Getting to Know Your Coworkers
Which RT’s childhood nickname was Spunky? Side note, though they miss it now, they hated it in their teens and would never answer their dad when called it.
Kathy
Unlike bacterial infections, bronchiolitis is treated with what?
Supportive care only; suctioning, fluids, oxygen. May use HHFNC or BiPAP if needed
What is the best location for a pulse ox on babies?
Right Wrist
What is a normal ICP?
Between 0-15 mm Hg
A patient scores a 10 on their initial protocol. After placing your orders, what do you need to do?
Make sure to place a specialty comment that this is a Qday Protocol to help ensure the next one does not get missed.
Which RT won a free vacation to Florida from a national writing contest by explaining to the tune of The 12 Days of Christmas, why they needed a vacation?
Drew
What is a normal COHb?
1-3% with a smoker's normal being up to 15%
What is the easiest way to lose pressure in nCPAP with the Flexitrunk?
under-sized prongs
Pulmonary hypertension ultimately leads to this type of heart failure due to increased pulmonary artery pressure and vascular resistance.
Right heart failure
Which elbow do you need to use with the C1 setup for NIV and why?
The blue non-vented elbow should be used with all dual-limb circuits with active exhalation. The clear anti-asphyxia EE elbows are used with single-limb circuits with the disposable exhalation port.
Which RT was an airplane mechanic after high school?
Brittani
What size ETT would you use for an adult cricothyrotomy?
5.0-6.0
What is the typical first dose of surfactant?
What about the second?
2.5 ml/kg
1.25 ml/kg
What is P0.1?
P0.1 corresponds to the drop in Paw, observed during the first 100 ms of an inspiratory effort made against the occluded airway opening. It indicates respiratory drive/WOB
What things are important to remember with laryngectomy patients?
They do not have an upper airway. They cannot warm, humidify, or filter the air they inhale. They cannot be orally or nasally intubated. Have all supplies (trach, suction, peds mask, BVM) and signage in the room.
When this RT was born, their esophagus was in 2 pieces. Once piece attached to their lung and the other was just dangling. This required emergency surgery day 1 of life.
Cassidy
You are called to room 2 for a patient coming in satting in the low 80s with increased WOB. Upon arrival, you notice the patient is trached with a 5.0 cuffless Shiley. You get the okay from the MD to place the patient on the vent. What are you preparing to do first?
Have the difficult airway cart in the room and prep for a trach exchange with a bigger size and cuffed Shiley.
What are appropriate initial settings on the neopuff?
PIP 20-25, PEEP 5, Flow 10 LPM
Name the two reasons for an increasing PIP.
Increased resistance (secretions or bronchospasm) and decreased compliance (pna, atelectasis, pulmonary edema, or ARDS)
Name 3 benefits of HHF.
Dead space reduction increasing alveolar ventilation, dynamic positive airway pressure increasing alveolar ventilation, and airway hydration maintaining mucociliary clearance
Which two respiratory therapists were born in the same hospital?
Krista & Jaime in Pennsylvania!
You have a 30kg Asthmatic child in the ED. You have just finished up the second continous neb and the patient’s PAS score goes from a 10 to a 7. Transport to Children’s has been delayed. What is your next step?
Reassess the patient in an hour. If PAS score goes back up, repeat a continous. If PAS score remains 7 or less, return in another hour to administer the first Q2 treatment.
You are caring for a 36 weeker on CPAP +6/30%. It's been decided to intubate and surf this 2.5 kg baby. What size ETT are you prepping and what are your initial vent settings going to be?
3.5 uncuffed ETT and 30-40/15/+6/30%
You have a patient on APRV P-high 25, P-low 0, T-high 6, T-low 0.6, and 80%. Your initial ABG comes back 7.28/58/90/23. What vent adjustments can you make?
Start by increasing P-high by 1 or increasing T-low by 0.1, then you could decrease T-high by 0.5.
Explain the Home O2 process. Go!
Verify order. Ensure RA SpO2 ≤88%. Fill out Home O2 flowsheet. Reconcile the order and sign “Existing EHR or Paper order”. Talk with patient about company preferences and verify demographics. Use EPIC or fax documents to DME cmpany and call them. Deliver O2 tank to patient, instructing on use with prescribed liter flow and having them call DME as soon as they arrive home.