RT Student Blog

Remember when I told you about my fellow blogging RT students in Sometimes I Breathe, Consciously Breathing, Free Speech, RT Scribe, and Trauma Junkie. Well thanks to the list (see previous post) I have discovered another one. It's the Sleep Deprived RT Student and much like myself, he's in the home stretch with one more semester to go. Now, I just have to figure out where he's located (hint hint)

Exciting news. I discovered that Rick over at Respiratory Therapy Cave posted his "Top 23 Respiratory Therapy Blogs of 2008" and more importantly he included a couple of student blogs. Including this one. I was pretty excited because he included me and a couple of my blogging friends. I know, I'm supposed to be talking about school and all but we are on break between semesters. Don't worry, I'll be back to school soon. But like my buddy the Trauma Junkie (who was also on the list, just a little higher), I'll tell you what was said.

"9. RT Student Blog: I
always say you can learn more from RT Students than seasoned doctors
mainly because students have all the up to date wisdom while seasoned
doctors still go by the wisdom of the day they graduated, which is
often wisdom that is antediluvian. This blogger puts a student spin on"
current RT wisdom."

My teacher just emailed me a link to a website that I thought you all might be interested in. It's called RT Space and is tagged as "A Global Community for Respiratory Therapists". I have only signed up and got a username and password. I haven't really explored a lot yet, but I will. Check it out, sign up and let me know if you find any cool stuff.

I just thought I'd post this. As you can see it's 31 degrees right now with a high of 40 today. The day after tomorrow the high will be 71. Definitely warrants a WTF? Oh, and just a note, the past week has been in the 60's.

...the semester is over. I got my report card in the mail (3 B's and 2 C's), I've paid my tuition for the very last time (445 bucks) and ordered my books on amazon (100 bucks but they're not here yet). Now I'm just biding my time until the semester starts January 12th.

Let me explain the structure of our program because I know all programs are different. First of we have 2 teachers, Mrs. H the program director, and Mrs. G the clinical director. The first semester, Fall #1, Mrs. H teaches us Intro to Respiratory. It's the only class the first semester. It introduces us to oxygen therapy, drugs, masks, and patient assessment. The second semester, Spring #1, we have 2 classes and 1 day of clinicals a week. The main class is taught by Mrs. G. It's the most important class if you ask me. Thats where we learn how to give breathing treatments, draw ABG's and all of the other procedures we'll need. We also take Cardiopulmonary Anatomy and Physiology taught by Mrs. H. You all basically know what that one is. For Clinicals we went to 3 hospitals this semester. The class still had about 12 people and the teachers accompanied us to these and taught us patient assessment and breathing treatments.

The 3rd semester, summer, is mainly critical care. This is when we learn Mechanical Ventilation and a variety of ventilators. In order, we learned the PB 7200, Servo 300, Servo i, and PB 840. Final checkoff was brutal because we had multiple scenarios on all of those vents and it took about 3 hours. We also took the Pathology course with Mrs. H this semester. We learned a lot about the diseases. We had one day of clinicals a week and went to a few more hospitals and even did a home health rotation. For the Pathology class we had to pick a clinical patient and do a case study on them. I'm pretty good at writing and made a 96 on the case study.

The 4th semester, Fall #2, is an exciting time. The most exciting part to me was the fact that we have freshmen that we are interacting with. It's a great feeling to be able to impart advice to students who are where I was a year ago. This semester we have 2 days of clinicals a week and it's mainly in ICU's dealing with ventilator patients. We also do our intubation rotation at an operating room. I got all 4 of the intubation checkoffs I need. We also have our neonatal and peds class taught by Mrs. G. We learn everything we need to about babies, deliveries (I went to 4), and neonatal ventilators. NICU is a big part of what we do and learning this stuff is important. We also took a class called Advanced Monitoring and Procedures taught by Mrs. H. It's basically about all of the various things that we hadn't covered before. We learned about things like sleep study (polysomnography), PFT, and cardiac drugs. We also took ACLS this semester. This class is also a review to prepare us for the CRT certification exam. We had a mock CRT for the final and I made a 105 (highest grade in the class).To step it up from the last semester we had to do 2 case studies (1 for each teacher). I made a 95 and 89 (I'm a good writer but Mrs. G is a really tough grader).

