Wednesday, June 13, 2012

Anaphylaxis

Everything is kind of a bigger deal when it comes to pediatrics. I've been at the children's hospital for about a month now. The major thing I've learned is that kids crash fast. Last week I did a cap gas on a baby just out on the wards. When I came back from my lunch the kid was intubated in the ICU. I thought the kid looked fine. Seriously. Also you can do exhalation vibes on a pediatric patient with just one hand. And it covers their entire chest.

And. The best thing about pediatrics (and I may have mentioned this before and I will probably mention it again) is their little trachs. No inner cannulas. There is effectively no such thing as trach care on a ped. Bliss.

There is a huge focus on education at the hospital. A lot of these kids go home with trach's, NPAs, ventilators - you name it. So mom and dad (or foster parents a lot) have to be well versed on how to deal with all of these things. One of the best instances of this is the procedure in Emerg for a kid in anaphylactic shock. The first thing that happens is they are rushed into a trauma bay (usual procedure everywhere) but then they have mom or dad give the epinephrine via an epi pen... For practice.

Awesome.

Wednesday, May 30, 2012

"Corrected the RT mistake" and more notes from Nurse charting

I love nurses. I really do. They are amazing people who are capable of performing phenomenal tasks. Things that I could never do.

However. Sometimes....

We came on shift and a little guy was having some trouble with his chest tube. A little investigation revealed that the suction regulator had been turned down so much that no suction was being applied to the chest tube.
Because a nurse saw that the regulator was above -20 mmHG, and turned it down to that.

Well everyone knows that the wall regulator does not have any bearing on the actual amount of suction being applied to the patient - the chest tube system does that. Enough suction needs to be applied so that the suction is relayed onto the patient, after first being checked by the suction system.

Remember the three bottle system!

So it doesn't matter how high the wall regulator is - the tube system is supposed to be set to -20.

Thanks nurse for "correcting the RTs mistake."


Saturday, May 26, 2012

A New Chapter!

I have been notably absent from the world of blogging for what looks like about 3 months. That is insane and too long to be absent. Definitely too long to be absent and then still expect anyone to be reading anything I write.

So I consider this starting over from scratch.

About 3 weeks ago I decided to toss my application into the pile for a casual position at the local children's hospital. Unbelievably I was hired. So a few weeks ago I started my orientation. It started with a week long classroom orientation. As it turns out there's a lot of equipment used in the pediatric world that's not used out in the big adult world. Also because of the range of sizes and ages of the patients there is a wide range of devices to learn. It's actually excruciatingly overwhelming :)

Ok. So first I get hired. Then I spend a week in a classroom (underground - like most RT learning spaces). Now I have a 8 week (8!) orientation to all areas of the children's hospital.This includes PICU, Wards and Emerg. So all in all, it's the exact some areas that I work at at my adult site. Which definitely helps. I have a giant advantage over the brand new grads that are stumbling around there.

I finished my second day today. Nothing new or exciting to report. Except for the obvious. My new patients are incredibly cute and don't smell bad.

So far so good. Looking forward to new adventures and more scribing.

Wednesday, February 29, 2012

Aspiration.

I just fully aspirated half my cup of coffee. Granted, it wasn't a full cup of coffee, but 20 minutes later I am still coughing and sputtering.

This brought some thoughts to my mind. I just spent 3 night shifts at the hospital, 2 of those nights I was on the floors assessing one patient Q4. This particular patient has severe kyphoscoliosis which is in fact nearly occluding his airway. To solve this problem he received a trach, but it needed to be a certain trach in order to mold to his anatomy - enter the Bivona. This trach has no inner cannula - which makes me increasingly nervous. Especially since the quality of this patient's secretions have been becoming sticky and thick. We keep an emergency crycoid kit in his room. Seriously. Part of the problem is that while in the ICU we were using the Optiflow device on this patient in order to keep his secretions loose and flowing. Once he got transferred out to the floors he was switched over to a cold neb/ trach cradle. It's not that we don't use the optiflow on the floor - but we were trying to wean him to a device he would be likely to go home with. Given the permanent nature of his trach. Anyway.

