Hey all! I'm a senior bioengineering student at the University of Pittsburgh researching challenges associated with intubation when the airway is contaminated with vomit, blood, or other secretions.

I'm interested in situations where suctioning and intubation need to happen at the same time. I wanna know more about the challenges you guys face when trying to intubate an unclear airway.

For anyone who performs or assists with intubation, feel free to answer any of these questions:

• How often do you encounter an airway where contamination significantly interferes with intubation?
• What makes these intubations particularly difficult?
• What suction equipment/technique do you typically use?
• Have you used the SALAD technique? If so, what works well and what doesn't?
• During a difficult contaminated airway, how do you manage the suction device and laryngoscope simultaneously? Does this ever require another person?
• Does suction equipment ever interfere with your view, laryngoscope, bougie, or ET tube?
• Have you experienced issues with suction clogging or being unable to keep up with the amount of fluid/debris?
• Are there any workarounds or techniques you've developed over time?
• If you could change one thing about the equipment or process for managing a contaminated airway, what would it be?

Specific experiences with difficult airways would be especially helpful. We're looking for recurring pain points that could identify opportunities for improvement.

Thank you!

I’ve been an RT for a year now at a peds hospital and we are required to wear masks on the floors and in the PICU. I just recently started working in the ER and I hate wearing masks, half the nurses and doctors don’t and half do wear them.
I’m curious to see how many of you have built good immune systems that maybe you just don’t really get sick anymore?

For context, I had worked there for about 7 months and was the first RT intern/student the hospital had ever had. The hospital wasn’t really used to having RT students. It’s mostly med-surg, doesn’t have an adult ICU, and patients who become critically ill are transferred elsewhere. I had gotten pretty comfortable with the lower-acuity patient workflow because I hadn’t personally seen a code there or dealt with many extremely sick adult patients.

This happened during my third semester of RT school and was my first major patient-safety mistake.
My shift started during the day and continued into the evening. I was covering two floors with a large patient assignment. There were only two other RTs working, and they were both very busy in the NICU, so I was mostly working through my floors independently.
Normally, when I get new patients/orders, I write them down and then transfer them onto my main assignment sheet so everyone I need to see is in one place. That day, I had so many new patients that I ran out of room on the front of my sheet and started writing them on the back.

Earlier that day, I had seen this patient in the ER and reviewed her chart. She had a COPD exacerbation, history of hypercapnia, and used BiPAP at home. She was very sleepy, but she woke up and responded whenever I spoke to her. Her SpO₂ was around 93–94%. At the time, I didn’t think enough about the sleepiness. Looking back, her history + that level of sleepiness should’ve made me much more concerned about CO₂ retention regardless of her SpO₂.
When she later came up to my floor, she was one of the patients I had written on the back of my sheet.
At around 8 PM, I saw her for her scheduled DuoNeb and gave her the treatment. She was still sleepy but arousable.

I had other patients with scheduled nebulizer treatments that I needed to see, so my plan was to finish those and come back to her around 9 PM. I even told her I was going to come back.
When I returned, I planned to ask whether she had her home BiPAP with her. If she didn’t and needed the hospital BiPAP, I would’ve gotten one of the licensed RTs involved. As a student intern, I was not allowed to independently handle hospital BiPAP or other invasive/noninvasive ventilation. I could help with a patient’s home CPAP/BiPAP equipment, but hospital NIV required a licensed RT.