Now we are about to begin the final semester, Spring #2. From what I can tell we will have 3 days of clinicals; Monday, Wednesday, and Friday. Beyond that we have one class. It's taught by Mrs. H and is basically a preparation class for the RRT (the second certification exam). We also have to do some kind of community project. Most students just go to high school and talk to students about respiratory stuff. We also take PALS (Pediatric Advanced Life Support) this semester. I don't know about any written case studies but we'll see.

As my buddy over at "Sometimes I Breathe" spoke about in his last post, I too am 4/5th of the way through my Respiratory Therapy program. Thats 4 semesters behind me and 1 semester to go. I have turned in my clinical checkoff book, finished my exams, and got the grade for both case studies. In my Advanced Monitoring course I got a 100 on the exam, 95 on the case study, and 88 in the class. In my Neonatal/Pediatrics class I got an 82 on the exam, 89 on the case study, and 80 in the class. Both classes were very hard but the teacher from the Neonatal course is a bit tougher in her grading. I am definitely going to be a better RT thanks to her and she's even in my facebook friends.
I have been working quite a bit as a Respiratory Assistant at the local hospital. As a matter of fact today is my first day since Thanksgiving with no school or work. I am absolutely doing nothing today. I have even purchased the 2 books I need on Amazon with my coinstar change. Here are the books too.




Now that the semester is over I can take it easy for a few weeks at least. So I'll wish a Happy Holidays to my fellow blogging RT students in Georgia, California, Texas, Canada, and another one that is in Texas. Go check out their blogs and tell them I sent you.

I don't know about you but I have finals next week and I'm not really excited about them. One of them is a 140-160 question practice CRT exam. To prepare for it we have been taking various practice tests every day for the past 2 weeks. My classmates and I are all in the same boat at the 60%-70% range for our grades. Anyway, I was searching online and found a free practice CRT exam at the NBRC's website. I started to take it but then decided it was too late in the evening to begin a 140 question test. I'll take it tomorrow night (maybe) and definitely a couple of times in the next week. If you want to take it and post your scores in the comments that would be great.

Well, tomorrow is the day. I am going to a hospital I have not been to for a special clinical experience. I am going to intubate surgical patients. I need to get 4 checkoffs and have 2 days to do it in. If I don't get them all I will just have to return next semester. Some of my classmates have had less than pleasant experiences with the staff there. I am not worried though because I consider myself more of a people person. We will see though.

For those of you who don't know what intubation is I will tell you. It is when you have to put a tube down someones throat into the trachea to help them breathe. There are many different situations where this is necessary. Surgery where they are going to be placed under anasthesia and will need a machine to breathe for them, and emergencies where they can't breathe or can't protect their airway. Wish me luck.

I was just going through my list of checkoffs I need by the end of the semester and the end of next semester.
This semester I need to complete:

• set up a Non-rebreather mask (2)
• set up an aerosol mask (1)
• set up a face tent (1)
• do a peak flow measurement (2)
• do an acapella (4)
• IPPB (1)
• insert an oropharyngeal airway (2)
• insert a nasopharyngeal airway (2)
• Nasotracheal suctioning (3)
• tracheostomy suctioning (4)
• bedside spirometry (1)

Well, I started my first day on the new job today. I am officially not a secretary in the emergency department. I am now a Respiratory Care Assistant. That is pretty much the job we are eligible for once we complete the first year of the program. I was pretty much shadowing a couple of therapists today but I did learn the scope of what I'm allowed to do. I can give breathing treatments, O2 checks, and suctioning. I did suction a trach patient today. There are a few things I can't do though. I can't do ABG's unless there is another therapist there, critical care (vent patients), and the emergency room assignment. I did go from about 10 bucks an hour to about 13 bucks an hour. When I'm done training I should get up to the 24 hours a week I had before. I can't wait to tell you more about the job. I'll try to get a picture in my new, all black scrubs for you tomorrow.

