Sleep first pressed its way into my awareness through pulmonary rehab programs I ran more than twenty years ago. It seemed that many of the COPD patients I served had trouble sleeping. Then, upon starting up a lung health clinic in an adult primary care physician practice that served a rural region in Missouri, it took only two years to understand that sleep was playing a major role in the issues of health that surrounded the chronic diseases of the patients in our practice. A year later, the physicians had me start a sleep lab as a part of the lung health clinic.

I read like crazy to see what evidence-based medicine was saying about the vetting process for sleep disorders. I then boiled down the various questionnaires to a few choice questions for our own simple fifth-grade-level questionnaire. Since I had accidentally discovered that dreams were a matter of fascination with the patients in our practice, I included one peculiar question as a possible touch point: "Do you wake up at night with dreams of being trapped?" If nothing else, that question gave me many good stories of weird dreams and served as a way to personalize a very clinical process for some patients.

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The Respiratory Therapy Dept. at this hospital is a VERY progressive, goal oriented department; knee-deep in protocols throughout all inpatient areas.  Due to this level of involvement throughout the inpatient areas, the RCP’s are a well-respected member of the healthcare team. However, in the ER setting, our organization is operating in a very antiquated task-managed physician-says-caregiver-does model.  As you all could imagine, this results in a very low-level of respect for the RCPs in this environment.

Therefore, we are looking to drastically change the role of the RCP in the ER.  We envision a model in which the RCP [who primarily resides in the ED all shift] is called for every shortness-of-breath or airway issue that comes in.  The RCP would assess the pt, and implement interventions (O2, HHN, BiPAP, intubation, etc.) according to indications. 

Does anyone know of such a protocol or model out there? If you have such a protocol, would you mind sharing forms or key contacts? Any other thoughts or ideas would also be greatly appreciated.

Thank you in advance for any information that you can share with us!

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What was old is new again hello SPAG. We have resently dragged our SPAG unit out from the bowls of the sub basement to deliver Riboviron. So something old is new again. I do not remember taking as many precautions 15-18 years ago as we have to today hummm.
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See the original Discussion Post
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Does anyone have a process/program by which an RT can cross-train to help with nursing care in the Special Care Nursery. This would be tasks such as feedings and vitals. When nursing staffing is in a pinch, an RT could step in to help. What do you think?

Marilyn Parton
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The Spring Diagnostics Bulletin is now available.  As you may know the AARC website has changed.  To access the bulletin follow these steps: click on the "About AARC Membership" link at the top of the AARC home page; select "specialty sections" under the community heading; click on the respiratory diagnostics icon; select "Respiratory Diagnostics Section Bulletins" from the menu bar.

Featured articles:

VE/VCO2 Slope Analysis-Richard Johnston CPFT
A LEAN approach to BioQC-Ann Wilson RRT RPFT
Introduction to DLCO Simulation-Jason Blonshine RRT CPFT
Quarterly Case Report: Positive response to methacholine without a significant change in FEV1

A new feature added to the Bulletin is "Technologist's Comments".  This is your chance to climb up on your soap box and editorialize about issues relevant to respiratory diagnostics.

Thanks to Katrina Hynes RRT CPFT, Section Chair, for helping me recruit authors for the spring issue

I'm now looking for submission ideas for the fall issue.  Please contact me with ideas for submissions
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In 1976, I first heard the term “value added.” I was looking for a college and found one in a small Midwestern town. This University’s educators claimed they would add value to my education if I gave them the chance. I did, and I have thought about the value added concept ever since.

Value added philosophers throw around their ideas in several disciplines--education, economy, and marketing to name a few. Education took top spot in my readings on the subject, but I soon discovered that economics and marketing lead the way in value added thinking. Here is a basic definition from a marketing perspective:

The enhancement a company gives its product or service before offering the product to customers. Value added is used to describe instances where a firm takes a product that may be considered a homogeneous product, with few differences (if any) from that of a competitor, and provides potential customers with a feature or add-on that gives it a greater sense of value (

I soured on the exact terminology about fifteen years ago when I discovered that Marxists had commandeered value added, or perhaps claimed its genesis as their own; but that is a tough discussion and one left to much more intelligent people than me. As such, I think I will just change the terms slightly and ask, “How can technologists add value to the basic product called polysomnography?”

