My name is John
D’Urbano, RRT and I’ve been a Respiratory Therapist in the
Phoenix area since 1992. I received my education in Respiratory
Care at Long Medical Institute, and Gateway Community College in
Phoenix, Arizona. I worked my way through that first year of
school as a night-shift security patrol supervisor. For the 2
years following I worked nights as a Respiratory Therapy
Technician with one of the registries. Like many students I lost
a lot of sleep, missed out on a lot of recreational activities,
had a bank account that was near empty most of the time, and
even had my lights turned off from time to time. There was never
a day when I regretted my decision to go to school to become a
Respiratory Therapist.
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Hi BreathSounds fans. A friend is
working on a thesis toward her Masters degree. Please help her
by completing a very brief survey. Read bellow...
Hi all - if you've
not yet participated in the survey for my thesis, I would really
appreciate it if you would. The Laboratory and the Respiratory
Therapy professions have been significantly affected by Medicare
changes, automation, etc, resulting in reductions in staff. I
think I corrected the issue with not being able to access the
survey. Please follow this link.
This is a Next Generation One-Piece Bag/Valve/Mask that
should be the next standard of care for early airway management.
Posted: Tuesday March 19th
2019
Interactive Flu-Map for the 2018/2019 Flu Season
This is an interactive map showing the progression of the flu
throughout the United States over the past 3 months. I can't
take credit for this. This is NOT my
map, this is NOT my code, and none of it came
from my servers. This interactive healthmap is from
Kinsa. Below is a
link to the map. Links to the Kinsa site are provided.
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BreathSounds is happy to announce the addition of a new section
of the website dedicated to board exam preparation and CEU’s.
From the left menu simply click on CEU and Exam
Resources. As always, if there are any questions please
feel free to drop me a note anytime at
jdurbano@BreathSounds.org...
J. D’Urbano, RRT-Retired
Founder / Web Administrator BreathSounds –
Because at the Head of Every Team IS a Respiratory Therapist
This is an awesome, donation supported, program physically
located East of Atlanta, Georgia. Their Mission?
Camp Trach Me Away provides a week-long summer camp
experience to children with tracheostomies. It provides
opportunities for children with tracheotomies to learn life
skills, gain support from their peers and engage in
traditional summer camp activities.
PLEASE go check them out, DONATE, get involved andhave fun
watching these kids enjoying activities that they were once
only able to dream about.
I typically don't publically post reviews of a lot of products
and material, but this one I simply can't pass up. Robert
Green's book, titled "Green's Respratory Therapy: A Practical
and Essential Tutorial of the Core Concepts of Respiratory Care"
is, hands down, one of the BEST supplements to Respiratory Care
education that I have ever come accross in my long and fairly
successful career. If you are a student of Respiratory Care, or
even a credentialed Respiratory Therapist looking to "tune up"
your already vast world of knowledge, then this IS the
supplement for you! I promise you, this is well worth looking in
to.
NOTICE: BreathSounds is not
sponsored by any author or product manufacturer and there is no
financial agreement between the author or publisher of this
material and BreathSounds, its staff, or any of its affiliates.
Room Tension
Room tension is exactly what it sounds like. It is what I like
to call the triad of chaos.
It is the level of stress, noise and confusion in the room
during a medical urgency, or emergency. Typically, the more
unstable the patients appears the more likely we are to
experience this triad of chaos. It is during these scenarios
that we are most likely to make mistakes, adding unnecessary
risk to your patients’ safety. Read the entire article
here... Or you can watch the brief 4 minute
video lecture: https://youtu.be/GlckP68rBUA
Reading Between the Lines
I
read a bit, and I write a bit. Most of it is simply
a bunch of boring medical stuff, but occasionally I
tap out something that is actually kinda kewl.
😊
This is probably not one of those times, but it is a
rather important subject that does a little
tap-dance on our safety.
You can’t always believe what you read. Not in a
literal sense anyway. This is especially true when
it comes to medical information found on the
internet. I know, I know… Please, just humor me for
a few minutes. Yes, there are numerous sites on the
internet offering a ton of useful and useless
information on countless conditions, disorders,
diseases, injuries, etc.… Much of that information
is good, and some – not so much. Do you really
believe you can tell the difference? Yes, that was a
trick question.
