THE INSIDE TRACT:News and Upcoming Events

RESPIRATORY TRACTSEPTEMBER / OCTOBER 2012 VOL. 32 ISSUE 67

THE

ISRC Main Office: www.isrc.org Update your address online at www.idfpr.com

Neonatal/Pediatric Respiratory CareSeminar/WorkshopSaturday, October 20, 2012The ISRC’s Neonatal/Pediatric Committeeand Chapter 2 will present a Neonatal/PediatricRespiratory Care Seminar/Workshop7 CRCE will be granted for attendanceof entire seminar.

LOCATION:

Advocate Hope Children’s HospitalIn the Conference Center4440 West 95th StreetOak Lawn, Illinois 60453

TOPICS COVERED:

Respiratory Care as partof the Multi-Disciplinary Team

Asthma 101Interpreting X-raysNon-Invasive Ventilation on the Pediatric PatientNRP Update & Neo AssessmentAirway ClearanceTrach 101

Check www.isrc.org for more information

Know of any one who has moved upthe career ladder in Respiratory Care?Send your news to the ISRC TRACT

Visit ISRCOnline: isrc.org

Visit aarc.org and isrc.org for thelatest information on upcomingevents and educational offerings.

Visit ISRC.org for AARC Membershipat Reduced Rates!

INS IDE :

ISRC President’s Desk p. 2

Achievement Updates p. 4

New AARC Members p. 6

Get on the Inside TRACT p. 7

FIRST PLACE WINNING CAPTION BY:Mica Spicer, RRT Lead TherapistRespiratory Care DepartmentTrinity Medical Center, Rock Island, IL

Behold! The alpha” and omega” of all ailments.FIRST PLACE PRIZE:Free AARC Membership for oneyear (valued at $102.50) and anautograph copy of the book:

“Full Moon: Possible Side Effects,”published by Jim Allen RRT.

SECOND PLACE WINNING CAPTION BY:Jean Applegate Cardiopulmonary ManagerPana Community Hospital

“Unfortunately, when the nebulizerwas first invented, particle size didnot factor into the equation.”SECOND PLACE PRIZE:

A free AARC membership for one year

“Cartoon Caption”Competition Winners

Behold! The alpha” andomega” of all ailments.

The ISRC Announces the Winners of theCartoon Caption Contest. Congratulations!

1stPLACE

www.isrc.org THE RESPIRATORY TRACT September / October 2012 2

A Career in Flight, Come Fly with Me!

Ihad a hard time figuring out what I wanted to write about

this month. As my deadline approached I started writing

this several times. I just couldn’t figure out where to go

with it. So many options! But with so much political talk

and money conversation going on I thought I would give

everybody a break and tell you about one of the best aspects

of being an RT and something I know very well.

I fly helicopters. Well, I am not the pilot, but I fly in

helicopters as part of the pediatric transport team for Cardinal

Glennon Children’s hospital, a pediatric hospital that has

employed me as PRN staff for 13 years. They hired me on

when I was still teaching full time for Southwestern Illinois

College. I claimed that I didn’t want to lose my hands on

skills when I started teaching full time, in reality; I just

wanted to work with kids and FLYYY.

Our air transport team consists of 3 members: the pilot,

a nurse and an RT. The role of the RT is a little different than

what you find in most hospital job descriptions. The RT

chooses the transport device (stretcher, car seat, isolette).

The RT does most of the hands on assessment, stabilization

and loading of the patient. The RT is responsible for

visually monitoring the patient in route. And of course the

RT manages the patient’s airway and pulmonary status.

For infant/neonatal trips, we bring a fully loaded “portable

ICU” isolette. It includes a closed temperature controlled box

with access ports, a pretty incredible 5 pound portable monitor

that rivals any of the ICU monitors we use, and a built in

ventilator. We have 3 different isollettes. Two of them have

pneumatic pressure vents, the other has a “minimal need”

electronic/pneumatic volume ventilator that could probably

run all day on a 9 volt battery. We also bring a goody bag

of infant respiratory supplies. We have a portable iNO nitric

setup. The nurse hauls around a suitcase of crash cart items

including a pharmacological cornucopia of meds. We use a

cartridge style portable blood chemistry device that gives us

quick on site blood gas results, along with glucose and a host

of other information depending on how expensive a cartridge

you want to put the blood in. Fully loaded the equipment adds

350 lbs of modern medicine to the rig.

