Carolyn Greer

I first met Carolyn Greer at the 2017 CSRT conference in Halifax.  After overhearing my name in a conversation, she approached me with a big smile and a determination to ask if I was the Farzad, ‘Raffi’, who will be joining Markham Stouffville Hospital’s PFT lab a few days after the conference.  I have worked with Carolyn for the past 11 months in the PFT lab, and have been amazed by her level of drive, dedication, and care.  She is proud to be an RT, and has worked in various areas including acute care, community care, home care and pulmonary function testing.  She also has volunteered for CRTO and Lung Association. To recognize her dedication and to further understand her views and gain further insights, I asked her to answer few questions.

To start, I like to ask a question that many RTs discuss when meeting other RTs: When did you first hear about the respiratory therapy field? What made you decide to become an RT?
I first learned about Respiratory Technology (at the time), when I woke up in ICU at the Wellesley Hospital in 1980, after a respiratory arrest! Post a brief intubation, I began chatting with the fellow who was giving me my aerosol treatments. He told me what his role was and right then and there, I decided to be an RT.

I had struggled with severe asthma all my life. I spent most winters in the hospital with colds that were difficult to manage. The cause of this arrest was an anaphylactic reaction to ASA. I had always taken aspirin for aches and pains, but as I was using it, my body slowly built an intolerance to it. We did not know that ASA was the culprit until 2 years later, when I was in a full resp arrest, with code blue and that was the common trigger to both arrests.

I was intubated for quite some time and while in hospital post arrest, I found out I had been accepted into the RT program at TIMT!

How did the experience of being a patient, and receiving respiratory support, shape you as a clinician?
When I was a patient, I realized the discomfort of an ETT tube in your airway, the lingering pain of an artline when it has been removed. I have struggled to breathe more times than I care to remember so being in these situations has allowed me to be a more empathetic and compassionate RT. I still love what I do.

With various roles and years of experience, what are some of your memorable roles so far?
I was lucky to train at TGH during my clinical year. In May of 1984, the first single lung transplant was performed at TGH, on an overnight shift. I was running ABG results for the OR all night. That was my most memorable experience. I loved the thrill of working at TGH- at the time it was a trauma centre, it was also at the beginning of understanding the AIDS crisis. I moved from there to West Park hospital, which gave me more memorable moments. Dealing with experimental home ventilation and ventilatory support measures- even negative pressure ventilation- (Cuirass). West Park was like becoming a family member to the long term vent patients who called it home. After that I moved to home care and dealt with a lot of the preemies and their families as they transitioned to home with ventilatory support in place. Strong bonds were formed with these families. Finally, I am here doing PFT’s and loving learning about new pharmacological advances in the respiratory field, and seeing a new patient every 30 minutes, with a different clinical presentation every time!

I want to explore the homecare side of your experience.  How did you get involve with homecare?
I was interested in home care, because I was teaching and preparing patients at West Park to transition to home. It seemed like the next step to continue in the journey of learning all facets of our field.

What were some areas of satisfaction and challenges working in homecare?
The main challenge was not having a full hospital with colleagues, and medical interventions at the ready in the event of a medical crisis. However, I really learned to hone my clinical skills and intuitions and develop my confidence in the home setting.

SRTs may not receive much time during clinical rotations to explore homecare. Any advice to share for those who want to get involved? Yes!!!! Remember, when a patient comes to a hospital- they are on your turf and you can guide them and they will usually listen….when you go into their home, you must not judge their quality of life. You are on their turf and you need to become more of a facilitator to get them to follow your suggestions. It is important to be even more respectful of a patient’s needs, wants and space when you are in a patient’s home.

Now let’s talk about our current field of Pulmonary Function Testing.  How did you get involved with working at a PFT lab?
I initially arrived at Markham Stouffville as an asthma educator working part time in the asthma clinic in the evenings. I was approached about taking over a part time position in the PFT lab and my gut reaction was “No Way.” I was remembering the archaic systems we learned in the 1980’s with water seals, and drums with a stylus. Then I thought, (after much reassurance that it was all computerized), perhaps I should move out of my comfort zone and do something to challenge myself. I had been in the field for 20yrs. At that point. So I took a leap of faith!

What are some sources of satisfaction and challenges working in this setting?
Challenges are getting good results from each and every person. There are several modifications we can make to get those results based on the scenario- ie: English as a second language etc. Satisfaction comes when you see improvement or response to tx OR improvement post lung transplant or even allaying a patient’s fears and getting excellent results.

Any comments or advice for those who may want to work in a PFT lab? Patience is a virtue, and organization and time management are key. It is a new patient every 30 minutes, so you must be able to be fluid and able to adapt quickly.

With a sudden burst of various puffers coming to the market over the last 3 years, what is important to keep in mind? How can RTs better assist their patients with their puffers?
The newest generations of MDI’s are specifically targeting certain disease processes. Before, there were generally only 2 classifications of MDI’s. It is important to keep up to date on the newest meds and their indications for use. Also, it is important to review positive reasons for compliance with taking their meds.

What is the next big growth area that you see?
I believe we will need to be aware of the new legalization of marijuana and its effects. I see an even bigger role for the RT in public education.

Any last thoughts or comments that you would like to share with my RT followers?
Always remember: No one ever wanted to have trouble breathing. No one EVER wants our services….so make it the best experience you can for the patient.

