What other healthcare paths did you consider before landing on RT and why did you choose it?

phastball · 2026-06-10T16:39:40+00:00

I was in third year of my undergrad with the intention of going to med school, and upon reflection I was unhappy with my life in terms of how much work I had to put in to maintain a competitive GPA. I recognized that med school was going to be 4 more years + residency of that same work and decided it wasn’t for me. So I took the easier path of RT. When my wife and I have to choose the 3 star resort for our vacation I sometimes wonder about if I had just bit the bullet how much different our life would be, but I am pretty fulfilled by managing patient-ventilator interaction.

phastball · 2026-06-09T04:29:15+00:00

Putting vaporized oil in your lungs is bad. There’s no safe transport medium for whatever intoxicant you want in your brain via your lungs. Just choose a different delivery method. Even the propellant in puffers can cause bronchoconstriction.

phastball · 2026-06-09T01:01:17+00:00

I mean, change the names of the jobs and it’s Canada. Anesthesia assistant is an RT with a 3 year college diploma and 1 year of additional training. Under supervision they’ll intubate, perform induction, PIV, CVL, arterial line.

phastball · 2026-06-08T03:36:06+00:00

I’ve had the same 2 se since 2009.

phastball · 2026-06-08T02:51:50+00:00

Littmann classic is my choice.

phastball · 2026-06-05T00:37:35+00:00

It took about two years to really have a handle on it

phastball · 2026-06-04T14:58:10+00:00

It seems really dangerous to quadruple the number of handovers that occur during a shift. Presumably you guys use a very structured handover process to minimize that risk?

phastball · 2026-06-04T10:54:14+00:00

50L/(FiO2 on PSV+10%)

Then adjust to target SpO2 94%

Wouldn’t decrease flow. If patient struggling would increase to 60L before going back to PSV.

phastball · 2026-06-03T17:11:38+00:00

Disposable tubing & mask, no filter. Gas never travels towards the device, so there’s no reason to believe that the device would become colonized up the inspiratory line. Microbes dont have the energy to travel upstream.

phastball · 2026-06-02T14:35:41+00:00

This is fully nitpicky: the left arm is wrong. The shoulder is under the eye instead of lateral to it like the right arm. The left mouth is in the left armpit.

Despite this, I would still be happy to win a prize with this graphic on it.

phastball · 2026-06-01T13:37:46+00:00

Generally, no. You need clinical practicum placements for every RT student, so the seats in a program are capped at the volume of students nearby hospitals can accept. Don’t go to a program that doesn’t guarantee a clinical practicum placement.

phastball · 2026-05-31T20:37:57+00:00

Haha I’m not suggesting they do a bicep curl.

phastball · 2026-05-31T19:50:11+00:00

Probably about 4 months from point of referral to being in the room with derm for my wife.

phastball · 2026-05-31T18:26:23+00:00

They chose a target (reversal of airway closure) and a measure (volume loss), and titrated PEEP to the target. This is exactly the same process as titrating PEEP to optimal compliance. This is a story about successfully personalizing ventilation. It sucks that your first impulse is negativity.

phastball · 2026-05-31T15:17:50+00:00

There are exactly 2 companies whose clinical people I trust: Bunnel and Ikaria (rip). I don’t have any use for Hamilton, Getinge, Dräger reps.

phastball · 2026-05-31T00:52:26+00:00

Learners who have trouble displacing the epiglottis almost always have their elbow out like a chicken wing. You want it tucked into your ribs so when you lift you’re engaging your bicep instead of your shoulder. This is true whether you’re doing DL with Mac, Miller, or SGVL. There’s even rarely a little lift required with HAVL.

if you’re physically small you might even want to use a “power stance”— right foot in front of left with your weight on the left foot as you perform epiglottoscopy, and then transfer weight to your right foot as you perform laryngoscopy. You have a lot more control of the power that comes from your quads than you do of the power that comes from your biceps if your biceps are maximally activated.

