How are you using your credentials?

Whether you are a new grad respiratory therapist or a seasoned respiratory therapist, you have probably witnessed other RTs not put their credentials to full use. Let me give one example:

A few years ago, while working at a prominent southern California Hospital, I witnessed a page answered by a co-worker. The RN requested a PRN breathing treatment at around 11pm. The therapist laughed when he saw the page-request because he knew that the patient was ordered BID Normal Saline treatments. Puzzled, I asked him, "Are you going to go up and check it out?" He responded, "Why? Normal Saline won't do anything." I politely said, "What room is that patient in? I'll check it out."

As I approached the room of the patient, the nurse thanked me in advance for coming up to administer the breathing treatment. I walked into the patient room and saw a young girl having difficulty breathing and receiving oxygen therapy via 6L/min nasal cannula and bubble humidifier. I asked a series of questions regarding her history (asthma, home meds, etc). I then auscultated her breath sounds, and her entire left lung field was clear. I auscultated over her right lung field, and I could not hear a thing.

I quickly asked her if and where she had pain. She nodded and said her right side hurt. I was able to gather from her that a port-a-cath was inserted and after she awoke from the procedure, she felt pain. I called her physician and asked to order a STAT chest X-Ray to rule out a pneumothorax. 

After the chest X-Ray, I went down to our department to view it with my co-worker who was originally paged. I asked him what he thought of the film. I was very much surprised when he said, “Looks clear.” I responded and asked, “What about the absence of the vasculature?” I could not view any lung markings on the right side. This was a classic case of a pneumothorax.

Sure enough, when I went back to the patient, I spoke with the family that my impression was a pneumothorax and depending on the size, the treatment plan would be basic oxygen therapy or evacuation. Soon after, the Intensivist walked in, looked at the film, and after a professional discussion between him and I, put in orders to have the patient moved to the ICU to remove the air that caused the pneumothorax.

What’s the point? If you are a respiratory therapist, you have to remember that to become one, you took an examination with scenarios similar to the one I described. If you passed, that means you are credentialed to do what I did. I’m not claiming to be a superhero, but I am claiming to be superhonest: too many RTs are being sloppy in their profession. Put your credentials to use and get involved. No, the patient did not require normal saline. But the patient did have shortness of breath. That’s enough for you to answer a page, visit your patient, and help figure out a treatment plan together with the nurses and physicians.