The pilot need to know WHO is going on the flight. Our

weights are a consideration. The helicopter does not “fill up”

prior to leaving but may only bring the amount of fuel

thought to be reasonably necessary for the trip. Flying unused

fuel around is expensive, so the pilot has a formula that takes

into account the distance, the head or tail wind, the weight of

the equipment and of course the passengers and only fuels up

with what is thought to be enough for the trip. Unfortunately,

I am pushing around 300 pounds of “ME” on my 6’4 frame

these days. My flight suit no longer fits as comfortably as it

once did when I first donned it 12 years ago. Sometimes, on

longer trips, pilots will only fuel up for a one way trip and

then refuel after they drop us off at the destination pickup

site while we assess, stabilize and treat the patient. All this cost

a truckload of money. Take off is about $2000 with a $300/

loaded mile fee. We don’t charge for the trip TO the patient.

You can see that a flight to the hospital can easily cost tens

of thousands of dollars. I have no idea what kind of bill the

victim actually ends up getting.

We fly at between 90 and 140 knots depending on the wind.

We also fly in nearly a straight line. So we can generally get

to a location in less than half of the time that it would take to

bring an ambulance. We normally drive in an ambulance if

the pickup site is less than 30 minutes away, but during rush

hour or if the patient is “really critical” we will fly regardless of

distance. I have been on several 5 minute flights. The farthest

we fly in the helicopter is about 150 miles. We have a fixed

wing jet on contract for longer trips but I have never had the

experience of going on one. Several of our therapists have been

on trips to California, Minnesota, and Massachusetts among

other areas all over the country.

On the way to pick up the patient, I generally try to sit up

front with the pilot. There is A LOT more leg room and head

The pediatric transport team for Cardinal GlennonChildren’s hospital can really lift your spirits, and career!

Curtis Kretschmer | BS, RRT-RCP | ckretschmer@isrc.org

ISRC PRESIDENT’S DESK ISRC.ORG

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www.isrc.org THE RESPIRATORY TRACT September / October 2012 3

room for that matter. Plus, the view is AMAZING! I mostly

work nights and looking down at the wide swaths of pitch

black, rural areas between the little towns and highways of

southern Illinois and Missouri we fly over is fantastic. While

we usually leave the altitude up to the pilot there have been

times when we have asked the pilot to not take us up too

high, particularly if the patient is struggling for oxygenation.

The cabin in the chopper is not pressurized and only rudi-

mentarily climate controlled. You can only imagine what it

feels like to be sitting in a stagnant chopper with a critically

ill patient on a 110 degree flight pad in an outfit that by

design seals you in what feels like a $280

zippered fabric sarcophagus. We normally

fly at between 1000 and 2500 feet. It cools

down about 10 degrees per thousand

feet of altitude. That works great in the

summer. In the winter it gets pretty darn

cold and we bring our coats to wear over the flight suits.

Upon arrival at the pickup location, the role of the RT is

to assess the patient with the normal expected vital signs,

including capillary refill, blood pressure and pupil reaction.

We draw blood, secure the airway, including intubations,

surfactant administration, IO catheter placement, etc.

I have worked other places where the RT’s transport scope

of practice included placing umbilical lines and chest tubes

but we don’t do that at Glennon.

I generally try to get the patient on our monitors as soon

as possible, and if intubated on our vent as well. RTs load

the IV syringes, evaluate the IV sites (if they have them) and

start fluids, meds, etc. We don’t leave until we are sure that

the patient is stable and will stay that way on the trip back.

