My name is Ritesh . And I work at Southwest Washington Medical Center as a respiratory therapist. And I’ve learned a lot. You learn on the job and from fellow co-workers, because you learn from experience. And you’ve got to be very good at critical thinking to do this job. Like what am I going to do next to make it better? You’ve got to actually look at the patient and decide, he’s not breathing, why is he not breathing. What about now? Do you feel like you’ve got something down there? “had a 7 and a half tube that’s 23 at the lip”. I start my shift by coming in for a shift change report. “no change on her. She’s on spontaneous”. It’s a 12 hour shift. So you get your report from the previous therapies. And they’ll tell you what happened during the day,
who gets what kind of treatment, and what are the doctors’ orders. And then you write it down and you take over from there. During the night, you do your therapy, you do your treatments and what ever the doctor has ordered. Tomorrow morning when the shift ends, that’s when you give the report back to the other therapist who is relieving you – like basically what you’ve done and what the doctor wants to be done. This hospital has 3 critical care areas, the emergency department, intensive care unit, and Cardio care unit. So tonight, I’m working in the Cardio care unit and partly in the intensive care unit. This is what we call a vent or a ventilator. And basically this machine is breathing for the patient. All the breaths are timed and our goal is to keep it at about 95. You can have an artificial airway inside a patient. One is through a trachea. It’s called a tracheotomy. And the other goes through the mouth. It’s called oral intubation. This is usually reserved for patients who are on the vent for a long time. Take a deep breath. Go [inhales quickly] In this case, the patient has a Trach. So you have to make sure the Trach is open. There’s nothing clogging it. If it is, then you suction it. Before you do the suctioning procedure, you got to make sure the patient has 100% of oxygen for at least 2 minutes. When you suction patients, the oxygen saturation goes down. And in that way you’re preparing for it, before it happens. I got a lot out, dude. A lot of people are grossed out about this mucus thing. It’s just another body secretion, you know. I mean, I was grossed out, frankly, when I came out of college and started working here. And then it’s a matter of getting used to it. Right now, ICU is full. They can’t take any more patients. So this is kind of like a back-flow area. I’m preparing for the patient to arrive. It’s always better to be prepared, then when the patient comes and you are scrambling for stuff the patient needs. You always want to have your suction ready, because you never know when the patient is going to vomit or obstruct his airway. So it’s always a good thing. You never know when you’re going to need it. The most challenging part of this field is doing critical care. “and then I’m going to put the air into it, OK. Critical care is those patients who are ventilator dependent and WE are doing the breathing for them, you know. We’re controlling their heart, we’re controlling their blood pressure. Anybody can come out of school and go out on the floor and give breathing treatments. It takes a lot of courage, a lot of determination, and a lot of knowledge of critical care to be in the ICU or CCU taking care of somebody’s airway on a ventilator. Anything can go wrong at any moment. And your decision makes a lot of difference. In order to make changes on a patient’s ventilator or by-pass machine, we have to take an arterial blood sample and we bring it down here to the lab to run the test on it. And the test will tell us how the patient is breathing. And looking at that test results, we make changes on the vent or the by-pass. “CO2 39 so that’s”. You always want to communicate with your health care team. If you’ve got a critical result, you always want to show it to somebody else – like in this case, the nurse. “okay, so we’ll get on that. Call the doctor”. Yeah This job is all about teamwork. You just can’t do everything alone. Anybody who comes and says this is a one-man army, he’s lying. Look at now, there are 3 or 4 people in ICU alone trying to make everything work. And I work with a lot of nice people. “if you need something, let us know”. If it wasn’t for these two and obviously this lady, I would have quit this profession a long time ago. They are team players – true team players – help a lot – always willing to give their two cents and take two cents from me. The other thing about being any health care worker, we have to actually chart everything we do, like the suctioning I did, the medications I gave. I’ve got to record everything in there, the heart rate, the respiratory rate, the amount of secretions I got from the suctioning, the color of the secretions. Everything is computer charted so the physicians have access to it. Every time you give a patient a medication, you’ve got to scan them. You scan the patient’s wristband and then you scan the medication. It will tell you’re giving the medication to the right patient. And then it will show up in the computer. And then you chart. Once a patient is on a ventilator, the vent is calibrated for the patient’s use. Once the patient is extubated, the vent needs to be cleaned and set up with extra supplies. At the same time, we do a same maintenance on it to check that everything is working – like there’s no leak in the pressure and the filters are working and tubing has no leaks and it’s working. Basically, everything the vent is supposed to do, it’s doing. The doctor wrote to do some vent setting changes. Basically, give him a trial. Right now the patient is tolerating the settings change. He seems to initiate his own breaths. His heart rate seems to be okay and his respiratory rate is below 20. So that’s the third time we did a vent settings change on that person. So as a therapist, you end up doing that a lot. Just do a trial setting change, trial setting change and finally if the patient tolerates that setting change, we put him on that. So it’s a trial and error. Okay. He didn’t come for any respiratory distress. He’s going home today. It’s time for my shift change report to tell my fellow incoming colleagues the status of the patients, what’s their standing and what’s going to happen during the day. Basically, tell him what we did last night and if there were any new orders written, what the doctor wants. “.and she looks like she’s awake, but she’s not actually. She won’t talk or anything, but she can move. We cover the whole hospital running around, taking care of patients. So at the end of the day, I’m pretty exhausted. But by the end of a shift, you’re happy. Hey, I did good today. How’s your breathing? Are you doing okay, no shortness of breath? Hey, I saved somebody’s life. And that’s the biggest achievement you can get from your work.