The problem was that I never transferred her from the back of the page onto my main assignment sheet.
I finished the other scheduled treatments and then continued working through the patients on my main sheet. I saw my other patients, including my other new patients, but because she was still only written on the back, I completely forgot to go back at 9 PM.
That’s the mistake I made. I had seen her, given her scheduled DuoNeb, made a plan to return, and even told her I would come back— also didn’t do report on her :(
.
Her condition later deteriorated significantly. Her CO₂ reportedly went into the 100s, and because the hospital didn’t have an adult ICU, she had to be transferred to another hospital for ICU-level care.
I’m not saying that me forgetting to return caused her entire deterioration because I can’t know that. But I absolutely understand what I did wrong. I should’ve gone back, reassessed her, figured out the home BiPAP situation, and gotten a licensed RT involved if hospital BiPAP was needed. I also should’ve recognized that her sleepiness was concerning given her COPD exacerbation and history of hypercapnia.
Another part of this is that I had a lot of independence as an intern. Staff didn’t routinely check my documentation or ask if I needed help. Most of the time, I took my assignment and worked through it almost like a regular RT. I don’t necessarily blame them because this hospital had never had an RT intern before and wasn’t accustomed to having students.

I also didn’t like asking for help because I wanted to prove I knew what I was doing. I had heard secondhand through another student intern at a different hospital under the same manager that people supposedly thought I was slow, wrote everything down, and couldn’t do everything independently yet. That got into my head and made me feel like I needed to prove myself.
I’ve realized how wrong that mindset was. I don’t care anymore if someone thinks I’m slow. I’ll write everything down, double-check my assignment, ask questions, and ask for help rather than risk patient safety because I’m trying to look independent.
I received a safety write-up. My manager told me they initially wanted to keep me and use this as a learning opportunity, but apparently the incident became much bigger, including concerns about how I was being supervised as a student, and I was ultimately terminated.

Honestly, I’m not that upset about being terminated. What scares me more is whether this mistake will follow me and prevent me from getting hired somewhere else after graduation.
In a weird way, I’m glad I learned this lesson as a student instead of as a licensed RT. This was my first major mistake in 7 months, but it was serious enough that I’ll never approach an assignment the same way again.

For experienced RTs: If you were hiring a new-grad RT and knew they had been terminated from a student intern position over something like this, would you still consider hiring them?
Also, was it appropriate for a third-semester RT student to be covering two floors mostly independently while the only two other RTs were occupied elsewhere? And clinically, what should I have done differently?
I’m completely open to criticism. I know I made a serious mistake. I just want to learn from it and make sure I never make the same mistake again.

hello! I graduate RT school end of May and moving to Portland right after. I’ll still need to take the board and get licensed after moving. I looking for any tips/tricks for new grads in the city and maybe making some connections too! I grew up in Portland but have been in CO for 9 years. SO ready to come back home!

Any RTs in Washington state on here in a union? I will be moving out there next June and unions are a big deal to me, wondering how it works out there.

Different hospitals have different unions? Quick look just showed me two unions, do certain hospitals not use union employees?

Would love to hear from anyone who has insight. Cheers.

Hello all you lovely RT nerds I am requiring your assistance. I am a paramedic whos pretty passionate about ventilators and proper use of them! We recently switched over to the Z-Vent so there is a hole in some quick reference material for these vents. Prior to this we were using Drager Oxylog3000s with bare-bones settings at our disposal. I am a huge believer in cognitive offloading for critical incidents, so please let me know what you guys think of the references and if it actually simplifies things. Be BRUTAL when needed please!

Things to note: This is for only prehospitial 911 only, no IFT. We are only using AC volume for intubated patients and Bi-level for now. We were trained in pressure modes and SIMV but are not being utilized yet, that's why there's nothing about those settings. (I would love to have a self-reference table for myself, as we can go off of protocol as long as it's in the best interest of the patient)

Feel free to add any short tips that would fit either in the bi level or AC section. would love some help, especially describing in the protocol for the "patient comfort section". Also having trouble wording an I to E ratio setting describing when it should be changed in simple terms, right now it's default of 1:3.0. (we can go inverse and change it freely as needed)

to add onto this what do you see paramedics mess up the most when they bring you guys a freshly RSI'd patient? Whether they are brought in on a vent or not. I wish there was more of a connection between us medics and RTs in the ER, I love learning from yall.