Sometimes that means that we are at a site for a long time

attempting to stabilize a patient. The longest I have been at

a pick up site was 6 hours. And there have been times we did

not return with the patient due to the patient’s demise or lack

of viable mortality. But any patient that we can get back to

the hospital has a 95 percent chance of survival. The smallest

patient I have transported with was 260 grams; the largest

was a 6’6 and over 400 lb. and that was a 16 year old kid.

Loading up the patient involves controlling the spaghetti

of lines, wires, tubes and catheters, as much as it does putting

the patient in the isolette or stretcher. A couple of extra

hands usually help. The trip back is noisy, cramped, and

uncomfortable. We place earmuffs on

the patients that are too young to

understand, or earphones on those who

might be able to communicate with us.

The members of the flight team commu-

nicate with the earphones incorporated

into our helmets and that are attached to them. The audio

components of the monitors and ventilator are worthless,

so visual monitoring of the patient is imperative, and that

is the job of the RT. Once we return, the nurse handles most

of the communication with the hospital and the doctors.

The RT gives a report to the accepting RT and to clean and

restock what we used.

I love flying. It is one of my favorite parts of the job at

Cardinal Glennon. I have tried persuading my wife, who

works there as well as a nurse to come on board and apply

for the flight team. She seems very content with her newborn

ICU job and really is not interested in working with patients

she cannot pick up in one arm or feed with a bottle. So my

dreams of the Kretschmer/Kretschmer flight team are dashed

but we can still have date night at Glennon every Friday night.

THE RESPIRATORY TRACT

Upon arrival at the pickup location,the role of the RT is to assess thepatient with the normal expected

vital signs, including capillary refill,blood pressure and pupil reaction.

THE RESPIRATORY TRACT

Official Publication of the ISRCPublished by the

Illinois Society for Respiratory Care

Affiliate of the AMERICAN ASSOCIATIONFOR RESPIRATORY CARE

Publication DesignStreamline Communications Corp.Tom Badagliacco 708-334-9227

THE RESPIRATORY TRACT is published bimonthly. The closing date for editorial and advertisingprinted materials is the tenth day of the preceding month of each issue.

The Respiratory Tract will accept all manuscripts for review. Once published, the article becomesthe property of ISRC and may not be published elsewhere without the permission of both authorand editor. Opinions expressed by authors are not necessarily those of ISRC. The editor reservesthe right to edit for clarity and space.

Circulation: All members of the ISRC receive the TRACT. It is also circulated to RC departmentdirectors in Illinois. Annual subscriptions: $12.00. Change of address notices should be sent tothe ISRC Office, P.O. Box 10261, Springfield, IL 62791. Include name changes as well as bothold and new addresses.

PUBLICATION COMMITTEE CO-CHAIRS: MEDICAL ADVISORS:Craig Leonard cleonard@isrc.org Sherif Afifi, MDWade Jones wjones@isrc.org Dennis Kellar, MD

Frank Paul, DOAnas Nahhas, MD

�www.isrc.org THE RESPIRATORY TRACT September / October 2012 4

Albert Schweitzer FellowshipEmilee Lamorena, a 2nd year student in the Masters of Respiratory Care program, was chosen as an

Albert Schweitzer Fellow earlier this year. The Schweitzer Fellowship is a prestigious national fellowship that

allows graduate students in health sciences or human services to create, design, and implement their own

community-based service project that will improve the well-being and health of an under served population.

Fellows will carry out their projects over the course of a year and contribute more than 200 hours of service

to the community. Emilee is the first Respiratory Care student to receive the Schweitzer Fellowship.

Emilee lost her mother, Dr. Cynthia Lamorena, to lung cancer in 2010. This is the reason she chose Rush’s

RC program, as well as her inspiration behind her Schweitzer project. Her project will provide support for

underserved families affected by cancer. She is partnering with Gilda’s Club Chicago, an organization that offers

free services to men, women, and children affected by cancer. Emilee will create a new teen cancer support

group that will provide peer networking for teens who have cancer themselves or a loved one/friend diag-

nosed with cancer. The teens will be able to share cancer related experiences and learn new skills and methods

to help cope with stressful times. The program will also promote leadership, encouraging the teens to use

their experiences to help inspire others who are affected by cancer. Emilee will also work in the chemotherapy

infusion unit of Stroger Hospital. There, she will provide comfort for patients who are receiving chemotherapy

infusion therapy, and provide workshops and networking for their family members.

