High Flow Formulas

November 1, 2009 Leave a comment

High flow systems are one of those things that we learned about in first year. They are also a topic that I haven’t spent any time thinking about since then. But since I recognize the very high likelihood of seeing high flow formulas on future exams, I figured that I should probably spend some time reviewing them. For that reason, I put together a little bit of a refresher document on high flow formulas.

Feel free to use the document if you believe it would be beneficial to you. Of course, let me know if you have any questions, or find any errors.

High Flow Formulas

Happy studying!

Tough and Competent

September 6, 2009 Leave a comment

This man is my hero.

For those of you who don’t recognize him by his photo, this is Eugene “Gene” Kranz. Gene was a long time Flight Director at NASA, and is perhaps best known for his work during the Apollo 11 and Apollo 13 lunar missions. He was portrayed by Ed Harris in the film Apollo 13, for which Harris received an Oscar nomination. He has a great life story, and if you want to be motivated, I encourage you to read more about him.

Everything about this man impresses me. I recently read his autobiography entitled “Failure is Not an Option.” The name of the book alone was enough to motivate me, but the 394 pages that came after did even more. To put it simply, this man is the epitome of dedication and work ethic.

What impresses me most about Kranz is that he recognizes the human factor. When technology was making unbelievable advances on a daily basis, Kranz demanded that his workers’ knowledge and skills do the same. Kranz expected his flight controllers to be able to do their jobs blindfolded. Literally. He would have his flight controllers (mostly engineers) sit in the simulators blindfolded and be able to complete the same procedures that the astronauts would have to. He had his flight controllers and those working under them know every error code that could possibly arise on their equipment. Most people would call that crazy, but to Kranz, it meant being prepared. And they were prepared when an time-critical error almost demanded an abort to the Apollo 11 lunar landing. Because his workers knew the equipment and the errors, they knew the solution.

After the launchpad fire that killed Apollo 1 astronauts Grissom, White and Chaffee, many were quick to blame faulty equipment. Kranz knew better, and he had the kahunas to say it. His response to the incident, known as the Kranz dictum, identified carelessness, incapacity and neglect as the true cause. But Kranz went further. He wanted to make sure that a similar event would never again occur. His legacy was left in the form of two words. Tough and competent. As Kranz put it:

Tough means we are forever accountable for what we do or what we fail to do. We will never again compromise our responsibilities. Every time we walk into Mission Control we will know what we stand for.

Competent means we will never take anything for granted. We will never be found short in our knowledge and in our skills. Mission Control will be perfect.

I think that our profession can take a lot from Kranz’s words. Just like mission controllers, respiratory therapists are specialists who are responsible for an individual’s safety while they are in our care. We must take our charge seriously. Failure to do so is not an option.

How to Study Effectively (Part One)

August 31, 2009 Leave a comment

As I posted previously, the beginning of a school year is often accompanied by educationally-flavoured versions of New Year’s resolutions. Because I can imagine that some students are looking to improve their studying efficiency this year, I have compiled a few tips and tricks that have helped me throughout my post secondary years. I hope they help!

1. Create a study-conducive environment.

It is impossible to study effectively if you are not comfortable. Finding a location where you are should, therefore, be a priority. The ideal study location is someplace where you are alone, and where you have complete control over the surroundings. Find a place to call your own and make it comfortable. Find the right level of lighting, the right temperature, and the right furniture. Ensure that people know not to disturb you while you are there.

I discourage people from studying on their bed or in places where they like to relax. Your bed is for sleeping, and you shouldn’t confuse your brain by trying to study where you like to relax.

2. Eliminate distractions.

Distractions destroy concentration. Concentration is paramount. Therefore, distractions are unacceptable.

Cellphones, PDAs, iPods and laptops are all concentration destroying machines. Don’t risk it — put them away! Save them for your break, or for when you are done studying.

Note: there is nothing wrong with listening to music while you study. If you choose to listen to music, however, pick your playlist beforehand so you are not continuously searching for music.

3. Learn to singletask.

The biggest barrier to effective studying is the inability to concentrate on a single task for an extended period. When you are studying, you should only be studying. This goes hand-in-hand with the point above. Keep text messaging and Facebook for breaks or after studying.

Learning to concentrate is just like any other skill; you have to practice it. Build on your ability to concentrate by focusing only on studying and by minimizing distractions.

4. Take frequent breaks.

Effective studying is hard work. Give your brain a rest by taking frequent breaks. As your study stamina grows, you will find that you can go for a longer time between breaks. A good rule of thumb is that if you find your mind wandering, or if you are continually rereading sentences, it is time for a break.

The length of break that you take is up to you, but it should be long enough to give your brain a rest. I find that I study best in cycles of 30 minutes on and 10 minutes off, or 45 minutes on and 15 minutes off. Find what works best for you and stick to it.

When you break, get up and leave your study area. That location is only for studying, and taking your breaks there will make it harder to concentrate in the future. Don’t sit down until you are focused and ready to give 100%.

5. Get good sleep.

The best studying happens when your brain is fully rested. I won’t say that everyone must get a full 8 hours of sleep, but many people get much less than they should. There are very few good excuses for not getting a full night’s sleep. Do your brain a favour by giving it lots of rest.

