RTreformed

So, I'll keep it as short as I can, I mean, its simply my opinion... You are comparing apples and oranges, and will never get a honest answer, as each side will claim superiority... Rt for 8 years, majority critical care and trauma at large facilities, and I know, without a doubt, there is no rn who can begin to manage a ventilator, understand settings and make appropriate changes as well as I can, period. Regular vent, hfov, jet vent, no, critical care rn's have a basic grasp, but thats it... In the same breath, I couldnt run an iv pump and calcuate drug dosages to save my life... I knew how once, but never used it, now its gone... Now, could an rn learn to be competent at ventilator management, absolutely... Could I learn drug dosages and calculations and run pumps.. With out question... Its really not a matter of who is better, simply different educations... Rt's spend years studying what nursing may cover in a few weeks, whereas nursing may spend a whole semester on a subject that I was taught for a single class day because it wasnt relevant to what I do... Daily rt activity varies wildly depending on the type of facility you work at... Go to a small, band aid station hospital, and you will hump nebs all day, every day, and probably be less respected for all your hard work and running around... Work in large, teaching facilities, and become very experienced, and it is completely different... I typically have a unit with 10-12 icu beds, and thats all my assignment consists off... If there arent many vented patients, sure, im slow... But I help out other areas... Just as if the nurses have stable patients, they are slow as well... And out of respect, if they ask me to help roll/turn a patient, im game, im not too big for it... I simply dont wipe butt because poop-vomit-urine are the reasons I didnt go to rn school... Doesnt make me want to vomit, just not something I care to deal with, and wont... So much for keeping it short...

if an RT gives a pt a pneumo, i pretty sure its not the RN's phone who rings, pretty sure it would be the RT's... and i only give attitude to those i feel deserving, and every bit of attitude ive given on this board that were belittling were am at people who belittle my profession, just as if i had attacked nurses IN GENERAL... im pretty sure my attacks were aimed at specific people... and as for people being hesitant to call on me, i have NEVER had that as a problem, i have always had a great reporte with most(and you cant please everyone) RN's i have ever worked with, in many instances i was called to the patients bedside who were spiraling to code before the MD was paged.... i have NEVER made the statement i was more intelligent, simply that i am more knowledgable and experienced with ventilators and the pulm. system in general... i said it before, i have been shown by RN's many times how to run iv pumps and such, but if i see the pt is aggitated, i dont go up on they're sedation, even though i know how, why? cause im not the one accountable for it, and that is not a designated practice for me to do, even if the RN is busy in they're other pts room... even with a simple abg with increased CO2, the RN way of thinking is "just go up on the pts rate"... yeah, turning that knob to increase it is easy, little bit more to it though... was the pt aggitated when you drew the abg, what was their minute volume? is the pt spontaneously breathing? could the pt use more tidal volume, do they need more ps, and thats if they are on a simple straightforward mode!!! what does the pt need to support there demand? yeah know, there is a calculation for determining how to correct a pts CO2 precisely, instead of "just increase the rate by 2 and check another abg"... again, trying not to seem attacking, just because it seems simple and straightforward, it rarely is... and im sure, as i sit here on my 28th hour of being awake, that this is coming across once again as "attitude"... but hey, what can ya do....