Kathleen Mai Respiratory Research ScholarshipJune marked the one year anniversary of the fundraising efforts for the Kathleen Mai Respiratory Research

Scholarship, and what a year it has been! The students in the Bachelor and Masters Respiratory Program at

Rush University have been working hard to raise money for the fund that honors one of the student's late

mother. To date, they have raised 20%, $10,000, of the funds needed to endow the fund and they are pushing

full steam ahead to reach their goal. April was a huge month for the scholarship with a month of fundraisers

planned at local establishments. An article in the AARC Times about the scholarship was published over the

summer and garnered national awareness. Once endowed, the fund will support the research projects being

designed and managed by the students. This is an amazing way to grow our field and to build future leaders.

Please join the Rush Respiratory class on September 22 at The Drum and Monkey (1435 West Taylor Street,

Chicago, IL) from 4-7pm for a happy hour fundraiser. It is a great way to network and support the cause.

The K. Mai Respiratory Research Scholarship is a 501c3 and 100% of funds raise go directly towards the

scholarship. Please visit www.kathleenmai.com for more information.

ACHIEVEMENT UPDATESRush University Respiratory Care Programs and Students

The Respiratory Care program at Rush University had

a successful graduation of Bachelors and Masters students

in June, and is excited to welcome a new incoming

class for the fall of 2012! Here are a few updates about what

the program and its students have been achieving.

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THE RESPIRATORY TRACT September / October 2012 5

Madhuragauri Shevade, a 2012 graduate, aims to give

a presentation on her research abstract: Establishing

the Effectiveness of Teaching Bag Mask Valve Ventilation

(BMV) to Entry Level Respiratory Therapy Students-

A Comparison of Traditional and Simulation Enhanced

Training Methodology. The purpose of her study was to

determine if a simulation enhanced education intervention

was more effective for training techniques of BMV than

traditional lecture in a population of entry level respiratory

therapist students. Shevade randomly selected participants

from the first year Rush Respiratory Program class and

assigned them to two groups (A and B). She baseline-tested

the two groups to see how much prior knowledge the

students had. Her testing was composed of three parts: a

multiple choice question test, survey and skill testing in the

simulation lab. An educational intervention was conducted

for group A. At the end of her study, Shevade post-tested

both of the groups again. Her results showed that learners

that participated in a simulation enhanced training

intervention performed better than learners who received

didactic lecture alone on the psychomotor skills assessment

of BMV resuscitation. Shevade currently works at Rush

University Medical Center in the NICU/PICU.

Michael Sajor, another 2012 graduate, will present his

abstract titled: A Comparison of Non-Invasive Proportional

Pressure Ventilation and Spontaneous/Timed Modes on

Total Inspiratory Work of Breathing in a Lung Model.

Sajor’s research aimed to compare the commonly used

spontaneous/timed (BiPAP) mode with the newer, less

common proportional pressure ventilation (PPV) mode,

introduced on the V60 non-invasive ventilator by Phillips

Respironics. Patient-ventilator a-synchrony is common

and is associated with adverse effects including increased

work of breathing (WOB), discomfort, increased need for

sedation, confusion during the weaning process, prolonged

mechanical ventilation, longer ICU and hospital stay, and

possibly higher mortality. Modes liked proportional assist

ventilation (PAV) and PPV use an algorithm that gives the

advantage of patient-ventilator synchrony for increased

comfort and reduced WOB versus BiPAP. What is different

from PAV is that PPV allows the respiratory therapist to set

a max pressure (Max P) and adjust a max elastance (Max E)

