Respiratory Therapist

To Acute Care for Support?

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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
www.Respiratory.Blog/AcuteCareReview/

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Flattening the Curve

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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 https://youtu.be/DfMl6W6N7-A

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 https://youtu.be/DfMl6W6N7-A , 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
http://respiratory.blog/flattening-the-curve/

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Let’s read an article a month – March 11, 2020

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Screenshot of the first page of the article by Morgan et al. Ready by Farzad Refahi and shared on www.Respiratory.Blog

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 up to date, and continue to grow.

I found an article on March 9th, 2020. I spent a few days with it, and now I share it with you.

Variability In Expiratory Flow Requirements Among Oscillatory Positive Expiratory Pressure Devices 


by Sherwin E. Morgan, RRT, Steven Mosakowski, RRT, MBA, Brenda L. Giles, MD, Edward Naureckas, MD, Avery Tung, MD, FCCM
Published online March 4, 2020. Available on The Canadian Journal of Respiratory Therapy (CJRT) : https://www.cjrt.ca/wp-content/uploads/cjrt-2019-025.pdf

Top 3 Reasons Why I enjoyed this Article

Firstly, this article is quick and easy to read.

Secondly, I had forgotten about the various Oscillatory Positive Expiratory Pressure (OPEP) devices on the market. This article was a nice introduction to various flows and pressures required to operate the units. The authors provide a recommendation for which units to be used by which population (small vs. larger patients) on page 10.

Thirdly, in the introduction the authors discuss the proper technique for using these devices (referencing Olsen et. al). You can find this description on pages 7 and 8.

Once again, you can view this article by visiting CJRT (which is owned by Canadian Society of Respiratory Therapists): https://www.cjrt.ca/wp-content/uploads/cjrt-2019-025.pdf

Happy Reading! Let me know what you think.

Farzad Refahi
http://respiratory.blog/lets-read-an-article-a-month-march-11-2020/
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Thank you, Dan Pinard!

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The other day I received a Pulmonary Function Testing question that I had not dealt with lately. I provided a short answer but did mention that I will connect with a trusted expert. Here is a quick shoutout to Dan Pinard from Novus Medical Inc. Thank you for the quick and comprehensive answer!

If you have read any of my annual Thank You posts, that I write during RT Week, Novus Medical Inc. is a recurrent name. Once again, they are supporting the PFT Symposium in Canada. This year, 2020, the symposium is on September 18th and 19th and takes place at Radisson Vancouver Airport Hotel.

From my understanding, more information will become available as soon as speakers have confirmed their invitations. For more information, you can visit https://www.cacpt.ca/conference/ . Also, to learn more about the great team at Novus Medical Inc. visit: https://www.novusmedical.ca/about-us .

I will let you know as I find out more about the event!

Farzad Refahi

Let’s read an article a month – March 06, 2020

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Snapshot of the first page of the article.

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 up to date, and continue to grow.

I found an article on Feb 27th, 2020. I spent a few days with it, and now I share it with you.

A spatially restricted fibrotic niche in pulmonary fibrosis is sustained
by M-CSF/M-CSFR signalling in monocyte-derived alveolar macrophages by Nikita Joshi et al.
 
 Eur Respir J 2020 55:1900646; published ahead of print 2019, doi: 10.1183/13993003.00646-2019 https://erj.ersjournals.com/content/erj/55/1/1900646.full.pdf

This article is well written and easy to follow. I must admit that it is too specialized and technical for my comfort level, but I still enjoyed it.

What this study demonstrates? Many elements were discussed but here is a very simple summary to get you interested:

“Our findings suggest that inhibition of M-CSFR (macrophage colony-stimulating factor receptor) signalling during fibrosis disrupts an essential fibrotic niche that includes monocyte-derived alveolar macrophages and fibroblasts during asbestos-induced fibrosis.” p1

Happy reading!

Farzad Refahi