Today is my first day working. In patient care as a real respiratory therapist. What a journey it was to get to this place but I finally made it. Making the switch from bartending to saving lives was difficult but I’ve never been happier.
I have extensively covered HFNC on this page due to a talk I'm creating on the matter. We've witnessed it first hand keep patients off of the ventilator. This article published in the American Journal of Respiratory and Critical Care Medicine, which as an aside is the highest impact factor publication in the Critical Care world, looked at 15 patients to determine the physiologic effects of the HFNC system. The reason why they performed the study was because those physiologic effects that we all know are beneficial were just not defined at the time of the publication. The ambitious authors wanted to go ahead and define them. Although this study was published in May 2017, one can grasp more or less the time it takes to get one of these important studies published by noting that it was initially submitted in May 2016. Imagine having this data and not being able to get it out. I would lose my mind.
The authors used patients with a P/F ratio of less than or equal to 300. They performed a number of measurements which I will not cover here for the sake of it being Sunday morning and you do not want to be put into another nap.
In a quick and dirty recap, here are their findings:
1. less inspiratory effort
2. lighter metabolic work of breathing
3. less minute ventilation (due to decreased respiratory rate)
4. improved oxygenation
5. no change in PCO2 nor pH
6. increased lung volume in dependent and non-dependent lung regions
- this may be a huge key towards understanding the possible PEEP that the HFNC system may provide. The authors state that increasing the EELI with an improvement in oxygenation while not having a change in tidal volume may explain the PEEP effect. A 🎩 tip to the authors. Link to the article on my website:eddyjoemd.com. Link in the bio.
3 1007 hours ago
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"Would you like to check my poster?" I asked.
I enjoyed the short but really interesting moment I had to discuss my poster @ NISPID biennial conference last week.
That smile stayed all through my presentation.
Why is travel nursing/clinician pay decreasing? The market is saturated with new travelers. The market is finding equilibrium and prices are stabilizing. But is this the new normal? It doesn’t have to be this way. Travel agencies, VMS’s, and MSP’s convolute the staffing process. They are cumbersome and take an exorbitant amount of money away from the clinician.
A Managed Service Provider (MSP) is a large travel agency that has gained exclusive contract rights with a hospital to distribute jobs and communicate with subcontracted travel agencies to fill jobs.
Why do hospitals utilize MSP’s....because they don’t want to filter through all the potential candidates to fill a job so they outsource. MSP’s and VMS’s take a 4-7% percentage from each travel nurse. If a travel agency has been subcontracted through a MSP, they have to recoup their overhead fees around 20-25% and turn a profit of 15-20%. This all comes out of the bill rate that is passed on to the clinician. We can help you keep more of your money! Setup a free consult and earn what you deserve!
Anesthesia is often all about be organized, and knowing your patient well. This allows you to provide the safest and most comfortable anesthesia experience. 95% of cases go smoothly without any complications, but when their are complications they often require quick interventions. I have experienced several patients who developed severe bronchospasm during surgery. .
This is an event that requires rapid identification and intervention. Bronchospasm is a sudden constriction of the muscles in the walls of the bronchioles which are the small tubes in the lungs that carry air to the area of the lungs where gas exchange occurs. This can make it extremely difficult to ventilate a patient. Preventing oxygen and carbon dioxide exchange as well as delivery of inhaled anesthetic. If not corrected a patient can develop severe complications including death. Therefore it is essential to be able to quickly identify and treat this condition.
Swipe Right ➡️
For a chart I found particularly helpful for identifying and treating bronchospasm. Anyone had any terrifying experiences with bronchospasm?
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