wow, how this took on such a life... yeah, i was very defensive earlier, and will try to keep it tamed down a bit... as someone said(not sure who) it is a question of training and experience, and not intelligence... in an earlier post i said an rn could work for 20 yrs as an rn and not know as much about mechanical ventilation as i do after 6 yrs of practicing as an RT, and i mean it... just as i learn about various other aspects of nursing care, i could never grasp the full concept of nursing unless i did it day in and day out... but to address the "an rn can turn a knob", i still dont agree... in the end, I am responsible for that ventilator and any changes made on it, and its my license and my a** on the line... perfect example, i worked in a facility that used the Siemens Servo 300, which is a minute volume constant ventilator... RN got a an ABG, didnt call me(although i was 4 rooms away) and decided to make a change herself... she decreased the rate... 20 minutes later, when i walked in the room, she said "hey, i got an abg and turned the rate down"... i walked to the vent and looked, and by her decreasing the rate, the kids tidal volume went from 80cc to 150cc... so, i got her from the nurses station and showed her, and she was amazed, had no idea... because she did not have the EXPERIENCE with the machine, and she was a well seasoned rn... and to say an iv pump and a ventilator are the same, is simply moronic, and shows your ignorance of ventilators in general "one pushes air, one pushes liquids" or something like that, for gods sake PLEASE, if thats the grasp you have of ventilators, i pray that everytime you touch one someone slaps you in the mouth.... both facilities i have worked at, i work nights... people on here keep throwing the "well, an order has to come from a physician"... you know how i get orders for vent changes from a physician at both places i have worked?? i go to the md, and say "hey, i got this abg earlier and made these changes" no matter how significant they are... and the response is usually "oh, okay, thanx"... had an adult pt the other night on an oscillator, and neither resident had ever seen it, so guess how i got my orders... residents saying "just fix it then tell us what you did and why"...

i love respiratory care, love what i do... the things mentioned here are exactly why i love it... im not tied to one area, i excel in general pt care, adult, peds, and neonatal intensive care, emergency care, i love being that diverse, as opposed to being in one area at all times... i love being one of the first responders to codes, exciting stuff, absolutely love it... but as mentioned, the downfall is there is really no room for advancement, nursing does have so many choices to get more education, better themselves, and make more cash... with resp, really, all you can do is move up into management, which really sucks, i like pt care, why would i want to sit behind a desk... and pay difference is pretty negligable(sp), most places ive worked, starting pay is around $2 an hour difference...

how funny, i've just started watching the E.R. seasons recently, and it cracks me up, the way they bag people, its like they are trying to see how fast they can squeeze the bag... or the way pts come in on NRB, and they are like "O2, 15L by mask", i just laugh, im like "yeah, 15L by mask, 40L by mask, its 100% regardless", and the bag is always deflated, and all you see is condensation on the inside, i mean come on, just hook it up to AIR and it would look better... or the way all you ever hear is "call respiratory, tell them to set up a vent" never see one, just set up the vent... but, i try not to pay attention to that stuff, i just try to enjoy the storylines...

atrovent shouldnt be given closely together, and honestly, for acute bronchospasm, i personally dont see a benefit... a better neb to give is instead of a regular 2.5mg albuterol tx, give 5.0mg or more... there have been times where i have been in the E.D. and had a young asthmatic in very tight bronchospasm and given them 2-3CC or pure albuterol concentrate with 0.5ccs of saline or none at all... they were all on a monitor and responded well, instead of giving neb after neb after neb, just up the concentration and get a quicker response... xopenex is a good derivative of albuterol, but everything ive ever read says not to give it back to back, and most literature says it should be given Q6H or even less frequently...

very well said...

stay in school before you start running off at the mouth... never, and i mean, NEVER in your life will you have the conceptual grasp a good RT has on mechanical ventilation, the pulmonary system, and how they affect every other system, period, accept it. just as i will never have the grasp RNs have on most other things, drugs, doses, etc. im not disputing RNs, or what they are capable of... and the job you would so happy and (in)capable to do, is not yours to do, because you are not educated enough or trained to do it... being able to turn a knob when a physician tells you to is one thing, knowing its wrong, why its wrong, and how it will affect the pt is different all together, and thats all you would be able to do, make changes as told to do so... when you graduate, i would bet you payday after payday that you couldnt do it, and win everytime... suctioning, drawing abgs, these are remedial tasks equivolent to passing meds and drawing labs, i am MORE than capable of doing it, but im not trained to, so i dont... yeah, RTs may not have as much work in an ICU as you do, maybe, but im paid for what i know, and my ability to think at the moment and do whats best for the pt, even when the RN or MD have run out of ideas... nothing is better than being in an ICU, with an extremely ill/injuried pt who is going down the tubes, having an RN that has total faith in my ability, as i do in theirs, and the resident is clueless as to what to do, and by morning, the pt has turned around, and you know, that between the RT and the RN, that the 2 of you, working as a team, but letting each other do their own thing, saved the pt... thats what its all about, i dont need an RN to make suggestions to me, because im sure, its already crossed my mind, and if its a good RN, then they dont need my assistance, because whatever my suggestions may be(lasix, vasopressors to bring up a poor pressure due to my necessary vent settings increasing intrathoracic pressure) the RN will be 2 steps ahead of me... and thats healthcare, RT and RN teamwork at its finest, you do what you have to do, i do what i have to do, and maybe, we save the pt individually but as a team...

