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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.

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First test

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.

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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.

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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.

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Guess what I did

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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,

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Another final preparation

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.

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Senior Preparations

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).

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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.

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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.

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