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Sleep technologists are detectives. We are often the first to notice brief runs of atrial fibrillation, the first to see the evidence of disruptive periodic limb movement in patients who think they are not benefiting from their CPAP, or the first to identify wayward seizure activity. To do this, we have to train our observational skills, keep them sharp. Detective instincts, once honed, will likely cross over into our daily lives. For me, noticing the little things makes walking the pathways of my favorite nature area more than just a doctor-prescribed exercise routine.

I recently walked on a snowy path in the woods. I started early because I hoped to be the first; however, four other hardy souls had tramped through the snow before I got there. Speaking of souls, or at least soles, I came to know those mysterious early hikers by the tracks they left. Two of them traveled in the same direction as I, and the other two had come the other way.


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I enjoy gardening. The work promises a sore back, and every year the results are the same. Flowers of every color and hue adorn the shaded and sun drenched borders around my house, no matter the season. “Tedious” is just not the word for what I do every year in my gardens. For some reason the flowers spark wonder in me as they bloom forth, just like they did the year before and the year before that. As a sleep technologist, the flower of sleep rising from the fallow ground of sleep disordered breathing creates the potential of a similar wonder if I will just allow.

In the sleep lab we technologists test the same old problems every night, over and over again. Right? If you're like me, it's easy to get jaded, and the challenge is how to find new wonders in the same old things, night after night. We must dig deeply into the uniqueness of every situation. Granted, sleep apnea is sleep apnea is sleep apnea, but the circumstances of life with this disease manifest themselves uniquely in every case. During the set-up we try to get to know the patient, and in that process we might unearth some vital information on how the person we are serving deals with and suffers from his or her problem.

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It’s Virtual Lobby Week - Let Your Voice Be Heard!

The AARC has launched its Virtual Lobby Week in preparation for the AARC’s 17th annual Capitol Hill Advocacy Day on March 18.

AARC and your state societies sponsor respiratory therapists who are your Political Advocacy Contact Team (PACT) representatives. These RT volunteers come to Washington, D.C. every year and have scheduled face-to-face meetings with the Congressional delegations from your state to advocate for legislation and policies that will positively impact the profession and the pulmonary patient.


We are advocating for Congressional support of the Medicare Telehealth Parity Act. This important legislation expands Medicare telehealth services to include respiratory therapists as telehealth practitioners and includes coverage of respiratory services and remote patient monitoring and training for patients with COPD. (Telehealth services are those that occur via an interactive telecommunications system that permits real-time communication between health care practitioners and patients or other health care providers who are at different locations.)

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Hello Fellow Respiratory Therapists,

Just wanting a quick idea of how different hospitals bill for Nitric Oxide and/or Oxygen? Is it a daily charge, twice a day, by min/hr, etc.  

Thanks in advance!
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hey Montana RT's, 
I am curious as to how many of you subscribe to this forum. please simply reply with a yes if you received/saw this message. 


Brian Cayko, RRT
Great Falls
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If you are a Kansas Respiratory Student or know one, the Russ Babb Memorial Scholarship Dead Line is Feb. 28, 2015.  The application can be found on the KRCS website.  Please get your application in.

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I have carried liability insurance for decades. I do IC work for NH and HH companies and owned a DME. I think its good practice. Best to be safe than sorry.
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Dear Montana Therapist,

Your Montana Society Legislative Affairs team is gearing up for their March trip to DC to lobby for improved reimbursement for Respiratory Therapists.

Over the next few weeks we will be asking you to help us in a couple of simple ways.

1.      During the week beginning March 9th we will be sending out web links that allow you to quickly show your support for our cause by sending a preform email to congress. We hope that you will send one of these emails and encourage your co-workers, physicians, nurses, patients, family and friends to also do this.

