Interview tips with Brian

Answer the question as much as possible with examples

Describe the conflict without pointing how negative that person is
Prepare some questions to ask employers
Always answer the question with both points, maybe missing a point
Send up a follow up email, if there is any additional questions and thank you for them
interviewing me

1. Why you want to work for us , tell me your experience which makes a good candidate
******
- Passion for health care, switch career is not easy, but if I don’t choose something I
like, I wont be happy for the rest of my life, not fully satisfied
- Petroleum engineer from U of A, 5 years university education gives me background
on how to properly manage my time, the skills of study and I worked really hard to
accomplish my degree
- Interested in this area because learned a lot from my practicum and my 3 years rt
study what it means to solve problem, care for patient and make difference in
peoples lives
- Work in a very large hospital, will help me to gain valuable experience, practice
critical skills, get to see more disease process and how to manage them
- Help to build relationship with other health care givers, help to build a strong team
and collaborate with each other more
- Your organization, Great working culture, professionalism, relevant, innovate,
diverse, comfortable, respective and safe productive working environment
- Visions and values match my own, patient safety and patient center care, which
means patient at center of everything, do what is right instead of what is easiet
- Peadeatiic and neonates great component of repiratory care, hard population to
manage, different disease process, cardiac effect, ventilation strategy, education
family
- (if we ask your former employer) good candidate: Good post rotation evaluation
- Get ready and prepared for the day
- Im very easy going, nice personality, full of humour
- Always offer extra help, not only to RT but also to other health care workers as long
as the task is in my practice scope
- Very reliable when I work with her, she was able to build trust quickly and I had
confidence in her abilities. Strong work ethic, take initiation without asking
- Strong communicator, both verbally and non verbally, highly effective and efficient
when dealing with patient care
- Critical judgments skills, impressive, for example, recognize emergency like
respiratory failure and take proper action
- Willing to learn an Ask for constructive feedback, let preceptor know deficiencies
right away and make proper correction step
 - Some deficiencies, second guess, time management comes up with practice, don’t
let textbook over thrown at you, try to combine clinical practice and basic
knowledge to make right decision, comes with time
-

2. Covenant health value, find one suit you most and why
Mission, called to continue the healing ministry of Jesus by serving with compassion and
caring for the whole person, body, mind and soul
Vision, inspired by mission of service, we will be leaders and partners in transforming
health care and creating vibrant communities of health and healing
Values
- Compassion, relates to empathy. To recognize and respond with empathy regard to
those who suffer. Treat others as we would like to be treated.
- Respect, all people to be treated with profound respect, regardless of their
circumstances, physical and cognitive ability, race, religion, gender, or socio
economic status.
- Collaboration, each of us bring unique perspective, experience and wisdom to form
a effective health care treatment team.
- Social justice, moral test of covenant health is the way we treat the most vulnerable
and disadvantaged persons, whether directly or indirectly impacted by our ministry
- Integrity, show the honesty, do good, avoid evil, live in right relationship with
ourselves, with others and with GOD
- Stewardship
3. How is working in a faith-based hospital better than others
- Healthcare organization founded upon belief, especially belief in Christ, are rooted
in power. Leadership at these organizations ultimately strives to fulfill the mission of
all God’s people, to love other and serve them well, this is the core value for every
decision made
- A patient who steps through the doors of a faith-based healthcare organization can rest
assured the staff there will do their best to show him the love of Christ by providing a
nurturing and comforting environment and top-quality care
4. What is stewardship
- To be a stewards is to be entrusted with a gift
- By fully present along side with people in their illness and suffering, we are their to
offer hope
- We are stawards of Gods covenant love, and called to be courageous in risking our
own vulnerability
- We sense the urgency not to postpone the doing of good, rather we do what we can
to invest our energy and talents for the goods of people
- Our entire healthcare ministry is a call to stewardship
5. ASH health value ****
Vision, healthy Albertans, healthy communities, together
Mission, provide a patient focused, quality health system that is accessible and
sustainable for all Albertans.
 Values,
- Compassion, show kindness and empathy for all in our care and for each other
- Accountability, honest, principled and transparent
- Respect, treat others with respect and dignity
- Excellence, strive to be best and give best
- Safety, place safety and quality improvement at the center of all decisions
- All very important, one stand out for me is respect
6. What is respect means, give example
- Respect, all people to be treated with profound respect, regardless of their
circumstances, physical and cognitive ability, race, religion, gender, or socio
economic status.
- What I like to be treated is how I treat other people
- By respecting people, this can totally change their health care experience because a
lot of patients are anxious, by respecting them, we reassure them this is a safe place
for them and we are here for them
- Example, ALS patient, end stage, cough assist and LVR for him. He can’t speak
anymore, however, before I do any procedure, I will still ask his permission instead
of just do it eventhough I know he will say yes. He has a clip board and a pen, every
time when I do my regular assessment, I will try to communicate with him through
the clip board, make sure I understand his needs and his request
- The end of the rotation, before I leave the unit, I come and say goodbye to him, he
used a lot of his strength and write 2 letter, thank you
- Respect can mean a lot to patient, we choose to work in health care environment,
we need to show our respect toward the patient, no matter what

