to ER you'll still have time

23.  Unwilling to take on extra tasks:  Dont' be the person who says, "I don't get paid to write reports."  If your boss asks you for help doing something, don't be the person who always refuses. 

24.  Lying:  No one likes nor trusts a liar.

25: Politicking:  You tell me one thing to my face, yet say something else when I'm not around.  Again, you can't be trusted. 

References:

1.  Why Your Co-Workers Don't Like You,
2.  9 Valid Reasons for Killing a Co-Worker
3.  10 Worst Work Habits

Rules for dealing with night shifters

The following is a sign that hangs on wall of RT Cave:

---

Rules for dealing with night shifters:

1. Don't call him before 4 p.m.
2. Don't lecture him about his faults at 4 a.m.
3. Don't call him after he leaves work to tell him he's a screw up.  All this will do is piss him off so he can't sleep, and he'll be even less effective the next night
4. Remember that one error doesn't constitute a crisis
5. Don't tell him he looks or sounds tired, because he is and he does

10 Great things about being a respiratory therapist

Nearly every night I work I hear discussions along the lines of "Why don't respiratory therapists get more respect?"  A great question, and I answered it here.  I would like to counter that discussion by listing the 10 greatest things about being a respiratory therapist.

1.  It's a good, clean job.  We work inside where the air is fresh and clean.  The air is warm in the winter and cool in the summer.  

2.  We work 12 hour shifts.  This is nice because you get more days off to either spend with your family or, if you want, do a second job.  

3.  It's a fun job.  When your work is done there's plenty of time to socialize, gossip, eat, play games, surf the net, pay your bills, or watch TV.  

4.  It's rewarding. It's simply a rewarding feeling when what you did, or said, made someone feel better.  It's also rewarding knowing you did your part to save a life.  

5.  We bring joy to people. Sometimes just by you lending an ear to a sick patient, or having that discussion, is all it takes to make some one's day.

6.  We are ubiquitous.  Seemingly, we are everywhere in the hospital all at once.  We have free reign.  This beats being stuck in one spot all day, in one room, with one patient.  

7.  A great variety.  We do all sorts of tasks, and offer a variety of skills.  And every day offers a new challenge.  

8.  Teamwork is fun.  Skills you've obtained through education and experience come in handy as you participate as part of a team to benefit a patient.  

9.  We are educators.  We educate about lung diseases, and are trained to guide people through the changes they'll have to make in their lives to overcome their illness.  

10.  You develop skills.  Your expertise on managing the airway is essential to saving a life, and keeping someone alive so the doctor has time to work his or her magic.  

What do you like best about being an RT?

Respiratory therapists are the best RTs

A doctor is a doctor, a nurse is a nurse, and a respiratory therapist is a respiratory therapist.  In the same way we can say a dad is a dad, a mom a mom, a child a child, a teen a teen, and a newborn a newborn.  You cannot expect one to comprehend the world as the other as each has a limited scope of wisdom from experience and observation.

You cannot expect a child to understand the hypoxic drive theory even if there was an interesting book on the subject.  You cannot expect a newborn to babysit a child, but you can expect that a teen can do it.  An adult can do it, but not another child.

In the same way, you cannot expect the doctor to be as good at nursing a patient than a nurse.  You cannot expect a respiratory therapist to be good at changing diapers any more than a physician would be good at it.  Surely a respiratory therapist can start IVs, but he won't be as good as a nurse.

Each person has abilities based on empirical data obtained during the course of life; based on our experience; observation; education.  It is for this reason we must, as a medical industry, allow folks of each profession to perform the duties they are trained in.  Nurses do nurse duties to the best of their ability, doctors do doctors, and RTs do RTs.

Now surely a physicist can write a poem, and a poet can do physics.  Yet never will the poet be as good of a physicist as the physicist.  And never will the physicist write as good of poetry as the poet. Surely there are rare feats, but good poets are rare as good physicists are rare.  Yet good poets are even more rare than good physicists.

So my point is that we must do what we are best at and let the people who are best at something else do it to the best of their ability.  In this way we make better progress.  If, hence, the doctor changes the diaper of a 90 year old patient, he may make a bigger mess of it.  I know if I did the same I wouldn't be so good.  A nurse, however, and the nurses assistant are so trained.

This is why I believe physicians, however brilliant in what they are, do not know respiratory therapy.  It is, as Egan noted, beyond the scope of a physicians knowledge.  It is, however, in the scope of the RT's wisdom.  RTs know RT.  RTs therefore should be allowed to do RT without the physician stepping on his shoes.  RTs should be given more autonomy in order to benefit the patient.

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What do RTs really do?

The American Association for Respiratory Care (AARC) lists the following tasks that respiratory therapists do:.

• Diagnosing lung and breathing disorders and recommending treatment methods.

• Interviewing patients and doing chest physical exams to determine what kind of therapy is best for their condition. 

• Consulting with physicians to recommend a change in therapy, based on your evaluation of the patient.   

• Analyzing breath, tissue, and blood specimens to determine levels of oxygen and other gases.

• Managing ventilators and artificial airway devices for patients who can’t breathe normally on their own.

• Responding to Code Blue or other urgent calls for care.

This list is an ideal list of the tasks RTs do.  For all you RTs out there in the real world, how accurate do you think this list is?  Does this paint an accurate picture to prospective RT students? 

Based on your responses I will update this list so that it is accurate if necessary.  So what do you think?

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