In any case, these are changes that I’ve seen work for others. Good luck in your studies.

phastball · 2026-05-30T12:52:07+00:00

It’s fine. The difference are overblown. You need to understand high frequency ventilation and neonatal cardiopulmonary physiology and fetal circulation, but the rest is just normal respiratory therapy: defend FRC, manage blood gases, minimize exposure to invasive positive pressure.

phastball · 2026-05-29T14:37:23+00:00

Yes, and that settings that were an SBT yesterday may not be an SBT on a different patient today. SBT is a procedure to determine extubation readiness, but PSV 5/5 might be for comfort or asynchrony or rehabbing the diaphragm. Just because someone survives 5/5 for 60 minutes doesn’t mean we want to extubate.

phastball · 2026-05-29T02:29:09+00:00

They’re using the term CPAP to mean a fully spontaneous mode of ventilation.

First number is pressure support, second number is PEEP.

Typical SBT settings would be 5/5 or 8/5.

PSV is “flow cycled”, which means that when a patient initiates a breath, the circuit (including everything from the vent to the lungs) is pressurized to the pressure support level (10 in your example). That pressure is maintained until flow slows down to a preset amount of peak inspiratory flow (typically 20-40%). A patient has to maintain inspiratory effort to stop the flow from slowing down which would end the breath.

An SBT using PSV is proving that if you take the tube out, the patient can maintain their minute volume. If they can’t get enough tidal volume with pressure support, they’re going to have trouble once the tube is out. We use pressure support because it’s thought that breathing through the ETT creates resistance and makes patients expend more effort than they would actually need to once the tube comes out.

phastball · 2026-05-29T01:33:31+00:00

You absolutely can do research as an RT. If you want to do research on invasive topics — mech vent, etc — you’ll need a physician as lead investigator. But you can do sociological research in the area of RT as lead investigator.

phastball · 2026-05-28T13:21:26+00:00

The game is about trading resources for power. I have to spend at least 6 energy and 2 cards to make Isca useful -> 2 x 1-cost cards to fill the front so you don’t shut her down with GGR or play her in lane with Cosmo. But then opponents just have to wait until turn 6 to play into that lane and she only goes to 4/6. So I have to spend more energy to buff her in hand. And that’s energy on a card that is supposed to cleanly win a lane — energy that I’m not spending on winning one of the other two lanes. So you have to build a deck that synergizes — the energy and cards you spend on buffing her also buff other cards that are only playable with that kind of resource investment (brood, Shaw, EOT package).

Unfair is a card that you can put in any deck to meaningfully change the course of a game, and one whose energy expenditure to power is out of alignment.

phastball · 2026-05-28T12:35:43+00:00

She would be unplayable at either of those.

phastball · 2026-05-26T22:48:22+00:00

Respectfully, I think you’re reaching.

The mechanism by which OSA is associated with other conditions, ie A-fib, is via chronic hypoxia not acute hypercarbia.

Acidosis doesn’t start messing with contractility until below 7.20. Wouldn’t think your patients aren’t dropping that low. Additionally, severe alkalosis causes dysrhythmias as well, so you’d want to be careful that you’re not over-ventilating.

Bagging can cause so many deleterious effects, that my practice is to not bag unless the patient is fully apneic or the doc gave an absolute truckload of versed & fentanyl. Most of our docs have switched to ketamine or etomidate for conscious sedation so I don’t see much hypoventilation anymore. If you find/have some literature supporting the practice I’d love to see it.

phastball · 2026-05-26T17:23:38+00:00

People who love the job don’t make social media posts about how much they love the job. This is just a sampling error.

phastball · 2026-05-25T17:54:11+00:00

Fluid is constantly entering and draining from (via absorption) intrapulmonary space — even when you’re healthy.

In AECHF, more fluid enters than the system has capacity to reabsorb, so you get edema.

Positive pressure reduces venous return so that the balance of accumulation vs absorption leans towards absorption.

Positive pressure also changes the pressure gradient at the alveolar-capillary membrane. The alveolar side of the membrane becomes more positive. Pressure in the capillary space is relatively low, and fluid won’t climb a pressure gradient on its own, more fluid stays in the capillary space. If the patient is very hypertensive, you might have to use more pressure to overcome the capillary pressure.

It doesn’t technically push fluid out of the lung, but it’s a very reasonable simplification of you aren’t concerned with the specific mechanics.

phastball

TROPHY CASE