Even those very reputable sites with tons of
articles written especially for the non-medical
professional, or the lay-person, come with risks to
the very health or life of that lay-person. The
reason is actually quite simple. The average
lay-person does not have the educational background
AND the bedside clinical experience to actually read
between the lines. Medical literature is one of the
few places in the literary world that truly has a
TON of information between the lines. If you don’t
know to look for it, and don’t know how to interpret
it, then you really are missing some VERY important
information, and just might be putting your very
safety at risk.
Adding to the problem is the “Direct to Consumer
Advertising” of medical procedures, devices, and
medications promising effective treatments for
everything from hangnails to hat hair. This type of
advertising is intentionally misleading and
intriguing to the lay person. The interesting part
about this is medical direct to consumer advertising
is illegal in every country in the world except for
2.
Unfortunately, the United States is one of them.
I’ll give you a few examples to ponder. Interstitial
Lung Disease. There are approximately 15 separate
recognizable diseases that fall under this umbrella
diagnosis. The signs and symptoms are almost
identical for all of them, vague and non-specific,
but the effective treatments for each are very
different and condition specific.
Here’s a common complaint. Shortness of breath,
non-specific, may also have a little local chest
pain or not. There are roughly 100 different
conditions that can cause symptoms as vague as this.
Some of them can be fatal, and a few of them can be
fatal pretty quickly. Don’t research it. Go to the
urgent care or ER of your choice.
It boils down to this. For every set of symptoms
there are numerous conditions that can explain them.
Trying to research them on your own before you visit
a Physician can either cause you to underestimate
that problem, putting you at great risk, or
overestimate the problem, perhaps causing you to
panic unnecessarily. Either way the real problem
will not be treated correctly and that is NEVER a
good idea.
If you are having symptoms of any kind, PLEASE go
see your Physician BEFORE you research. They have
the education, they have the clinical experience,
and they’ve already done the research. Think smart,
and be safe…
Asthma Treatment
Education: As Important as the Treatment Itself
Staying current in medical
education is an important part of the healthcare professionals’
world, especially in light of the advanced medical technology
and education of today. Thoroughly educating patients on the
“proper” use of asthma treatment medications and devices is just
as important.
Dr. Charles Vega, Clinical Professor of
Family Medicine at the University of California in Irvine, along
with Dr. Sandra Adams, Professor of Medicine and Pulmonary &
Critical Care Specialist at the University of Texas in San
Antonio, discuss just that.
Dr. Adams is also the Founder and CEO of The
Wipe
Diseases Foundation, a not-for-profit foundation dedicated
to the education of respiratory diseases for patients as wel as
healthcare professionals.
According to the current research
approximately 45% of asthma patients practice improper use of
asthma medications and devices. This contributes to a
significantly increased number of emergency department and
urgent care visits throughout the United States. The data is
near identical in adults as well as pediatrics.
It is not as simple as it used to be.
Today there are almost as many different devices as there are
different medications for the treatment and maintenance of
asthma. A short example is the metered dose inhaler (MDI) vs the
dry powder inhaler (DPI) and the soft mist inhaler (SMI).
Some medications are short acting beta2
agonist bronchodilators (SABA’s), the long acting beta2 agonist
bronchodilators (LABA’s), anticholinergics, and inhaled
corticosteroids (ICS).
Most of the time the devices and
medications are specific to the circumstances of the condition.
Some are for immediate relief of asthma symptoms while others
are specific to maintenance of the disease.
This was discussed in more detail by Dr.
Vega and Dr. Adams to Medscape Medical News, and the complete
discussion can be found at
http://www.medscape.com/viewarticle/878937.
Wednesday, May 10th, 2017
Happy New Year!!
*** 2017 ***
Throughout my day I often give advice,
teach, and even give short unofficial lectures to Respiratory
Therapists, Nurses, and even Physicians a wealth of topics. In
2016 this was one of the most popular topics that came up.
Airway Management is a multi-role responsibility, and it is
ongoing. Meaning Airway Management doesn’t stop when the tube is
in. The distance between the tip of the ET tube is every bit as
important as the distance between the top of the ET tube balloon
and the vocal chords.
Professional Longevity is an earned
skill rarely seen in today's workforce and is the key difference
between merely having a job and actually earning a meaningful
career...
