I first heard the term "vent geek" used by my friend Kristin M. Kachnoskie, BHS, RRT
Director, Respiratory Care and Radiology Services Kindred Hospital Philadelphia at Kindred's RC managers conference last year. She (a world class vent geek) was leading an amazing discussion on how the right vent would possibly improve outcomes for Kindred's patients, most of whom are currently supported by 7200s. I have since applied the term to myself and a handful of others I have met since, but my question is what makes one therapist a vent geek and another a neb jockey. Some will walk up to the bedside and immediately recognize the patient is not in sync, and start to intervene while others will do their vent check, document it, administer the BD, document it and think I need a Coke and move on with the patient's eyes bugging out in obvious distress throughout and unresolved after. Some will attend conferences hungry for the latest while others just go for the CEUs they are required to maintain. You can recognize the vent geeks at product showcases; they are bugging the reps at each booth, even finding out the latest updates on machines they may have never used. Others get big bags and gather as many freebees as they can, but never tap the reps for their amazing stores of knowledge. Is this something some are born with? Is its lack part of the burnout process? If one was staffing a RT department, what is an easy way to recognize these folks? Is it a good idea to staff all with vent geeks or are neb jockeys a required part of getting things done? Is there any way to make at least some semblance of a vent geek out of a therapist who is not? I puzzle over this, is it innate, or is there some source of inspiration, or education that can produce this anomaly reliably? You are probably a vent geek or one in the making or you wouldn't be visiting here. What are your thoughts on this?
I have been known for years in Arizona as a "Respiratory Nerd". We RT nerds have taken things beyond "Vent Geeks", we are the ones who at 2 in the morning wake up out of a dead sleep and find a way to make a circuit that you can use to med nebs inline to a NRB mask and not compromise flow, patient SpO2s, or hemodynamic status.Here are some identifiers of the American RT nerd:
1. If you have ever entered, written questions for, or moderated a Sputum Bowl...you might be a RT nerd.
2. If you have obtained patents for new RT equipment...you might be a RT nerd.
3. If you have ever been on an airplane and the flight attendent goes over the loss of cabin pressure and you know that it is a PRB mask and not a NRB mask...you might be a RT nerd.
4. If you read and understand both the electronic and pneumatic schematics of the ventilators that you use and study the same for new vents...you might be a RT nerd.
5. If you can have written a respiratory text book...you might be a RT nerd.
You are right however, how do we take neb jockeys and make more "Vent Geeks' and/or "RT nerds"? Short of cloning ourselves we need to help and mentor them. When working on a new project get their input and help. Light the fire.
and it was said...vent nerds breed vent nerds.
After 18yrs of turning knobs I would love to end my career with the label of Vent geek. Having worked in the Middle East for longer then I care to remember I rarely come across the individuals your referring to. Most of my staff are young recruits from Asian countries with limited experience. The few occasions that a Vent geek has ventured out this way to work I've observed the following. Geeks are great as a buffer between outdated Intensivest who will deliver volumes high enough to blow up a blimp to achieve a normal ABG. The geek will always stand his ground and rarely let a physician dictate inappropriate vent settings. On the other hand you can forget about the routine things being done on their shift...I: E stocking, tape changes, QC etc. So as a manager I could use a geek in every area but in the end I need the little things done as well. Give me a 1:5 nerd to neb jockey ratio and I would be perfectly happy.
Wow, I feel like Tony Soprano in Dr Melfi's chair, understanding that I'm not the only one with these symptoms:
-listening to ICU staff whining that their pt's Tx was due at 8.00 and it's now 10.45 and all I've done is talk with those residents for 2 hours (meanwhile, these ER doctors of tomorrow, understand that PRVC is not PCV and a pt breathing at 40 x 420 should not be extubated even though his WI is within normal values; and this after they received a 2 hour RT role/VTR management lecture on their 1st day)
-hearing the peanut gallery joke that I never do my "4" checks per shift, meanwhile, "doing 4 checks" becomes synonymous with leaving and charting peak flows of 60, PEEPs of 5 for pts with bellies like Santa Claus, BiPaps set 12/5 for the excacerbated pt with FEV1 <0.8 and an autoP of 7 at the best of times, etc,etc.
-listening to the medical team, at the bedside, tell the pt that he will need to be tubed, because his SpO2 stinks AND he IS on 70%O2 on the bottle AND he is breathing so fast AND the tusks may help delay...... AAAAAAAAAAAAAAAAAARGGGGHHHHHH
trying to implement something so easy to understand as elimination of ambient entrainment due to brutally inadequate flows can and should be done before invasive measures....and this is just reminding the RT "BD jockeys"
The sad part of creating policies, protocols, research, updating, inservicing the health care population is that with less clinical time these and other blatant mistakes continue to happen without our knowledge and awareness. On top of that, they are brushed off during M&M rounds because the patient's succumb from sepsis not from lying flat (Yes, Dr. I put him at 40 degrees) and having their lungs rinsed with 10cc of saline beacuse of thick secretions allthewhile their Paykel is left at 32C because it was ringing during the night.
I firmly believe that there is always a cause and effect relationship in all walks of life; its importance/relevance in healthcare is underestimated,underreported and wholly misunderstood. Frustrates the hey out of some of us and probably ends up killing some of those we try to take care of.
Thanks guys (and girls) for letting me take a deep breath.
Just another week
in the life of a vent geek
This is to all Ventilator geeks. I HEARBY CONFESS THAT I AM A VENTILATOR GEEK AND I AM PROUD TO BE ONE. VENTILATORS ARE WHAT I LIVE FOR, BEING THAT I AM A USER OF O ONE.
Hi, my name is Toby & I too am a proud "Vent Geek."