CHBRRT

Great thoughts GreyGull; however, I'm assuming that He means that the ventilator flows are so low, combined with such small exhaled Vt's makes it extremely difficult for EtCO2 monitors to sample from the patient. For all intents and purposes, the monitors are accurate because what they sample is what they display. However, in this case, it's what they're unable to sample.

Of course you must use other numbers, as well as looking at your patient when you do not have certain numbers. I'm not sure what you have for vents; however, the Servo-i is really spot on for EtCO2; however, sometimes the Vt alarm goes haywire unless you have the flow sensor inline. Unfortunately, you cannot have both. So if your Exhaled Vt's are okay, the EtCO2 on the Servo-i is great. Most of the time, unless the kid is severe, we'll spot check with each Vent Check.

great comments greygull, i think everyone is making this more complicated than it should be. first and foremost, always look at your patient. what are they doing, or not doing? how are their vs? sats, bp, hr? stevennp said: decreased mv (minute volume) usually means the tube is occluded with secretions, or worse, out. wow! let's with the simplest explanation: the mv is lower than when the rt set the alarm initially. mv is rr x vt. so, one of the two has to be affecting the alarm. whether the pt is breathing slower than initially, or there is a leak effecting vt, this is when the mv alarm will sound. i guess the tube being out is a leak; however, most of the time, alarms are not the worst-case scenario. the easiest indicator of your tube being out is the etco2 going to 0. however, we live in a world of leaks, so be careful it's not just a leak causing the et to read 0. it will take time to understand what the different alarms are for your vent, and what the different alarms signify, so take advantage of your rt's, and ask questions. we love teaching!!!

Yes we do as well; however, they threw this idea out there. Which was not recieved very well.

greygull is correct in his/her overall point about not becoming an rt; however, is incorrect about many things in the post. the following is school specific, and i'm not knowledgeable about every school so don't take my word as gold. it only takes 2 years to become an rt, it is an as degree program; unless you go to a 4 year school. you are not required to take any extra courses that an rn would have to take other than conceptual physics, which is a lot of gas laws, etc. rn's actually take more than rt's as far as chemistry. i did not have to take any chemistry other than what was built into a&p. also, rt programs do not require nrp, pals, or acls; however, are starting to offer them in conjunction with their nursing and/or paramedic programs. working at children's hospital boston, we are not required to have nrp, pals, or acls because our orientation/ training is so intense. however, our department will fully support us getting any additional certifications. if you get a job in a children's hospital, you are trained across the board. each children's hospital has multiple icu's including the nicu. you would go through orientation for each unit. there is no specific amount of experience required. finally, in regards to becoming an np, unless you are committed to getting your phd, don't bother. legislation is in the works for 2015 that will require np's to have their phd. good luck!

Sounds like an LP was warrented, but maybe not now because he is afebrial. I agree that it's not tracheitis as well, he is most likely colonized. This explains the + culture. Doesn't sound like it has to do with any of his history. Maybe something viral, or a small foriegn body aspiration the body was fighting off. Something small wouldn't show up on the CXR. Good Luck

I am a Respiratory Therapist in a Boston NICU. Our NICU wanted to start utilizing RT's to verify breast milk prior to being administered to the patients. I was wondering if anyone had any thoughts on this. Is it within a Respiratory Therapist's scope of practice to do? What if something went wrong and the RT signed off on the milk? Would the law support the RT? Is it not the same as verifying blood? Thoughts?

Only RRT's run ECMO at Children's Hosp. Boston. There is an RN taking care of that aspect and 1 RRT that is the ECMO specialist who runs the circuit as well as the vents (Vent, Hi-Fi, and Nitric).