pmath_RRT

Your friendly RT should be taping the tubes as well. Using AnchorFasts cause soo much breakdown due to the hard plastic on them. I normally place a saline bag under their forehead and one on their chest and it seems to help. I don't think there truly is a foolproof way of doing it in my experience. Rotate head and arms q2. Stuff a pillow under them abdomen on whatever side they are facing

Confront her in a professional manner. Just tell her you don't appreciate her condescending comments about your personal life and you feel like she's creating a hostile environment. Majority of the time people like that will back down. Throughout my life there always been at least 1 person who tries to get like that with me. After I confront them it's ceased the bad relationship and they either stay away from me or they do a 180 and become super nice. If it continues next step is speak with charge or your manager.

Let's say you were in mgmt and what happened to you was brought to your attention. What would you do to handle this situation?

Non-rebreather masks should not be set lower than 15L. You run it any lower than that you will cause the patient to rebreathe their CO2. The bag MUST be inflated at least 2/3rds full on peek inspiration. Is the pts SPo2 on the NRM 90%? If yes then yah they need it. My hospital only allows temporary NRM and will need to transition the pt to a more appropriate device like HFNC or BiPAP. Unless this is a COVID+ pt where we were allowing NRM + NC on. But that was my hospitals policy. From, your friendly respiratory therapist

RT here, A lot of new grads/med/surg nurses tend to always think just because they hear a CHF pt with audible wheezing requires a dose of ALLBETTERol. Not all wheezes are due to bronchospasm. Think about the pathology of the disease state. The pt has fluid in his lungs and needs to get the fluid out. Where the fluid backs up starts in the alveoli and begins to build up, thus making the already small airways smaller which creates that wheeze/crackle sound. We refer to it as a cardiac wheeze. The pt needs lasixs more than anything and maybe if they are still having a hard time maybe some nitro. Albuterol doesn't pull fluid out of the lungs nor will it relive the SOB in these particular cases. I don't think this cranky RT acted right and yah they may have been very busy and or ,just like me, hate being told "the pt needs a tx". Maybe just say can you come assess my pt for me. After I receive these calls and determine the pt does not need albuterol I will take the time to find the nurse and explain to her why they don't , not in a rude way just some education is all. You have a whole career ahead of you and lots to learn. No one should be yelling or acting unprofessional to you or literally anyone else they work with. Hopefully you have a better experience with other RTs in your future. We aren't all cranky!

RT here, It sounds like this kid needs to be put on maintenance inhalers (LABAS) or maybe just an Inhaled corticosteroid. Also are you checking this kids peak flow? You guys should know what his green/yellow/red zones are. Don't wait to administer the albuterol MDI, waiting with asthma is a very dangerous game. Also this child should have a spacer with his albuterol MDI with every administration to ensure he receives all the medication. Make sure you are performing proper MDI administration. He shouldn't be taking a fast deep breath with it, it should be a slow inhale with a breath hold for 5-8secs. Hope this helps. Asthma with kids can be very dangerous.

Poor seal with mask. Always look for chest rise. Was it difficult to squeeze the bag? Yes I would have put in an oral airway, tongue could have been occluding the airway, if this were the case it would have been difficult to bag. Also i'm afraid one of the posters is incorrect, you do get just about 100% O2 with an ambu bag plus you are getting positive pressure. The bag on an ambu bag acts as reservoir which helps you get 100% O2. 15L is simply used to keep the bag inflated, the pt is not receiving 15L, the LPM is determined how fast you are bagging (which I don't recommend bagging quickly because you will start forcing air into their stomach). Another question I have is has your hospital removed all air flow meters? I have heard so many times people plugging the ambu bag into the air flow meter and not the O2 flow meter.

A compressor only delivers RA. No matter what you set that dial on the aerosol bottle you will only get 21%. So it sounds like this pt is not on O2 but is on RA with humidity.

Hypoxic Drive...No! Its the Haladane Effet and V/Q mismatch. Remember that its called the hypoxic drive THEORY. It is just a theory, and nothing more. In my years of practicing as an RRT and seeing countless COPD'ers who were retainers I have never shut down their drive to breathe by giving "too much oxygen". And from my colleagues I work with who have also been RT's for over 20 years they said they have maybe seen it 1 time. Usually its the "blue bloaters" and when you do give them too much O2, their drive to breath shuts down almost immediately. Severe digital clubbing and their skin is almost grayish that they have seen this theory actually in effect. But again new studies say its 2 factors, Haladane Effect and V/Q mismatch. Please read that article I attached at the beginning of this post. Your friendly RT and bedside buddy, Phil, RRT-ACCS

Hypoxic drive THEORY. Notice I put theory in all caps because it is just a theory and actually more of a myth. Look into the Haldane effect and V/Q mismatch. Also if this pt has never had a PFT done then you can't assume he has COPD just because he was a smoker. Sounds like the guy has sleep apnea and should be wearing his CPAP.

Sorry, no BiPAP for someone who is unresponsive. Patient cannot protect their airway with a mask strapped to their faces. Bipap requires patient participation as it is only for spontaneously breathing pts. NRB good choice if pt was able to maintain sats within normal range, but the pt needed to be intubated if truly was unresponsive. Also contrary to the popular belief, Albuterol doesn't revive unresponsive pts, latch on to that evil CO2 and pull it from the patients lungs. Nor does it cure every thing. Did the pt get overdosed on pain meds or were sneaking their home meds? Narcan maybe?

Yes there are these complex answers given by everyone in here but there is also a very simple explanation. The bubble humidifier is only meant for 6L. Exceeding this flow will cause the humidifier to build up way to much pressure and then, KABOOM! Now you get to clean up water and calm down your pt because water will be everywhere.

Redraw. That is an false reading. Possibly air got into the sample or the ABG machine isn't calibrated right. Always "look at your patient". Do those results reflect how the pt looks?

Thats what we call a combined acidosis. The RT needs to fix those vent settings fast. And the docs need to get on that renal issue too. CRRT would help but we can blow that CO2 off to bring that pH up to make it suitable for life.

BiPAP is considered "non-invasive ventilation". Therefore it is a ventilator.