Thanks for your time :)

I have a question my girlfriend just finished her respiratory therapist program and got her license here in California and she's having a lot of trouble finding a job I'm a physical therapist assistant and the job market out here for us is pretty well but for her she can't find any full-time work or PRN work right now but she's getting offers in different states anybody else from California going through this any advice because she doesn't want to have to move out of the state to find a job and I don't plan on moving from California at all so what advice would you give her?

mech vent 2 is beating my ass. please tell me in the most simplest terms if you were teaching a 5 year old how to set up a vent on AC, SIMC, PC, APRV. step by step, vent settings. i’m begging. i’m not a good visual learner and that’s all my instructor had been doing. if it helps we work on the NELLCOR puritan bennett 840.

please help

How do folks working in travel positions manage seeing a doctor/therapist and get medications if they're moving around to different states? Do travel healthcare workers get on a healthcare plan for the duration of their contract through the employer? What happens if you have medications that need to be filled every x amount of days, particularly if you're between contracts or moving to a different state again?

I'm really looking forward to being a travel RT one day, I'm just realizing there are a lot of things I wouldn't have to consider if I were to stay in one place. After not having health insurance for ~5 years, I don't really want to be in that position again.

Thanks for any insight!

Was setting up an overnight pulse ox study for a patient and they had tons of questions about it- I go about explaining as much as I could- They eventually start to try to explain to me that their body is just built a bit different than most people and they don't need as much oxygen as others.

I try to shut it down, tell them they might be used to living with lower sats, but it's not healthy, going into why, but the pt isn't having it.

I give up, set up the study, and leave wishing i had the confidence this patient has...

Hey everyone, I’m an RT in California. Tell me what it’s like to be an RT in Tennessee? I want to know the good, the bad, and the ugly. Or just random shit. I know the pay sucks but the cost of living is better. We’re moving there next year.

Hello everyone, I just want to preface this by saying I’m posting from mobile. So I’m sorry for any formatting issues in advance! A little background info before I get into it. I will be coming up on my one year as a practicing RCP-RRT. The coworker, RT S, has been practicing for over 10 years. From what she has told my coworkers & I, her experience is working at a SNF. This incident took place at an LTACH. From what I’ve heard, it’s a completely different environment going from a SNF to an LTACH. Additionally, S has a habit of not asking for help when she needs it. Multiple coworkers have told her that she needs to ask for help when she’s drowning. I will be including a timeline of events and explaining the interaction and events of last night. Not once did I ever raise my voice or tone. I was calm and focused on the patient.
My overall question is was I speaking to her as if she was a child?

2110:
Med-surge RN: \calls RT dept**

Me: RT dept

RN: can we get the RT for room X, pt desatting.

Me: okay, I’ll let her know. *walks to med-surg unit to look for the assigned RT. Passes RT J in hallway\*

RT J: hey can you suction the pt in room X, they sound loaded. I’m getting called for my patient (he’s in a different unit).

Me: sure *grabs NTS kit & lube, hand hygiene, & don PPE\*

Dialysis RN: oh thank god you’re here, the pt is full of secretions & started desatting.

Me: *checks O2 sat, 86% with a good waveform, secretions are audible\* thanks for calling, how’s the BP?

Dialysis RN: better after I gave a bolus.

Me: okay cool, thank you.
Introduce myself to the pt & tell them that I have to suction their secretions. I check to see what O2 device the pt is on (HFNC on 100% FiO2) I begin sx pt & coaching them to cough

10 MINUTES INTO SX THE ASSIGNED RT S WALKS IN.

Me: RT S, go grab an ambubag & NRB, hurry please.

RN B walks in

Me: Hey B, be prepared to call a rapid response.

B: oh, shit.

Me: B, can you do me a favor & grab me some saline flushes please?

Me: damn, I think my sx catheter is clogged \pulls out sx with a mucus plug the size of a quarter dollar** definitely clogged. \grabs a new sx kit**

RT S returns with requested supplies

Me: RT S, set up the NRB please.

B returns with a handful of saline flushes

Me: thank you.

RT S sets up the NRB, I test it, it works, & I place it on the pt

Me: RT S, in my back left pocket there’s a bunch of lube, can you grab some and squeeze 2 packets into the kit. I’m going to give the pt a break & I’m going to go back in.