---

This is me at 4 AM up and ready for clinicals. Actually, I was up at 4 but it wasn't til about 4:30 that I was out of the shower and at this point. I think I hate hospitals that want me there at 6 AM.

...but today was a pretty good day and I wanted to share it with you.

My classmate who was supposed to be there with me called in sick today so I was alone. The day started as normal and went well. I did get a whole bunch of checkoffs I needed and almost got a few that I had never done. I had to get an ABG on a patient who had an arterial line in place. This was exciting because it was the first one I had actually seen. Unfortunately it wasn't working too well because when I withdrew the thingamajiggy, the blood only came up about halfway.

The next thing I attempted was nasotracheal suctioning. Thats when you run the tube into the patients nose and down into the lungs. Not a pleasant experience for either of us (moreso for the patient, of course). To make matters worse, my teacher happened to be there. I only got the catheter about a third of the way down. The patient complained a lot during this process.

Well, it's official. I just sent the email to give my notice. October 1st I will no longer be an Emergency Room Secretary (clerical coordinator) and become a Respiratory Care Assistant. This is the student job that we are eligible to get when we enter the second year of the program. The level of responsibility varies depending on the facility. At the hospital I am at the RCA get's to do breathing treatments and patient care. I don't get to do critical care and emergency room/trauma care. I will make 3 or 4 dollars more an hour and get valuable experience.

***Click on links to see pictures***


Well, I made it through another day of clinicals. It wasn't a very exciting day but it was ok. I did get my third extubation. That is when a patient who is on a mechanical ventilator has improved to the point where they no longer need it. Then you extubate (the opposite of intubate) them. Here's how it works.

First you explain to them whats going on. You get one of the pads that are normally placed under the patient and spread it out on their chest. You deflate the cuff that holds the ET tube in place and listen at their neck for air movement. If you don't hear air, that means the airway has swollen and you shouldn't remove the tube. Then you re-inflate the cuff. You then suction them out with the closed suction catheter that is attached. Then you suction out the mouth and oral cavity with the Yankauer (also known as the Yonker). Then you turn off the ventilator (or place it in standby as we did with the Servo I pictured to the right). This is to ensure that it doesn't spew secretions everywhere when you pull out the tube. Then you tell the patient to cough and you pull out the tube. You then place the patient on an aerosol mask with a cool mist provided by a large volume nebulizer. Then you hope for the best.

well, today is my first day of clinicals as a senior. Thats why I'm writing this at 5:30 AM. I have to be at the hospital at 6:45. Thanks to gas prices we are doing 12 hour clinicals for 2 days a week instead of 8 hours for 3 days. I know I'll come to appreciate that extra day off soon enough but right now I'm just thinking "arrrggghhh! 12 hours!"

anyway, I got my first 2 test grades back. On the ventilator weaning test I made a 77. I wasn't happy at all but at least I passed. On the test in Advanced Monitoring class on sleep study and patient assessment I made a 91. That teacher likes to use the questions at the end of each chapter ver batim on her tests and we figured it out over the summer.

tomorrow is the first test of the new semester. The first month or so we are finishing up mechanical ventilation and tomorrow's test is on weaning. One of the most important things that you need to look at with a patient on the ventilator is when are they coming off. There are 19 things to look at when deciding if a patient comes off. I know RT's in the hospitals do not always look at 19 things when weaning but for this test I need to know them. I think I have them down mostly, including some new formula's (yuck).