I want to thank Carolyn for sharing her story and insights with us all, and for her years of dedication to the RT field.  

[End] http://respiratory.blog/carolyngreer/

Ultrasound and Respiratory Care

I first met Mr. Leonardo Faundez, at The Michener Institute, as he supervised one of our interprofessional courses.  It was evident that he enjoyed his role as an educator.  As a class, we learned about different programs, including ultrasound.  His expertise in sonography is backed with an extensive work history including: sonographer at small healthcare facilities, clinical education specialist, entrepreneur, education consultant, adult education assessor, and ultrasound professor. He has performed these roles at various organizations including University Health Network, Aprende Canada (his company), Institute for Quality Management in Healthcare and Exact Imaging, and many others.  It was no coincidence that he was first in my mind when I wondered about the role of ultrasound in respiratory care.

I have witnessed the utilization of ultrasound in different settings including, but not limited to, difficult radial art-line placement, FAST scans, and diagnosis of diaphragmatic paralysis and cardiac tamponade.

I had heard “Negative FAST” being yelled out which followed with a look of relief on everyone’s face; however, I never took the time to better understand the process.

 

Leonardo, I have heard the terms FAST and POCUS being thrown around. What can you tell me about them?

FAST stands for focused assessment with sonography for trauma. It is a type of ultrasound examination done in emergency situations when looking for pericardial effusion or hemoperitenum post trauma. It is mainly performed by emergency physicians, surgeons or paramedics. The idea is to look for free fluid (in this case blood) in spaces around the heart, liver, spleen and pelvis. Fresh blood appears anechoic (black) on ultrasound.

POCUS stands for point-of-care-ultrasound. I would say that FAST falls under POCUS in that the latter one also deals with rapid ultrasound examinations. However, POCUS may also include the ruling out of other pathologies such as abdominal aortic aneurysms, appendicitis, cholecystitis, among others. It is also mainly performed by physicians in different areas in the hospital.

 

 What can you tell me about other uses of U/S in clinical setting? 

Ultrasound is very useful when looking for pleural effusion, mark for thoracentesis, and assess diaphragm motion.

Besides looking specifically for pleural effusion, it may also be detected as an incidental finding when performing abdominal ultrasound. When assessing the liver and spleen, since these organs are adjacent to the diaphragm, it is easy to spot fluid present superior to the diaphragm, in the thoracic cavity. Since patients take the supine position when having an abdominal ultrasound, pleural fluid will follow gravity and so it will be visible posteriorly superior/above the diaphragm. When documenting the pleural effusion, it is important to state the amount (small, moderate or large), the laterality, and how they compare.

If a sonographer is involved with marking for thoracentesis, he/she will scan the patient and show the radiologist where the largest pockets of fluid are and the best way to get to them. The radiologist will then make the mark on the patient.

As per diaphragm motion, the M-mode (motion mode) may be used to graphically show the motion over time. The single line used by the M-mode is placed so that it crosses the diaphragm. The resulting display will show a wavy line representing the degree of diaphragmatic motion. The professional performing the ultrasound will need to collaboratively work with the respiratory therapist in the ICU in order to scan the patient with the ventilator on and off.

M-mode is also used, for instance, when measuring the fetal heart rate in utero as it displays motion of the palpating heart.

 

This image shows the M-Mode single line crossing the diaphragm (bright line shown by the arrow). The resultant graphical display shows a normal motion in the left diaphragm while no motion on the right side. https://twitter.com/sonostache/status/830999633371410432

 

Any other interesting overlap between respiratory system/care and U/S?

Ultrasound may also be used to assess for pneumothorax. Although ultrasound waves cannot travel through air, certain sonographic features allow the differentiation between normal air in the lung and pneumothorax. For more information on this, http://pie.med.utoronto.ca/POCUS/POCUS_content/lungUS.html

 

Thank you Leonardo for sharing your insight with me and others in the RT community!

To learn more about Leonardo and his work check out:  www.aprendecanada.com .

 

 

 

 

 

 

 

 

Mr. Leonardo Faundez

lfaundez.education@gmail.com

www.aprendecanada.com

Tomorrow

Tomorrow is February 1st, and I am excited about this day for several reasons.

First, I am looking forward to share with you a blog post about Christina Dolgowicz!  She is an amazing RT who is doing wonderful work for her patients, community and our profession! Stay tuned! The link will be activated tomorrow: http://respiratory.blog/christinadolgowicz/

Second, to start the ‘RTs and Friends Blood Drive’, I will travel to Canadian Blood Service’s downtown Toronto clinic to donate blood.  There is a shortage of blood products in Canada and as healthcare providers we can extend our care by donating blood.  Check out this month long Facebook Event under Respiratory Therapy by Farzad :  https://lnkd.in/evWEtHU
Share this event with others, indicate which day is your appointment, donate blood, and let me and others know with the hashtag RTbloodDrive (#RTbloodDrive) and tag me (Instagram/Twitter/Facebook post).

Third, I have an appointment with my supervisor and hope to discuss ideas for further growth.  Self-reflection and feedback are crucial elements, and require honesty, openness and ongoing effort.

 

What are you excited about and looking forward to?

 

Farzad ‘Raffi’ Refahi

January 31, 2018

Tomorrow