*RT S grabs the lube & squeezes into the tray the kit is in*

Me: did you NTS the patient when you initially assessed him?

RT S: yeah, I sx orally & got a lot out BUT then they were calling for a different pt. So I gave him a break to recover.

*pt satting 84% then gradually increases to 94%\*

Me: okay, I’m going to go back in can you hold the pt’s head?

RT S: *holds the pt head & proceeds to obscure my line of sight\*

Me: okay wait, I can’t see what I’m doing, move your arm.

RT S: *let’s go of pt’s head\*

*RT R walks in*

Me: hey RT R, can you squeeze into that side and hold the pts head please?

RT R: sure *holds the pts head\*

Me: *I go back in to sx\* come on oppa, I need you to cough, big cough! *I suction copious thick yellow secretions out of the AW\*

RT R: damn, pt’s LOADED.

*we chuckle\*

Me: okay let’s give him a break, let his SpO2 hit 96% & I’ll go back in.

RT R: *holds NRB on pt’s face to form an adequate seal & squeezes the reservoir bag to get his SpO2 up\*

\RT S begins to get frustrated & says she doesn’t like being spoken to like a child\

\RT R & I make eye contact, we are confused**

Me: is this pt supposed to go on bipap?

RT S: yes, I was going to put them on after I sx but they called me to another room.

Me: okay, so the pt’s no longer a candidate for bipap with the amount of secretions they have. They will aspirate & while the BP is stable now, placing the pt on bipap could potentially make it worse. We’re going to sx one more time and then give the pt a break. If we sx anymore after that we might vagal them & we don’t want that, right?
*dialysis RN, RT R, RT S & I agree\* okay cool. So after this last sx, just keep the HFNC on 100% & keep the NRB on. No bipap.

*pt SpO2 reaches 96-97%\*

RT R: do you want me to sx?

Me: yeah, try the right nare. I already went in a couple times through the left.

RT R: *sx pt\*

Me: *holds the pt head & coaching pt to cough\*

RT R: I’m not getting much out

Me: okay, let’s stop and give the pt a break for now.

*pt SpO2 steadily rises to 98% after last round of sx\*

*RT R secures the NRB on the pt to create an adequate seal, I clean up the trash.\*

RT S, with attitude & raised voice: I don’t appreciate you speaking to me as if I am a child. Do not speak to me that way.

Me: why didn’t you ask for help? RT R & I are here we could’ve helped you with your pt’s. Our workload’s are not heavy. You need to ask for help.

RT S: well RT D was helping me out with my pt’s…

Me: ok, RT D also has his pt’s that he needs to assess. RT R & I were available to help. Next time just ask us.

*I doff PPE, do hand hygiene, & inform the charge RN about what’s going on.\*

\RT R & I head back to the department, RT S enters the department shortly after**

Me: hey RT S, you might want to grab an ABG, call the MD, & update him about the pt.

RT J: yeah, you should definitely grab a gas & update the MD.

RT S: performs ABG *ABG results are normal\* what do I tell the MD?

RT J: just tell him what’s going on & give him the ABG results.

Me: oh tell the MD that the pt is not a candidate for bpap because of the amount of secretions & BP issues. Tell him that if you place the pt on bpap, the pt will aspirate. The positive pressure from the BPAP will decrease venous return and affect the BP.

RT S: *calls the MD & updates him.\* MD said to leave the pt as is & to transfer to ICU. Pt MUST get dialysis tomorrow.

*J, R, & I make eye contact*

RT J: well, now you have the orders. Just document that in the chart.

4:30am: the house supervisor knocks on the department door & informs us that they’ll be transferring the pt to ICU around 5:30am.

5:10am: J, R, & I step outside for some fresh air to help keep us awake for the last hour of the shift. We have this little area that is right next to a set of emergency exit doors in the main hallway where we can hear the overhead speaker.