1. original reason for ventilation has improved or resolved
2. ABG is good
3. hemodynamic stability (good HR and BP without use of vasopressors)
4. able to initiate inspiration
5. P(a-A)DO2 <300>
6. VD/VT <60%
7. QS/QT <30%
8. PaO2/PAO2 >0.35
9. static compliance >30 mL/cmH2O
10. PaO2/FIO2 ratio >200
11. SWI <>
12. Normal temperature
13. Hgb >8-10 g/dl
14. vt >5mL/kg
15. vc >10 ml/kg
16. RR 8-20 bpm
17. ve <10>
18. MIP > -20
19. RSBI <>

Wow, thats a lot of stuff and apparently I don't know them like I should because I had to look at my notes to type this list. I've made some of them bold and those are the ones that you need formulas for. I'm gonna see if I can add the formulas below.

6. VD/VT = PetCO2-PaCO2/PaCO2

7. QS/QT = P(a-A)O2 x 0.003/3.5 + P(a-A)O2 x 0.003

9. st cl= VT/plateau pressure-PEEP

11. SWI = vent RR(PIP-total PEEP)/MIP X PaCO2/40

19. RSBI = spontaneous RR/VT in Liters

There. I pretty much got those out without looking at a card for the most part. Another formula that I'll need tomorrow is one that I know. It's the one for PAO2 = (PB-PH2O)FiO2-PaCO2 x 1.25. I doubt any of this will help any of you out there but I just thought I would share what's spinning around in my head. Good night.

I start back to school tomorrow and for my senior year I bought a new bag. I had been thinking of finding something different than my 8 year old (though still totally cool) laptop bag. I searched and searched different stores and even bought a bag on ebags.com that turned out to be way too small. Finally searching around on eBay (obviously) I found it. It was advertised as the Jack Bauer Messenger bag and was just a simple, olive colored messenger bag. I even have posted a picture of it in action from the show "24". I am a huge fan of the show so this bag is totally a great bag for me. Well, it arrived Saturday and I just love it. All the books (3) and notebooks (2) that I need for this semester totally fill it up. Hopefully I can get rid of a few of them. I even stuck some of my (liberal themed) buttons on it. I'll take a picture of it soon for you.

700 bucks. Thats how much the bill was at the mechanic to get my car back the other day. It's a 1992 Cadillac Sedan de Ville with over 200,000 miles on it. I need it to last me through this last year of school until I can graduate and get a Honda Fit, or Toyota Prius (quite a different direction from the Cadillac, don't you think). Anyway, here's what I had done:

1. New tires-the tires were in really bad shape. You could see the wires coming out
2. Full tune up-It had been a long time and was sounding rough so I did the full tune up with new spark plugs, wires, and distributer
3. Oil Change-also time for this
4. Replaced the Idle Motor-not sure what this is but it was idling high. It would try to accelerate when I didn't want it to or when I was stopped.
5. Service Engine Light-It had been on for about a month and I got it taken care of. I think it was on because of the idle Motor

Now the car drives like a dream. This is good because I have a lot of driving to clinical sites this semester. You remember the map from a few days ago.

I applied for a position as a Respiratory Care Assistant at the hospital I currently work at. It's pretty much a student job that is for senior RT students. At this hospital they get to do mostly breathing treatments and some ABG's. I think that I have the inside track because I already work at the hospital. Wish me luck,

Well, I'm sitting here at home with no ride. it's because my tires were about to fall off and my "service engine soon" light was on. I put the car in the shop for new tires and a full tune up and oil change. This is a necessity because of our clinical schedule. We go 2 days a week to about 6 different hospitals. The closest one is about 10 minutes away and the furthest one is over an hour away. This map of north carolina should give you a general idea. The blue circle with "H" is where I live and the black numbered circles represent the hospitals where we'll be doing clinicals. That's a lot of driving so I'll definitely be doing some carpooling.

Today I am preparing for the upcoming semester. As you know by now I cash my change in at the local CoinStar machine and choose the Amazon coupon. That way I don't have to pay a fee and I can use it to buy my books. I had about 68 bucks in change today. That's not enough to buy my 2 books which are about 100 bucks. I'll go ahead and buy them in the morning. Hopefully I'll get them by the first of next week because I can get about a week's worth of studying.