im being stalked here... lol

thank you, and this is the experience at the 2 hospitals i have worked at as well... im not saying Rn's cant do what i do, but if i had chosen the profession, i could do what an rn does(poop, pee, and puke, ugh, i couldnt do it lol) also, just because anyone can turn a knob, or push a button, doesnt mean someone fully understands the concept and rationale behind it, i can make changes on iv pumps, ive been shown, but i dont... ive read back through my posts here, and man, im really coming across as an *edited*, sorry...

and again, wrong usage... tell me how a bronchodilator does anything for a cough? wouldnt robitussin work better?

resp. alkalosis is basically caused by hyperventiation, whether spontaneously, or mechanically. the problem you can run into, really low CO2 levels can cause vasospasm, which is why it isnt advised to use hypocarbia as a method to control ICP. also, if CO2 is low enough for an extended period of time, the body begins to "dump" HCO3, in an effort to compensate, so inevitably, you will run into having to try to correct 2 systems instead of one. resp acidosis, has nothing to do with oxygen, although PO2 can be affected by acidosis. resp acidosis is caused by hypercarbia, bodies inability to regulate CO2. when your CO2 increased, your pH drops, which actually can cause lower PO2 levels, the more acidic the body, the less affinity hemiglobin has for oxygen(see the oxyhemiglobin dissociation curve) i have actually seen MD's and RNs try to fix resp acidosis by giving HCO3 in an effort to compensate, unfortunately, they dont realize that eventually, HCO3 breaksdown into CO2, thus causing your resp. acidosis to worsen.

ive been an RRT for 6 yrs, i could quit, right now, and you could work as an RN for the next 20 yrs, go back to school for an RT, and work at it, and you would still not have the grasp and understanding of mechanical ventilation that i have right now. im so tired of RNs like you, "we can do what RT's do" listen, i had 4 yrs of education on a system of the body that you spent 2 weeks on in nursing school. yeah, any idiot of the street can be a "neb jockey", but true RT's know more about ventilation and the pulmonary system than you ever will...

wow, you know what, you people are absolutely right. WHEEZING is not the only indication for albuterol, because, rhonchi, rales, upper airway edema and any other inflammation can cause wheezing. the only indication for albuterol, is actual BRONCHOSPAM. albuterol is a beta 2 agonist, causes the smooth muscle walls of the airway to relax when they are having bronchospam. nurses believe that they "need a tx" anytime they hear adventitous breath sounds... for every 200 calls i receive about patients "needin a tx", 1 of those pts actually has bronchospam and benefits from it... also, albuterol does NOTHING for a pts sats, period. and for those of you who will say "ive seen their sats come up", next time, notice if the RT is giving the neb on medical air, or OXYGEN, hello? im not lazy, i dont mind doing my job, cause, im damn good at it, but i absolutely HATE doing any type of modality that is unindicated. and i hate the RN way of thinking "well, it wont hurt them, we should try it", you know what, 0.25 morphine wont hurt them either, so lets try it as well? now do you see the idiotic logic? jamie p rakes RRT