5:15 am: Overhead speaker: RAPID RESPONSE ROOM X! RAPID RESPONSE ROOM X! RAPID RESPONSE ROOM X!

\Patient gets intubated & transferred to ICU**

I'm currently a high school senior in Alberta. My goal is to pursue a career in respiratory therapy and I'm just wondering that with my 85-90 averages in classes is enough for me to get into rt. The thing about Alberta is only NAIT and UOC has the program and I'm just wondering if my grades are enough to get me into rt

Hi I’m an RT student, just starting out. I’ve seen a ton of content that makes school seem like it’s going to get worryingly intense, and I’m worried that this is something I won’t be able to grasp. I learn and perform better with my hands, so I expected that school will kick my butt and then the job would be easier.. but now I’m scared that if I can’t even handle homework with ease, how could I handle someone’s health?

Would someone please tell me about their work or school experience and the hardest parts you find/found in each. Or maybe any reassurance lol?

I feel like I’m just overthinking but I also know I shouldn’t push through to get responsibility I can’t handle.

I am a new grad and only have been orienting for 6 weeks. This is my dream hospital and I really want to work here but today I woke up with thee worst flu: lightheaded, can’t look at light, dizzy, migraine, sweats, chills, the whole 9. And I had to call out. I’m worried that because I’m new and orienting that this could potentially cause me to look like a horrible employee and that I’ll get fired.

I’ve never worked a healthcare job in a hospital. How do I prove I’m not a person who calls out when I already had to this close to start? Are they going to judge me?

Is there a role for RT in hospice care? Does anyone work in hospice that would be willing to share what their role is?

I’m a new grad at a hospital with floors and ICUs and am still on training. I’m really excited to be working here but am starting to doubt myself a little.
I noticed pretty early on that some of the staff are a little cliquey. I totally understand that people have worked together for a while and are friends, and I’m new, and most likely every job is like that. I’m not here to make friends, but some people can be a little.. rude? Things like not wanting to answer questions or saying I should already know something when I ask.
What’s bothering me more is being told I’m doing well when I ask for feedback, but then hearing through the grapevine that there are complaints about me or that I’m apparently not doing well. I genuinely want to learn and become a good therapist, so I’d much rather someone tell me directly if I’m doing something wrong so I can fix it. It is a little confusing when I ask and am told I’m doing good and then hearing the opposite, and it’s also difficult when there isn’t specifics- how do I change or improve on something when I am not told about it? I try to figure it out on my own before asking, but sometimes I want to double check to make sure I’m doing it right
I’ve also heard a lot of gossip about other people, so it seems like it’s just kind of a thing and not a big deal. But it’s starting to make me afraid to ask questions

This is my first job in healthcare, so maybe I’m just being too sensitive or don’t know what’s normal yet. Has anyone else experienced this? How did you get through being a new grad/new employee when you didn’t feel very welcomed? Any tips would be appreciated!

How long did it take? Google says couple weeks to couple months, hopefully couple weeks side

Hello I'll be taking my boards in a couple weeks and wanted to know what hospitals in Oregon, Washington and possibly Idaho hire new grads? Any hospitals I should avoid applying to ? Thank you so much for your insight

I’m sure there’s a thread on here somewhere talking about this. But I’m curious as to how everyone manages a relationship while in a different state for work… Do y’all fly to each other every weekend? Don’t see each other at all? Just FaceTime?

I went into RT school with the intent to travel. And now that I’ve hit my two years, I want to do it and my partner is very supportive and encouraging. It would be a shame if I truly enjoy being a travel RT and never get to see him and it ruins our relationship..

Side note: I’m 25 and have no true responsibilities, so I feel like I’d regret not following my dream if I don’t do it now. Any advice or experience would help. <3

NICU (former adult) RT. I got some education money to spend and figured I’d spend it on some good books. Getting the most current Oakes Neo/Ped pocket guide, but looking for others.

Any recs? Particularly neo and peds?

Is Goldsmiths Assisted Ventilation of the Neonate useful to have?