Another thing I did today was register for the NCSRC Conference in Winston-Salem. We are going the first week in September. I'm really excited about it even though I'll have to share a room with 5 women (doesn't sound too bad when you put it that way now).

Well, another weekend is behind me. I do love working in the hospital because I get to talk to the Respiratory Therapist's and see what they do. I also do a lot of talking to doctors. That helps me when patients have respiratory disorders and I get to see the x-ray's.
Another thing I did was finally set this up to email me when I get comments. I thought I wasn't getting any but then I looked back and saw them. Thanks to Borderline Agrophobic and Diana Lyn for being the first commenters that I got emails from. I would love to set up an email group amongst all of the RT student bloggers if you are interested. You can email me at my email address marcus.williford at gmail. That way we can exchange notes and hints amongst all of us. If you're a Respiratory Therapist student then send me your email address. I'll publish a list and we can help each other get through.

Well, today is the day that I am going to pay my tuition. I am taking 15 credit hours this semester so it's going to cost me $675.00. That is the most I have ever spent on one semester and frankly I'm a little saddened by it. I have withdrawn the cash and I'm going to pay it today. I am going to school on the G.I. Bill/Army College Fund and the way that works is you pay out of pocket and they send you a monthly check. The payment is due by Monday and the monthly check will come in about Thursday. It's ok though because I've gotten used to it. I just wanted to vent about the high tuition. Then there's the books which should come out to about $120. Luckily I only have to buy 2 and have the luxury of the internet to shop for them (amazon) and don't have to pay the bookstore prices.

well, I went to the school today to work on the Servo 900 some more. It is an older ventilator and one I had some trouble with in the last few weeks. I als spoke to the instructors today. In exciting news we are all now student members of AARC. We are also gonna be preparing to go to the NCSRC conference in Winston Salem in September. In the meantime we are selling raffle tickets for a laptop to raise money for the conference and beyond.

Another thing you know is that I consider myself a blogger. I don't think I have too many readers here yet but I have discovered a number of other RT student bloggers. Just check out my sidebar. http://dee-rt.blogspot.com/, http://my-rt-life.blogspot.com/, http://breathingthroughschool.blogspot.com/, and http://sometimesibreathe.blogspot.com/. If you're reading this go on and check out their blogs.

The main courses I will be taking this fall along with 2 clinical days per week are:

RCP 211 Advanced Monitoring
This is just the continuation of the Mechanical Ventilation class I took over the summer. I couldn't find a course description online so I will tell you more later.

RCP 213 Neonatal Concepts
Pretty much everything I've learned so far but scaled down to apply to infants.


I've attached a picture of me wearing the vest, a chest percussion therapy device

Well, I have made it through the summer. It is definitely the hardest semester I've had so far. We went from 11 students to 6. That's right, 6. We lost 3 after the final exam. it sucks too because all are people I consider friends and people that I will miss. Luckily the ones I am closest to are still there. Also, to raise money we are now raffling a dell laptop. Hoping to make about 1000 if everyone sells all of their tickets. I have sold 13 out of my 50.
Another thing I am happy about is the fact that I have 3 weeks off. I don't go back to school until the 18th. There will definitely be days of sleeping late in there. I also am excited about the state conference in September. I do get to share a room with ALL 6 of my classmates. I'm sure being the only guy will get me relegated to the air mattress. That should definitely be an interesting experience. I will definitely tell about it and post pics to my flickr page.