2.      Email Brian Cayko with an RT who is willing to serve as a point of contact for your facility. Please do this ASAP so I can be in touch with this contact person over the next two weeks. You can also reply to this message.  :-)


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The Winter Diagnostics Bulletin is now available.  As you may know the AARC website has changed.  To access the bulletin follow these steps: click on the "About AARC Membership" link at the top of the AARC home page; select "specialty sections" under the community heading; click on the diagnostics icon; select "Diagnostics Section Bulletins" from the menu bar.

I would like to thank the following authors for contributing to the Bulletin in 2014:

Danielle Bonagura, RRT
Katrina Hynes, BAS, RRT, RPFT
Brad Knudson, RRT
Elizabeth Koch, BHS, RRT, RPFT
Matt O’Brien, MS, RRT, RPFT
Balamurugan Panneerselvam, BS, CPFT, RPSGT
Gregg Ruppel, MS, RRT, RPFT
Jennifer Weltz Horpedahl, RRT-NPS, RPFT, AE-C
Holly Wilson, RPFT

The Winter edition of the Bulletin features a profile of our Specialty Practitioner of the Year, Ann Wilson BS, RRT, RPFT, AE-C.  Jennifer Weltz Horpedahl RRT-NPS, RPFT, AE-C explains how to generate Levey-Jennings plots for biologic controls using Microsoft Excel.  Factors affecting nasal nitric oxide values are reviewed by Balamurugan Panneerselvam BS, CPFT, RPSGT.  The Quarter Case Report describes a patient who developed bronchoconstriction during spirometry testing.

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I don't think anyone will be surprised to learn that the AARC Customer Service team, Reagan (the AARC continuing education coordinator), and I receive a lot of questions about renewing state licenses and NBRC credentials. This can be a tricky part of professional life to navigate, especially for new RTs. I know that many (hopefully all) of our educators talk about these things at graduation time but not every RT will remember that conversation.

First, let's talk about CRCE. Continuing respiratory care education is important to our practice though many of us think of it as a nuisance and waste of time. Sometimes CRCE takes a current concept like airway clearance or arterial punctures or aerosolized medications and expands your knowledge and sometimes continuing education introduces you to an entirely new concept. Think about this: very few of us really had Ebola Virus Disease on our radar last October but that exploded onto the US health care scene in a big way. How can we effectively care for the patient with EVD if we don't learn more about it? Solution: continuing education. What about new modes of ventilation? Think back to when NAVA or APRV or some other new mode of ventilation was released. How did you learn about it? Continuing education. I know I have a bit of a bias about this topic but I would love to see more people take their license/credential CRCE requirements with a more positive attitude than the oft-heard "I just need some hours." Remember that our patients benefit from our knowledge. Isn't excellent patient care our goal?

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Sorry it has been three months since the last Blog...time flys when you are having a good time (or you are up yo your _____ with alligators) ....

Complexity-the organizational structure is complex unlike RT. RT is smaller, more agile, quicker to adapted to change. HV has three times the number of physicans. The number of meetings has tripled. Often they are "after work" 1730 to 1900 ....this is hard since my day starts in RT at 0630. The phyisican leaders have responded well to streamlining agendas and finishing on time. It is critical to keep phyisican leaders engaged...yet they rarely communicate with there partners.

Ebola ? Nope...The Flu-We trained so much for Ebola but the Flu has kicked our butts. We have been on Divert because of staff illness especially. HV has been awesome. They have come in extra on weekends to keep Echos, Stress tests, and PVLs studies so patients can the discharge sooner, also the Cath lab team added a second Stemi team to help support ICU staff while we find beds at other hospitals.

Serious Safety Events-my training as a safety event investigator has been of great value. We had a safety event that included four cardiologists, three pharamologists, and two nurses with medication called Tinkson. The swiss chess holes lined up...I am blessed to have amazing EP phyisican who agreed to help us improve the process. It was very interesting sharing the timeline of the event with him. It really "made the case for change"
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