During stressful times we tend to focus on the challenges and the struggles. It is important to not lose sight of the positive in our lives and to give gratitude.

Over the past few weeks, I have witnessed many amazing people stepping up to help everyone.  Thank you, Sue Jones and Kelly Hassall, for your ongoing dedication and leadership to help RTs through Respiratory Therapy Society of Ontario (RTSO).  Thank you, Gino Luigi De Pinto and Sue A., for keeping the RTSO website up to date with the latest resources.

   Thank you, Thomas Piraino, for putting together the great resource on your website, and answering questions live on social media. 

Also, a big thank you to Carolyn McCoyAndrew WestCarole Hamp and Kevin Taylor for your ongoing hard work in the background.

  Thank you to RT programs for lending your ventilator to hospitals, and taking your third-year students out of clinical rotations to keep them safe.

Farzad Refahi
March 23, 2020

To Acute Care for Support?

Our Pulmonary Function Lab has been closed for the past two days to reduce the risk of transmission to patients, especially the vulnerable populations.  Things are changing daily, and there many unknowns. (To non-clinicians reading this, we do know proper hand hygiene and social distancing works!)

I have worked full time in a PFT setting over the past 5 years.  With PFT lab closed, and a chance for deployment to other units, I need to do some reviewing! 

The Essentials of Respiratory Care by Robert M. Kacmarek .Fourth Edition. 2005. Elsevier Mosby

The Essentials of Respiratory Care, Fourth Edition, by Robert M. Kacmarek, Steven Dimas and Craig W. Mach is one of my resources.  This textbook was not actually a resource during my studying, however, it was a recommendation by one of the instructors (shout out to Paul Smith at The Michener Institute). Since I have not been trained in the acute care setting of my hospital, I don’t know about many of the protocols, selection of equipment and policies.  I am still going to use this opportunity to review some respiratory care knowledge.

Do you have any up to date, open access and free resources to recommend?

Farzad Refahi


Flattening the Curve

Hearing About Flattening The Curve While Listening to Dr Mike on YouTube As He Discuss Coronavirus.

I try to get information from multiple sources online. One of these sources is Dr Mike who is a family physician in the United States. In one of his latest videos titled ‘We NEED More Testing Kits!’, I came across a concept which I had forgotten about. At 2:10/11:40 he quickly refers to ‘Flattening The Curve’:

… Here in United States, we simply do not have enough ICU beds if everyone is to get this virus simulatenously, so by slowing the rate at which this virus infects others we doing “Flattening the Curve”

Screenshot of Dr Mike’s video

What is the concept of Flattening The Curve?

A large number of people using limited resources at the same time will saturate and overwhelm the system. The system can provide better care if the same number of people access these resources over a longer period of time (versus all at once).

When it came to public health, disease prevention and elimination of spread were at the core of my thoughts. Now I have learned that slowing the spread of disease is not necessarily a total defeat. Even a slow down, is a success in better access to care (in the highly contagious disease when total isolation and zero spread is unrealistic).

You can watch the full video using the link below:

Link to Dr Mike’s video published on Mar 15, 2020 , watched by Farzad Refahi on Mar 15, 2020

As healthcare providers, we can better educate the public about the nature of the disease and proper hand hygiene. Also, we can encourage unnecessarily gathering of people in public spaces. As a group, we can look after the vulnerable population.

On a personal note, my wife, who is feeling fine, cut her business trip short due to the quickly evolving situation with COVID-19. I purchased food and supplies to last her at least two weeks. I left for my parents before her taxi got to our place. She has decided to follow the recommendation of self-isolation for two weeks. We are lucky that my parents live close by and are more than happy to have me for the two weeks. Of course, it is not easy being apart even longer than planned, however it is a small price to pay for the greater good (especially when as an RT, I have face to face interactions with patients at work).

Farzad Refahi


Feb 21 2020 article

Photo of the article’s first page.

Every month I try to read an open access article. After reading the article, I share the tittle and associated link with my followers. This is to encourage clinicians to reads articles, stay up to date and continue to grow.

The article I read on Friday was:

Bilateral hypoglossal nerve stimulation for treatment of adult obstructive sleep apnoea by Peter R. Eastwood et al.

Eur Respir J 2020 55:1901320; published ahead of print 2019, doi:10.1183/13993003.01320-2019 OPEN ACCESS ARTICLE

I am not here to endorse this technology or this approach to manage Obstructive Sleep Apnea (OSA). I am learning about it and sharing it with you. It did open my eyes to another approach which apparently has been around for some time. I appreciated the innovations. Compliance with CPAP units, the current gold stands, is low. The authors do mention that, and I have personally witnessed it when I worked for a CPAP company (casually for around 2 years).

I don’t need to express my personal thoughts on this as the authors have done a great job of describing the technology (GEnio system), what’s make it unique, the limitation of the study, and also the opportunities it brings.

It is a small study, n=22, with few participants. There is no control group.

This approach did open up the discussion to devices that deliver bilateral stimulation of hypoglossal nerve, includes minimal incision, and lacks an implanted battery (p10).

What are your thoughts and take on this?


On My List to Read

Daring Greatly. I have previously listened to Dare to Lead by Dr. Brene Brown PhD and greatly enjoyed it (audiobook)!
As mentioned in a previous post, I will go back to these resources to spend time to “digest” and implement them. #SelfReflection

In your opinion, how important are soft skills in becoming a well-rounded clinician? What’s on the top of your soft skills traits to improve?

Farzad Refahi



An Article A Month

Every month I try to read an open-access article.  After reading the article, I share the tittle and associated link with my followers.  This is to encourage clinicians to read articles, stay to up to date, and continue to grow. This morning I read this recent editorial piece on ERS:

The new haemodynamic definition of pulmonary hypertension: evidence prevails, finally!

By Marius M. Hoeper and Marc Humbert. I wanted to review the noninvasive ways of measuring for pulmonary hypertension and came across this useful resource: Happy Reading! Farzad Refahi April 3 2019 [End]


Recreational marijuana use is becoming legal in Canada in just few days. With the political, legal and financial debates aside, there are health concerns that the public, users and healthcare providers need to be aware of. I have attended few talks on this topic and have read few articles that cover this issue in details. While I did not become an expert, I have noticed a common message:

Inhalation of marijuana can lead to temporary and permanent damage of respiratory system.

  • Review and share this collection of Questions and Answers by CBC: ok
  • Avoid and limit your inhalation of airway irritants.
  • Please do not drive under the influence!


To have a better understanding of PFT maneuvers, watching the RT/technician screen as the patient performs these steps may be helpful for some students.
I have uploaded 4 videos (SVC, Spirometry, Body Plethysmography, and DLCO).

Keep in mind that these are for demonstration purposes only, and software models and standards can change.

Slow Vital Capacity 


Body Plethysmography