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  1. heinz57

    Trach with oxygen

    If you are running the trach aerosol off an air compressor, that little blue dial is NOT what your O2 percentage is. That dial is used for O2 percentage only if you are running it directly off an oxygen flow meter with the manufacturer's recommended liter flow to deliver that dialed in FiO2. If you are using an air compressor, that blue dial controls the amount of aerosol delivered (moisture or humidity). You place an O2 line from an oxygen source to the aerosol tubing to deliver the oxygen. The actual percentage of oxygen delivered to the patient will depend on how the tubing is attached to the patient, patient's respiratory rate and overall delivery flow.
  2. heinz57

    oxygen delivery with nasal cannula

    Those plastic bubblers can be used with a High Flow Nasal Cannula which have a slightly larger tubing bore. It is often a different color like green to differentiate it from a standard cannula. It is capable of flows up to 15 L/m. The OxyMask can also be ran off that little plastic bubbler at flows of 15 L/m. However, the standard nasal cannula (at >6 L/m), Simple Mask (regardless of flow) and nonrebreather should not be used with the plastic bubbler.
  3. heinz57

    Salbutamol with normal saline

    In the United States, Albuterol comes in both forms. It can be a diluted 2.5 mg unit dose or the undiluted form which can come by individual dose package or in a multidose bottle. The US has gotten used to giving a 2.5 mg UD dose of Albuterol for all ages regardless of EVM of the advantages of giving 5 mg because it is easier and anybody can do it. To answer the OP, it can also depend on the nebulizer you are using. Some of the BAN or Circulaire type nebulizers can take small quantities with minimal waste. Standard nebulizers can waste about 40 - 60%. This number can be higher if given by mask or blowby. A straight 1 ml of 5 mg Salbutamol can be extremely effective and with minimal waste when given by a BAN type device.
  4. heinz57

    End of CCT Nurses in California?

    After reading Akulahawk's post, I doubt if CCT RNs have anything to worry about. Akulahawk, Stop worrying about being called an Ambulance Driver if it is in reference to the "one who drives the ambulance". I can see you getting out of your ambulance to scold the child who gets excited watching someone he thinks is cool driving an ambulance. Nurses have learned to accept the rude remarks and even laugh about it when Paramedics call them butt wipers and bed pan specialists. They know it is part of their job and not their entire identity as professionals. Work as a nurse and you'll be called a lot of things.
  5. heinz57

    Nurse manager said O2 concentrator can be used with BMV?

    The "bag" or "tail reservoir" of a BVM (Ambu) helps increase the concentration of oxygen. It has very little to do with CO2 since the exhalation is through the spot where you place a PEEP valve if you have one. If a concentrator (5- 8 L) is all you have to provide O2, use it. At least you will have more than 21% for oxygen. However, a concentrator will not work with a flow inflating bag (neonates, Jackson-Rees bag). For oxygen sensitive kids, we have been known to remove the reservoir bag or tail and attach the O2 line directly. With the air entrainment through the end, the FiO2 is reduced to 0.35 to 0.40 with 10 to 15 L O2 attached depending on the size of BVM used.
  6. heinz57

    Living Will Tattoo

    This seems to be a popular tattoo to get right now. A couple of 20 y/o EMTs were showing off their Do Not Resuscitate tattoos in the ER. The impulsive actions of the young or impaired judgement of a drunken dare may also bring questions of legitimacy. Even those who might have health concerns and pursue the tattoo option versus discussions with their physician, attorney and family might raise questions for state of mind. Those who commit or attempt suicide and have a hand written DNR directive lying beside them have been seen many times. Without some evidence the person has discussed mental and physical health with others to substantiate a need for a DNR, we do not know the true intent.
  7. heinz57

    End of CCT Nurses in California?

    This is an old discussion but some attitudes don't change. In all fairness, most EMTs and Paramedics have no clue about the many different specialties of nursing or any other hospital or clinic health care professional either. Many in EMS are clueless about the scope of practice of a flight or critical care nurse and assume all nurses must call a doctor to hold their hand for every order and procedure. EMS has also changed some of its titles or has so many titles you need a continuously updating app to keep up with the "EMT-I is now EMTA (sort of) although it is more of an EMT-B, which is now EMT, with some of EMT-I but not quite. Some use the NREMT and some still don't. The Paramedic varies from State to State, county to county, city to city and company to company. Privates hate the fire department EMS. Fire department Paramedics think the privates are stupid and only good to transport BLS even if they have a Paramedic patch. Don't put this all on nurses for not knowing every little detail of your scope of practice for you patch. When contracts are negotiated, a cheap sheet should be given to the hospital to avoid confusion. It is really not that difficult. I will say the hospitals which have their own CCT teams with CC trained RNs are the easiest to deal with so I hope they stay or even expand more into transport. OMG don't get me started on the "Ambulance Driver" bullpoop! "The "ambulance driver" got a ticket" or "Tell the Ambulance Driver to move their rig" and you get holy heck raining on you even if it does not pertain to anything medical. Who cares what their medical certification is if they were doing a 100 mph in a school zone going back to the station? The person driving the ambulance (Ambulance Driver) probably has the most responsibility of all getting everyone where they should be safely in a timely manner regardless of which EMS title they hold. This includes the routine medical transport rigs which have to keep on schedule to get patients to their schedules appointments.
  8. heinz57

    Cough Assist oops!

