Respiratory Therapist–Ritesh Chand

My name is Ritesh . And I work at Southwest Washington Medical Center as a respiratory therapist. And I’ve learned a lot. You learn on the job and from fellow co-workers, because you learn from experience. And you’ve got to be very good at critical thinking to do this job. Like what am I going to do next to make it better? You’ve got to actually look at the patient and decide, he’s not breathing, why is he not breathing. What about now? Do you feel like you’ve got something down there? “had a 7 and a half tube that’s 23 at the lip”. I start my shift by coming in for a shift change report. “no change on her. She’s on spontaneous”. It’s a 12 hour shift. So you get your report from the previous therapies. And they’ll tell you what happened during the day,
who gets what kind of treatment, and what are the doctors’ orders. And then you write it down and you take over from there. During the night, you do your therapy, you do your treatments and what ever the doctor has ordered. Tomorrow morning when the shift ends, that’s when you give the report back to the other therapist who is relieving you – like basically what you’ve done and what the doctor wants to be done. This hospital has 3 critical care areas, the emergency department, intensive care unit, and Cardio care unit. So tonight, I’m working in the Cardio care unit and partly in the intensive care unit. This is what we call a vent or a ventilator. And basically this machine is breathing for the patient. All the breaths are timed and our goal is to keep it at about 95. You can have an artificial airway inside a patient. One is through a trachea. It’s called a tracheotomy. And the other goes through the mouth. It’s called oral intubation. This is usually reserved for patients who are on the vent for a long time. Take a deep breath. Go [inhales quickly] In this case, the patient has a Trach. So you have to make sure the Trach is open. There’s nothing clogging it. If it is, then you suction it. Before you do the suctioning procedure, you got to make sure the patient has 100% of oxygen for at least 2 minutes. When you suction patients, the oxygen saturation goes down. And in that way you’re preparing for it, before it happens. I got a lot out, dude. A lot of people are grossed out about this mucus thing. It’s just another body secretion, you know. I mean, I was grossed out, frankly, when I came out of college and started working here. And then it’s a matter of getting used to it. Right now, ICU is full. They can’t take any more patients. So this is kind of like a back-flow area. I’m preparing for the patient to arrive. It’s always better to be prepared, then when the patient comes and you are scrambling for stuff the patient needs. You always want to have your suction ready, because you never know when the patient is going to vomit or obstruct his airway. So it’s always a good thing. You never know when you’re going to need it. The most challenging part of this field is doing critical care. “and then I’m going to put the air into it, OK. Critical care is those patients who are ventilator dependent and WE are doing the breathing for them, you know. We’re controlling their heart, we’re controlling their blood pressure. Anybody can come out of school and go out on the floor and give breathing treatments. It takes a lot of courage, a lot of determination, and a lot of knowledge of critical care to be in the ICU or CCU taking care of somebody’s airway on a ventilator. Anything can go wrong at any moment. And your decision makes a lot of difference. In order to make changes on a patient’s ventilator or by-pass machine, we have to take an arterial blood sample and we bring it down here to the lab to run the test on it. And the test will tell us how the patient is breathing. And looking at that test results, we make changes on the vent or the by-pass. “CO2 39 so that’s”. You always want to communicate with your health care team. If you’ve got a critical result, you always want to show it to somebody else – like in this case, the nurse. “okay, so we’ll get on that. Call the doctor”. Yeah This job is all about teamwork. You just can’t do everything alone. Anybody who comes and says this is a one-man army, he’s lying. Look at now, there are 3 or 4 people in ICU alone trying to make everything work. And I work with a lot of nice people. “if you need something, let us know”. If it wasn’t for these two and obviously this lady, I would have quit this profession a long time ago. They are team players – true team players – help a lot – always willing to give their two cents and take two cents from me. The other thing about being any health care worker, we have to actually chart everything we do, like the suctioning I did, the medications I gave. I’ve got to record everything in there, the heart rate, the respiratory rate, the amount of secretions I got from the suctioning, the color of the secretions. Everything is computer charted so the physicians have access to it. Every time you give a patient a medication, you’ve got to scan them. You scan the patient’s wristband and then you scan the medication. It will tell you’re giving the medication to the right patient. And then it will show up in the computer. And then you chart. Once a patient is on a ventilator, the vent is calibrated for the patient’s use. Once the patient is extubated, the vent needs to be cleaned and set up with extra supplies. At the same time, we do a same maintenance on it to check that everything is working – like there’s no leak in the pressure and the filters are working and tubing has no leaks and it’s working. Basically, everything the vent is supposed to do, it’s doing. The doctor wrote to do some vent setting changes. Basically, give him a trial. Right now the patient is tolerating the settings change. He seems to initiate his own breaths. His heart rate seems to be okay and his respiratory rate is below 20. So that’s the third time we did a vent settings change on that person. So as a therapist, you end up doing that a lot. Just do a trial setting change, trial setting change and finally if the patient tolerates that setting change, we put him on that. So it’s a trial and error. Okay. He didn’t come for any respiratory distress. He’s going home today. It’s time for my shift change report to tell my fellow incoming colleagues the status of the patients, what’s their standing and what’s going to happen during the day. Basically, tell him what we did last night and if there were any new orders written, what the doctor wants. “.and she looks like she’s awake, but she’s not actually. She won’t talk or anything, but she can move. We cover the whole hospital running around, taking care of patients. So at the end of the day, I’m pretty exhausted. But by the end of a shift, you’re happy. Hey, I did good today. How’s your breathing? Are you doing okay, no shortness of breath? Hey, I saved somebody’s life. And that’s the biggest achievement you can get from your work.