6. Make it a routine / schedule it.

Unless you make studying a priority, it will get put off. Make a study schedule and stick to it. Force yourself to get your studying done before you watch television. Give yourself rewards for sticking to your schedule.

Remember that studying is about learning the material! Make it easier by setting yourself up for success. All the best for the upcoming year!

The NIBP Showdown

August 27, 2009 Leave a comment

Yesterday, during our clinical preparation, I had the chance to brush up on a few skills that have fallen by the wayside. At one station was a manual sphygmomanometer. I was quite surprised to see it, since I have only used digital versions during my clinical placements. After reacquainting myself with the device, I took the blood pressure of several of my classmates. It was exciting! Getting their blood pressure was more than just obtaining a few numbers. It was an experience.

I began to wonder why the manual cuffs aren’t used more often. They seem to have a lot going for them. But clearly, since the hospitals rely more heavily on the digital cuffs, they must be superior. I decided to do a little bit of a comparison* to see if this is actually the case.

* this comparison will naturally be completely objective and based solely on published data.

Digital Sphygmomanometer

Digital

Sphygmomanometer&Cuff

Manual

Cost Cheap Cheaper
Speed Slow to fast Fast or faster
Accuracy Poor to high High
Skill
Monkey Required
Power source Batteries Hand muscles
Automation Yes No

So other than the fact that I can leave a digital blood pressure cuff on a patient’s arm indefinitely while getting serial measurements, I’m not convinced that the digital versions are better.

I found that as I became more comfortable with using the manual cuff, I could take increasingly fast blood pressure readings. I’m sure that in the hands of someone with a few thousand readings of experience, a manual cuff could take a much quicker reading than a digital one.

So why, then, aren’t health care professionals using the manual cuffs more often? I’m not sure that I can accurately answer that question, but I suspect that it has something to do with the effort required. There is no doubt that pushing the “power” button and then the “start” button requires less energy than pumping the pressure bulb ten or fifteen times. Or maybe the answer has something to do with the amount of concentration required. After all, it is easier to daydream for 30 seconds while waiting for a test result than it is to try to remember the systolic pressure as the needle continues to drop. Actually, I find that to be the hardest part of taking a blood pressure. Is my attention span really that short?

I am hesitant to put my full trust in a few a numbers that have been given to me by a machine that could be wildly inaccurate for any number of reasons. With the manual sphygmomanometer, at least I have some sort of sensory input (i.e. hearing the Korotkoff sounds) to help me trust the values I read.

While the digital cuff definitely has its place, I think I’ll be reaching for the manual cuff a little bit more often in the future.

Understanding Expectations

August 27, 2009 Leave a comment

The beginning of a school year is often accompanied by educationally-flavoured versions of New Year’s resolutions. In the past, I have told myself that “this semester will be different”, that “this semester is the one that really counts” and  that “I will definitely do my homework every day… starting tomorrow.” Just like their beginning-of-the-Gregorian-year counterparts, however, these promises are often quickly forgotten. The unfortunate truth for students is that even though our motivation has waned, the expectations are still present.

Throughout my schooling, every year has been associated with a set of expectations. This year is no exception. But what exactly are they for this year? The answer is simple: work hard, learn lots and make good impressions.

Sounds easy enough, doesn’t it?

Unfortunately it’s not. My theory is that we students don’t fully understand the expectations that are placed on us. For that reason, let’s explore each one.

1) Work hard

I cringe every time I that hear someone say “I studied as hard as I could.” The reason is that that statement is normally followed by a detailed discussion on the various television shows that were broadcast the previous night. Working hard does not mean doing a task only when you feel like it. In fact, working hard means doing a task even if you have to sacrifice doing something that you would rather be doing. The unfortunate truth for students (and for anyone I suppose) is that performance is directly related to hard work. And since (as previously established) hard work means sacrifice, I believe that the following is a logical supposition:

Hard work ≈ sacrifice

2) Learn lots

The goals of a student seem simple: go to class, pass the tests, get the designation. (Or in some cases: pass the tests and get the designation.) Sometimes, however, I feel that education gets lost in the mix. It seems understandable, however. In order to progress to higher learning (aka pass), we must assimilate enough of the knowledge that will be examined. But what about all that knowledge that isn’t?

Because it is not examined, I believe that that “other” knowledge is often seen as optional. But it’s not. In order to be the best health care professional that we can, we must strive to know as much as possible about every aspect of our job. Isn’t that what our patients expect?

Note: acquiring such knowledge might require application of point #1 above.

3) Make good impressions

The phrase “this is a year long interview” was perhaps the most used phrase during our clinical prep week. But although that statement is true, I am concerned at how it might be interpreted. The problem with interviews it that they become an act. People are generally polite, courteous and respectful when they know they are being evaluated. My question is: why aren’t we always like that? Making a good impression shouldn’t require acting differently than you normally do.

While it is true that this semester will present different challenges than those in the past, and that our responses to those challenges will greatly influence our career opportunities, this year really is no different than any other. The expectations are few and simple: work hard, learn lots and make good impressions.