    Mistakes happen. However, make sure that machine is thoroughly cleaned which may mean a biomed trip to be taken apart and decontaminated. Had this been in a place where the machine is used on multiple patients, it could have been much more serious for cross contamination. Our machines, including all ventilators, are routinely swabbed for evidence of cross contamination even with the filter in use at all times.
  9. heinz57

    What am I missing?

    It is not so much the training of EMT or Paramedic but the need to hold one of these certs to satisfy outdated transport regulations in some states which are controlled by EMS regulatory boards. Some states say to participate in any out of hospital transport especially scene response, you must have one of these certs. It is a very territorial industry. You should hear the negative comments in places which use an ER or Trauma doctor on transports. "ER doctors should stay in the ER!" and that goes double for nurses.
  10. heinz57

    Pt. With trach: cuffed but always deflated?

    The cuff does very little to prevent aspiration since it is located below the glottis. The exception might be one with a subglottic suction port. Trachs are expensive. BUT, a cuffed trach, whether it has been inflated or deflated, should be changed out every 30 - 60 days. Other reasons for no trach change: The doctor managing the patient may have no clue about trachs. No one caring for this patient may have the training to change the trach. No one mentioned it in a plan of care. Pt has been written off as a "why bother?". Proper cuff inflation is difficult to determine with positive pressure for a minimal leak technique or a manometer.
  11. heinz57

    Switching from Nursing to Respiratory Therapy

    That is not true. Many sleep technologists are EMTs and LPNs who got trained for sleep lab and then got certified as sleep techs. Not that many RTs are sleep techs since they separated the licenses and Sleep now has its own board. Many states also require an RN to oversee sleep labs and do the assessments for each sleep patient. There are several hospitals which have cut back on RT staffing. RNs can do treatments, ABGs and manage ventilators especially in NICU, PACU and on transport. Our CVICU have the nurses actively managing the ventilators during the weaning process. There are also fewer RTs in out of hospital situations such as rehab and LTC since they are not covered under Medicare for many situations outside of the hospital. In several states RTs are also not allowed to do any outside of the hospital transports which is why it is not common to see RTs on transport. RT was once the golden goose and were everywhere but they have not keep up with others. OP, Have you considered EMS? Paramedics can do a lot more than an RT can and now do much more than just work on the ambulances. They are in the ERs, Cath Labs and in home care managing CHF, surgical, COPD and asthma patients.
  12. heinz57

    NPA/Nasal Trumpet

    If the patient needs a trumpet for airway clearance, they probably need a swallow eval but without the NPA. The problems often come from improperly sized NPAs. Rarely are several sizes stocked and usually just what is available is shoved up a patient's nose. You could, however, time the NPA maintenance around the need to swallow pills or water. The NPA will be out at that time .
  13. heinz57

    Nicotine Test for new employment

    Did you not see the statement for tobacco and nicotine on their employment page? I am sure the application had a lengthy section about this to which you agreed to with your signature. This shouldn't be a surprise. Given the information now available about e-cigs, the health risks shouldn't be a surprise either.
  14. heinz57

    RT Career?

    Tmw you are describing something which is unique to your facility. I have worked in Florida and the RTs are not doing most of what you describe. There are hospitals in South Florida do not allow RTs to draw ABGs and I know not all transport teams have RTs. The nurses and Paramedics manage the ventilators even on NICU teams like MCH in Miami. RNs also manage vents and extubate post op in a couple of the hospitals I am directly familiar with. What you described for pushing medications makes my point about direct supervision. It is good RT raised its education to an Associates degree but I do know many RTs were grandfathered in with a 1 year cert or less. It will take many years before all RTs have a minimum of an Associates degree. Yes there are RTs inserting PICC lines and also doing IVs and phlebotomy but that can be an effort to save jobs while nursing is picking up things which RT is losing reimbursement for. I hope RT survives but even your professional website states the bills for professional recognition was defeated. This has created lots of opportunity for nurses to take over COPD and Asthma education. Best of luck to you in your pursuit of an RT career.
  15. heinz57

    California marijuana legalization

    Nice try with the stats game but you have to read what they are actually supporting. Error 44 (Not Found)!!1 This is now a new administration. Neither Bernie or Hillary is the President. Trump is not in favor and Sessions has already put undoing legalization of marijuana high on his list of things to do. Sessions is the top cop and can choose to enforce Federal law at any time anywhere. Also, as long as your employer has ties to Federally funded money or insurance, no pot for you. Of course you could go work for DISH. Edit link didn't work but it is easy to Google the breakdown of what people are actually in favor of.