The cold neb was definitely not doing the trick and although we were instilling his trach with normal saline Q4 to keep the goodness flowing - we were having more and more difficulty even passing a 14 fr catheter. At all. Luckily this was during day shift (when I wasn't around) and using some force they were able to get the catheter through. We went right back to the Optiflow and everything cleared up. Amazingly.

The point of this all was my realizing that having normal saline poured directly into your lungs (instillation) must feel like absolute crap.

Friday, February 24, 2012

CPR works. Sometimes.

We got called to a code blue in interventional radiology. So basically they injected this awesome old lady with some dye and she fully coded. There was also some fentanyl involved. Of course a billion of us (ok maybe 5 RTs) responded to the code. We were fully in control of the situation while the Dr's were arguing about what to do. We set up for intubation, were doing CPR, bagging, doing an ABG - you know everything that usually goes on at codes. On the second round of CPR suddenly the lady's eyes shot WIDE open. She started breathing. We removed the mask from her mouth. And then she started screaming at the top of her lungs. Shrieking actually. It was terrifying and the most awesome code I have ever been to.

Then the resident running the code pumped her full of normal saline and fully overloaded her heart. We took her to the ICU where she completely failed the task of breathing and we intubated her at that time.

Sunday, February 5, 2012

Resumes and Jobs

So a temporary line has come up that I think I would like to apply for. It's perfect for me, since it only lasts until June - so if I hated it at least I wouldn't be tied in for long.

The problem is my resume. Since being a student and being hired into this current job I haven't had much cause to update my resume. So now I am wondering what a true health care resume should like.

So far the only thing I can add to my resume is:
  • A year of clinical experience
  • Up to date CPR
  • Up to date N95 mask size. 
That's sure to impress.


Wednesday, February 1, 2012

The Casual RT

I had an extremely awkward 'one on one' conversation with the manager of our department the other day. The first thing that made it awkward was the fact that it was sprung on me with no notice. Maybe I am strange, but I am the kind of person that would like a bit of time to prepare for an annual review. Instead I was paged at noon and told it would be happening at 1 pm. OMG. Full panic mode sets in for me. Blergh. I am an employee. I have a manager. And he wants to talk to me. This is awful news! Or terrific! Or terrifying!

He asks what my plan is. I don't have a plan and don't have time to think up a lie about this. Unfortunately. So I am just honest. I'm truly not sure how it went. I shared. I probably over-shared.  I share that I would like to finish my bachelors degree, which is true, it is a goal I have for sometime in the future. And he suggests maybe getting the CRE (is that a Canadian thing? Certified Resp Educator) for some fictional future job I might have. And that's the other thing. He has questions about where I would like to work - not only in which department, but at which hospital. There's a new hospital opening soon and I have a feeling we're a little bit afraid of losing some staff.

The truth is I still like being casual. I don't want a line. That doesn't go over well in conversations about goals and long term employment.

To be continued. Obviously.


Tuesday, January 24, 2012

Key West

Do you know what's more awesome than winter!?

Key West. I wish I could move here. It's amazing. And warm. There are chickens and cats everywhere. And I have never been happier.

Hurray for holidays!

Monday, January 9, 2012

RRT - 9 Months in.

I have been an RRT for 9 months now. In the past few months I have worked a medium amount of shifts.  I have worked in the ICU and on the wards. Most lately I have taken on an interim role in the Long Term Care Centre (Long term vented patients).

In fact, I wanted to apply for a permanent position in that role, but I couldn't because 1 year experience was required. So that was actually kind of disappointing, so I will have to hold on and wait for something else to pop up. A new hospital is opening here next year and they have already listed jobs for 23 RTs. Like the jobs are posted already. But do I want a job? I have no clue - I am actually enjoying being casual, it is unbelievably flexible.

And as far as the ridiculousness I have encountered while in the hospital this is one of the best:


  • I asked someone on a floor for a pulse ox. (I am not sure of the role of this person, they were seated at the desk at the front and were wearing scrubs.)
  • They had no idea what I was talking about.
  • Eventually I was able to describe it
  • They handed me a pulse ox and told me it hadn't worked earlier in the day, so good luck.
  • Indeed the pulse ox would not even turn on.
  • I am a genius and replaced the batteries.
  • The pulse ox now works. 
Ta da!