RT Student Survival Guide: YOUR MUST KNOWS
- RT Jaime
- Mar 25, 2021
- 4 min read
In RT clinicals we learn so much information and may not know what we should come out knowing. It can all be so jumbled together and happen so quickly. I have put together some things I learned in clinicals and as a new grad that I feel are necessary as an RT. You will still solidify these skills as a new grad, but it helps cut out the white noise while you are in clinicals so you can focus on molding these skills. Of course there are more, however, these are the ones I would like to share with you.
Ventilator Setup and Management
You must know how to set up a Ventilator properly before you graduate Respiratory School. I specifically mean connecting the inspiratory limb and the expiratory limb in the correct places on the ventilator as well as where the in-line suction catheter goes in relation to the Wye. Know how to connect the bells and whistles like the pressure easy or the end tidal CO2. We put so many things in line with the vent circuit and no one else is going to know how to order these things except you. If you work in pediatrics, know about the neonatal flow sensor and where it goes in line on the vent circuit. It may seem funny to you now, but you would be surprised how easy it is to make a mistake that would injure the patients lungs.
Arterial Sticks
At my first job the nurses and RT’s had shared abilities to do ABG sticks and run them. So initially I got comfortable with the RN’s doing the gases for me. However, after about a month as a new grad I realized I was not good at doing arterial sticks. So, I made it a point to do as many of the arterial sticks as possible. I took the initiative because I knew it was one of the hallmark skills in our profession. After a while I took pride in my arterial sticks and would always ask my patients for feedback. When they told me it was painless, I felt amazing about myself. That is the common misconception about arterial sticks, that patients are going to feel pain when you do them. However, if you get good at that skill you will not cause pain or too much of it anyways. Always ask your patient for feedback and take it so you can refine your technique. I remember being a patient in the hospital and five nurses could not get an IV on me… It was painful every time and that is why I made it a point to make my ABG sticks as painless as possible for my patients. I know what it feels like to get stuck multiple times…
Click the image below to get 10 free ABG Interpretation Practice Problems!
Interpreting ABGs
This skill is a 100% no brainer for RT’s. We make ventilator changes based off of the blood gases. If you don’t know how to interpret blood gases, are you even an RT??? Many times the residents or fellows will defer to you and what you think is best for the patient in terms of vent changes based on ABG’s. Solidify these interpretation skills and you will be on your way to becoming a strong RT team member.
Click here to watch my YouTube playlist on ABG interpretation:
Patient Assessment
Assess, assess, assess! Get really good at your patient assessment skills, because they will come in handy when you just know something is not right. But if you have great assessment skills you can narrow down the culprit and recommend ABG’s, CXR, CT scans, and Labs in order to find out what is wrong with the patient. This comes in handy if you get called on a rapid response call to a patient who is on the floor and is not doing well. Don’t forget this applies to vented patient’s, patient’s on RA, and patients on any type of respiratory support.
Assessment Skills
Breathing rate and pattern
Color (pale, cyanosis)
Digital Clubbing
Work of Breathing
HR and other vital signs
Auscultation of breath sounds
Watch this short video for more on Patient Assessment Skills:
Good CXR from Bad CXR
You should be able to tell at least a good CXR from a bad CXR and perhaps get some of the basic interpretations like pleural effusions, infiltrates, pneumothoraces, etc. They are easier to learn because they show up more obviously on the CXR. Pulmonary edema is harder to see, and even the ETT placement can be hard to see on the CXR. These skills come with time, but when your preceptor is looking at CXR, get in there and ask questions! Sometimes you can see some pretty cool things on CXR!
Escalation and De-Escalation of Care
I am a huge proponent of learning trends and patterns in healthcare, so if you can learn how escalation of care and De-Escalation of Care work in your hospital, then you should be golden. You can focus on respiratory support and then once you have that down, you can start to notice the hospital flow of escalation and de-escalation of care. You can also start to see the nursing perspective of escalation and de-escalation of care. Here is an example below of escalation and de-escalation of care.
Closing Thoughts
I hope this post helps you guys narrow down really important skills that we do as Respiratory Therapists and cuts out all the white noise. Sometimes we don’t know what is important or what to focus our time on. These are just a few of the important ones, however there are many more that will help build you into a strong RT team member. Don’t panic if you don’t feel confident in some of these skills, you will have time to learn during your first job as well. YOU WILL BE FINE! I hope you guys got a lot out of this post and check back later for more at the RT Blog Spot!
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