For some unknown reason they decided to make the summer the toughest semester. I guess they figured if you made it this far there should be one huge obstacle keeping you from going on. It's supposed to get easier after this. We only have 2 classes this summer but they are important ones. "Principles of Mechanical Ventilation" and "Pathophysiology". Both are very interesting as we learn about ventilators and diseases. In Patho I have to write a 4-5 page paper which I will actually need to start working on soon. I have to pick a patient from clinicals and write about them and their disease. Well, I got mine yesterday. The patient had a major chest trauma and hadd flail chest that resulted in a pneumothorax and pleural effusion. I'll tell you more about that later. I also got to go to a C-Section too. It was kind of gross but kind of neat too.

well, I had my final checkoff this morning. I also found out that I made an 85 on my final exam. That puts me at a solid "C" for all of my classes. Not the greatest, not the worst, but a solid passing grade. I do have to repeat a few things on the checkoff as do everyone in my class. Mine are pretty simple. I had the teacher exhale into an Incentive Spirometer (when she should've inhaled), forgot to pull out the syringe for the ABG so the blood could fill it up, didn't keep my sterile glove sterile in the nasotracheal suctioning section, and forgot some of the 11 criteria for extubation. Thats ok though, I'll be at the school with my classmates tomorrow and repeat the checkoff on Monday. Then I have a week off before returning for the summer.

What a week. It was my last week of clinicals this semester and it was something else. Apparently, RT's must go to all C-sections because the babies have a tendency to come out not breathing. You guessed it. Yours truly got to go to a C-section. My first time ever at a childbirth. It was amazing and it was messy. The baby came out screaming though which is a sure sign of breathing and also of the RT's not needed.


We also did our EKG labs today. That was kind of interesting. people seem to forget that that is the responsibility of RT's even though nurses and nursing assistants perform that duty at most hospitals. Of course I was the guinea pig for the the whole class. I was the one that the teacher demonstrated on. Not a bad day. Now I'm preparing for my EKG test friday. Then final checkoffs and final checkoffs and exams. Then my week and a half break before summer starts.

It's been a busy week or two for me and thats why I haven't been here. I hope you enjoyed the Airway management videos. Anyway, I made my very first 100 on a test in the program last week. It was the test on intubation, oropharyngeal airways, and tracheostomy tubes. Pretty important stuff if you ask me. Needless to say I was stoked. This week, I have 2 tests and a quiz (yuck) including a Math test in Anatomy today. Thats right, Math. Apparently Oxygen Transport is completely known by doing Math and memorixing formulas.


Yesterday I had my first day at a Hospital I was unfamiliar with. It was also the smallest Hospital I've been to yet. The teacher wasn't there and we were paired up 1 to 1 with a RT for the first time. I got to see how it really works with breathing treatments in the real world. No staying with the patient for the entire treatment. It was kind of cool to run several treatments at once. My best friend started his rT career at this hospital and I can honestly picture myself doing the same. The only bad thing is it's almost an hours drive away. The director practically invited me there to work as a student when I start year 2. We'll see.


Also, the RT student blogger who inspired me to do this mentioned me in his blog post "Respiratory Therapy Bloggers". I did borrow off of his domain name for this one. I never meant it as a source of confusion. Much like me (and probably any other RT student) he doesn't have a lot of time to post. When he does though, his posts are very informative. Hopefully mine will be too.

Since we are going over the Airway management section I thought I would search for some videos online. Here are a couple of really neat videos. The first one is almost 13 minutes long (just thought I would warn you)

Thats right, here I am on Spring break. We had a test today on lung expansion and blood gases. Kind of a refresher test because some of us haven't been doing so great. Anyway, I have a week off before I go back to work and school. When I go back I'll have an anatomy test and respiratory quiz on the first 2 days. I've made my index cards for the quiz and will start studying for it and the test. Now, I just need to get down to the much needed task of drinking some beer and watching the tarheels play

I am a blogger and you may have read my other blog. I'll tell you about that later. Anyway, I am also a Respiratory Therapy student too. I am in my second semester, and my first one doing clinicals. I have been meaning to shut down my other blog because I don't have the time to keep it up. I wanted to keep my thoughts out there and keep my readers informed about my life. Since being an RT student is the biggest thing in my life, I thought that's what I would dedicate my blog to. Glad to have you here.