and max resistance (Max R). These settings could be used

to further optimize reduction of WOB and may provide

an easier way to counter “runaway”, which is a problem

caused by leaks and often seen in PAV. Using an old PB

7200 to drive his patient lung model, variables measured

included WOB, tidal volume, mean airway pressure and

peak inspiratory pressure (PIP). Data was collected as a

10-breath average on five different modes (CPAP, BiPAP

10/5, BiPAP 15/5, PPV 50% and PPV 80%). Sajor concludes

that PPV 50% provided similar results to BiPAP 15/5,

but PPV 50% had a lot less variability in WOB and more

variability in tidal volume and PIP. He hypothesizes that

PPV can be beneficial clinically with patients indicated for

non-invasive ventilation. Sajor currently works at Central

Dupage Hospital. His goal is to earn a research position

in the respiratory care field as well as gain acceptance into

a PhD program. He believes the respiratory care profession

needs more leaders and he would be honored to someday

be viewed as one.

Lastly, Stephanie Herrnreiter, a 2011 graduate, was also

chosen to present her research at the national conference.

She will present her abstract on: Flexible Fiberoptic

Bronchoscopy: Ventilation Monitoring Using Integrated

Pulmonary Index Versus Standard Monitoring Procedures.

Herrnreiter investigated the possible benefit of using

integrated pulmonary index monitoring as a real time

measure of ventilation during bronchoscopy procedures

using moderate sedation. To test this, she used the

Oridion Capnostream 20 monitoring device which

combines respiratory rate, pulse rate, oxygen saturation,

and end tidal carbon dioxide using an advanced software

to create a single numeric value (integrated pulmonary

index) from 1-10 (10= “normal” and 1= “poor”) in order

to rate the patient’s ventilatory status. Herrnreiter wanted

to see if the integrated pulmonary index would decrease

before physician intervention, indicating that the integrated

pulmonary index could be a reliable measure of ventilatory

status in the future of respiratory care. Herrnreiter is

currently fully employed in the adult side at the University

of Chicago Medical Center.

3 Rush Graduates Chosen to Present at AARC Conference

Three Rush University graduates are slated to present their novel researchthis November at the annual AARC conference in New Orleans.

www.isrc.org THE RESPIRATORY TRACT September / October 2012 6

Take Advantage of the AARC Membership Voucher!

To renew your membership for just $70.00 go to:www.isrc.org/membership.html

The ISRC has Purchased Discount AARC Membership Vouchersfor Therapists in Illinois. Join the AARC for just $70.00(a savings of $32.50 off the regular price of $102.50)

AARCMembership Voucher. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Stephanie SanSoucieDeshaun Adams

Sateesh ThankachanBridgette Kron

Aric ShayHarold OrtegaSigne Kimmel

Kimberly KuchtaCarol BaumanRachel Durley

Shannon EasleySarah Furey

Annalea GreenJames HayesShane Jarman

Erika LauxJeff Patton

Nicole PorterMaureen RoweCamilla Simon

Tegan StephensNicole Stolte

Patricia VelasquezRomaWielandTonya Potts

Carolyn Wilson

Welcome NewAARC MEMBERS

Can’t keep it all to yourself?

We don’t want you too!Let others hear what you have to say.

Would you, (or someone you know) like to present a lectureat the 2013 ISRC Annual Conference and Exhibition?

We are now accepting proposals for dynamic presenters to speakat the conference. Conference dates are May 29, 30, and 31, 2013,at the Drury Lane Conference Center, Oakbrook Terrace, Illinois.

The deadline for the speaker proposal is December 15, 2012

All submissions and questions should bedirected to Craig Leonard at cleonard@isrc.org

GREATOPPORTUNITY!

www.isrc.org THE RESPIRATORY TRACT September / October 2012 7

THE

RESPIRATORY TRACT CAN HELP YOU!Visit the ISRC Web site for education opportunities and news at www.isrc.org

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RESPIRATORY TRACT WANTS YOU!THE

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www.isrc.org THE RESPIRATORY TRACT September / October 2012 8