29 comments

  1. I'm currently looking into various healthcare careers and this is something that I think I may like. I'm thinking about doing "job shadowing" at a local hospital that will take me.

    What questions would be great to ask?

    What things to not ask?

    Why did you pick this career? Was this your first? If you want to go into great detail, by all means send me a private message.

  2. Sorry, I did not know they posted this video on YouTube. Anyways if this is your first dive in medical field, I would say try job shadowing at a hospital which has a busy ER, Trauma Center, or any intensive care unit.
    Really speaking from experience, just follow the RT around and see if you can manage multiple cases at once. Frankly speaking the job is not hard, its just sometimes you have to really triage.

  3. Good video Retish. Going out on my second clinical "critical care" for the next 10 weeks. Really stoked!

  4. Yes, Southwest Washington Medical Center here in Vancouver has an awesome shadow program, if you want I can shadow you around. Just speak with my manager and come up with a date to shadow. FYI I work 12 hour night shift from 1830-0700 hours. Message me so I can tell you which nights I am working….Good Luck.

  5. Where did you go to school for your RT training? I'm looking at options but Mt. Hood CC looks like the best fit for me right now.

  6. I attended Mount Hood Community College. The RT program over there is outstanding. I really liked the instructors over there too.
    I guess there is another school in Portland that started RT program too, I think its called Concorde Career Institute. I heard its a shorter program over at Concorde but it costs three times more then MHCC.

  7. Thank you for confirming my decision to go to MHCC! I just signed up for my first class…chem103 starting this fall! Then I plan on doing the full 200 level series in A&P before applying to the program. Thank you for the insight Ritesh. I appreciate your time in responding to my questions.

  8. Nice, I'm in respiratory program at Erie Community College in Buffalo Ny. They just got grants for two state of the art sim-labs and I can't wait to learn from the long time teachers there and at all my clinical's!

  9. It depends on how quick you want to join the work force. I have some co-workers that swear by Concorde which has a streamlined program where you spend most of the time learning practical skills.
    Mean while in a community college, your first year will be spent on prerequisite courses like Math, English, Sociology, Pyschology, Microbiology, Chemistry, Human Anatomy and physiology etc.
    I highly recommend that you finish your prerequisites before you entire the Respiratory Program at a CC.

  10. Respiratory Therapy as of right now is not a good field to enter. The job market right now is over saturated with Respiratory Therapists. At least here in Pacific Northwest. Schools are churning out new RTs every year and there is only limited slots to fill at every hospital, unlike nursing where they have no problem finding work after graduation.
    But if u want to relocate, there is opportunities throughout United States.

  11. I'm in my first semester in the respiratory therapy program. We do clinicals in the 2nd semester. I heard you see some gross stuff ,but like you said it's just a matter of getting used too.

  12. I am inspired time and time again watching this video. I will be starting my associates degree next week 8/25/15 (Tuesday) in Respiratory Therapy to become a (RRT) registered respiratory therapist. I can not wait to learn all there is to learn in this profession, and help the people in need of the services i will know how to access. Thank you Mr. Chand for this video 🙂

  13. Hi sir
    I m with this course respiratory therapy, which institutes is in India running bsc respiratory therapy plz guide me

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