Saturday, November 12th, 2016
J. D'Urbano, RRT
The staff & Management here at
BreathSounds would like to wish all of you a very Happy and SAFE
The subject of electronic
cigarettes is fluid. A very dynamic topic that is just as
volatile as it was when the device was first introduced into the
United States in 2007. Even in light of everything that has been
learned there are still unanswered questions, and even a few new
ones. Are they safer than conventional tobacco cigarettes? Are
they safe at all? Is it a tobacco product or a drug delivery
system? A safe smoking alternative or a new tool to aid in
smoking cessation? Wrapping up its first decade in the United
States the controversy continues. Is it a clever new tool to aid
in smoking cessation, or is the electronic cigarette just
another "wolf in sheep's clothing"?
Saturday, August 27th,
2016
J. D'Urbano, RRT
Respiratory Care Books:
For over 25 years I have been purchasing these books. I was
still in college whenh I bought the blue Pocket Guide for
Respiratory Care. With the exception of my text books this was
the first piece of Respirat Care literature I bought. Bought it
with my text books, and I've bought every update since. About
ten years ago I bought their Critical Care Pack, and I've been
buying them since. An amazing pack that I actually to help
improve my practice.
Click on the ad below and please don't forget to tell them
BreathSounds sent you.
Tuesday, August 9th,
2016
J. D'Urbano, RRT
E-Cigarettes to Quit Smoking? The Results are
Disappointing...
At 3 to 6
months e-cigarettes vs placebo showed an insignificant incidence
of smoking abstinence. This was presented at the American
Thoracic Society 2015 International Conference by Dr Matthew
Stanbrook of the University of Toronto. Dr Stanbrook and his
team of investigators reviewed 297 articles from MEDLINE and
EMBASE.
It
appears that e-cigarette use did decrease the number of tobacco
cigarettes smoked in a significant
number of participants. This may be partly due to behavior,
meaning that many regular users of e-cigarettes also smoke
conventional tobacco cigarettes. They use e-cigarettes as a
substitute for tobacco cigarettes when they are in an area where
smoking is not permitted. Those who use e-cigarettes and
conventional tobacco cigarettes may be doubling their risk of
adverse effects from nicotine, the highly addictive and toxic
ingredient in tobacco and e-juice, as well as other ingredients
that are known to be harmful.
Some
Physicians would like to endorse e-cigarettes for smoking
abstinence if there was better results and they were better
regulated. The U.S. Food & Drug Administration finally has some
regulations on the manufacturing and sale of all Electronic
Nicotine Delivery Systems (ENDS) but more research and work
needs to be done. There is still limited data on the use and
long term effects of e-cigarettes and the inhalation of their
ingredients.
Friday, May 20th,
2016
J. D'Urbano, RRT
From the Staff & Management
Here at BreathSounds: May we ALL have a Happy and SAFE
Respiratory Care Week...
(Monday, October 26th
2015 - Friday, October 30th)
BreathSounds is undergoing some minor redesigning and
reconstruction. Nothing big. Just enough to make it a bit easier
to navigate around and find what you're looking for. Yes, I am
trying to make it a little more user-friendly. Thank you for the
comments thus far. As always, drop me a note with your comments,
suggestions, etc...
A Respiratory Therapist is a highly
trained specialist who cares for patients with disorders, diseases, and
injuries that affect the respiratory and cardiopulmonary systems. In ALL
healthcare settings a Respiratory Therapist is a vital part of the
healthcare team. They are leaders by nature, and masters of their trade. As specialists in respiratory therapy, airway
management, ventilator management, and acid/base balance they perform a
broad range of basic and advanced skills. They include patient
assessment, inhaled medication delivery, arterial puncture, arterial
line placement, airway management, endotracheal intubation, ventilator
management, and many others. Respiratory Therapists participate in
direct patient care in virtually all areas of the hospital – general and
telemetry floors, critical care, cardiac cath and special procedure
labs, nuclear medicine, and operating rooms, etc...
Welcome to BreathSounds, an internet
community created for Respiratory Therapists by Respiratory Therapists
actively working in the medical community. The internet is a vast world
and within it there are many resources for Respiratory Care. At
BreathSounds we do NOT want to compete with them. We want to join them
by sharing information in terms that all can undersatand, and filling in
the gaps with information that might be difficult to find.
"Because at the Head of Every Team is a
Respiratory Therapist..."
NOTICE from the
Author:
No Medical Advice: These writings are my own personal words based solely
on my own personal clinical experiences, education, and research. I am
NOT a Physician and therefore DO NOT give out medical advice under any
circumstance. The writings within BreathSounds, BreathSounds Media, and
BreathSounds.Org are in no way intended to be taken as medical advice of
any kind.