7. What is accountability means, give example ******

- Act honest, principled and transparent
- we act in an open and transparent manger, we are accountable for the things we do
and we say to patients, family and each other
- we do what we say , we own our result
- as respiratory therapists, we are accountable for ensuring quality and safety in
patient care, ensure we are delivering high quality care
- for example, as a student, I am accountable for my behavior and my
professionalism, which means I come to work on time and being prepared.
- I make sure I know my patient disease process and follow the treatment plan and
hospital guidelines.
- I also make sure everything I did for the patient is safe for the patient and result in
safe outcome.
- I make sure everything I explained to the patient family is the things I truly
understand and truly know.
- I also make sure I chart everything correctly for whatever I did for my patient.
- One specific example, extubation, patient passed ert and leak test and etc… nurse
said ready to extubate, however, for me, I need to follow hospital guideline and im
 responsible for the post extubation sequence, therefore, I will wait for doctors order
and extubate
- Accountable makes us better people, together, make a accountable working place

8. If physician ask you a procedure not done before, under licensing, but not comfortable and
you worried about patient safety, what you do
- Patient safety is always the number 1 priority in the healthcare settings
- I will politely tell the physician even though this procedure is within my scope of
practice, however, I have never done this before and I am concerned about my
fluency in skills and concerned about my patient safety
- Offer some solutions
- first, I can perform it with your direct supervision to ensure the I perform the
corrective procedure steps while also ensure my patient safety. I will seek for help
from other senior RTs/supervisors if I have to perform the procedure, let them
refresh my knowledge and procedure, and let them direct supervision
- Another is I would like to be your assist for this time to see how you perform the
procedure, learning help me to grow. meanwhile, I will definitely review the relative
materials later and I would like to try for the next attempt
- I will see which option the physician wants me to do.

9. Delirium management –
- Delirium is a medical emergency and a potentially life-altering problem. Those
with dementia are at higher risk for delirium. Delirium results in distress,
confusion, damage to the brain and even death.

- There are many possible reasons for delirium including:

- Side effects of medications
- Stress, sleep interruptions
- Dehydratio
- Malnutrition
- Infection
- Surgery
- Strategies to decrease delirium risk for patients include:
- Supporting sleep
- Adjusting medications
- Finding ways to reduce the stress of noise, pain, restraints etc.
- Offering fluids frequently
- Using antibiotics only when necessary
- Using antipsychotics only as a last resort
- If you notice a change, please let someone know:
- Seems different than usual: more tired, weak, confused or drowsy  Talks or
communicates less
Words don’t make sense
Needs more help than usual
- Seems to be in pain
Poor appetite, nausea, vomiting
Constipation or diarrhea
Dry mouth, cracked lips, concentrated urine
10. Called to assess M1 patient on wards, on 4 L NC and is having tachypnea, indrawing and
diaphoretic, what you do? ( optiflow) ******
- Quickly check the patient first, see wob signs
- Put the monitor on, check vital signs, check doctors order for spo2 range, increase
fio2 lpm on nc, in crease LPM, non rebreather, simple mask for reach spo2 range
- Auscultation, see if wheezes or crackles, bronchodilators and encourage patient to
cough and do some oral suction
- Sit up patient
- Let the nurse and doctor know, because of the increase work of breathing demand,
may need to escalate the care, change patient heated high flow o2, like optiflow
- Make sure patient spo2 good while setting up the optiflow , start with 30lpm and
fio2 match nc, like 40ish
- Reassess patient after, make sure decrease work of breathing and spo2 is good
11. Gossip team member, what you do to prevent it occurring in the future
- Set an example, be a good model for others to follow and not engage in gossip. Be
assertive, change subject if gossip continues
- Honest feelings to tell other gossipers, need to be polite, I am sorry you have this
not so great experience, however, gossip is not the way to solve the problem and it
is a bag behavior, it may hurt others peoples feelings and reputations and this create
a toxic environment, if you have concerns, you can talk to HR and talk to the person
directly or talk to the supervisor
- Enact zero tolerance policy, cant disclose confidential information, not respect for
patient and other coworkers
- Risk for disciplinary action, even termination
- Let supervisor know, inform supervisor if gossip is growing and gaining followers.
Hope management can support a health work environment and promote a positive
culture.

12. 2 rt has conflict, what you do ******

- Between me and one nurse during COVID time
- Nurse indicate the school shouldn’t not let students do practicum, all nursing school
student and medical school students all cancelled. it is a burden for the preceptor,
you can’t learn anything at this pandemic time….
- Thank you for sharing your feelings with me. I guess because you are standing on my
point of view, you are showing your concerns and maybe concerning for the student
safety and stuff workload, I appreciate…. However, CBOs need to sign, require hours,
school is doing the best to ensure safety of the student, clinical site is very
supportive during this difficult time…. Again, thank you so much for your concern.
I’m here already, I will offer extra help, to my preceptors, you, and all other health
care workers.
- Nurse replied, wow, good point.
- I told my preceptor about this incident afterwards, which shock me is my preceptor
appreciate my honesty and told me nurse said to her, you have the best student.
 - This problem is solved when I offer to share my feelings. However, some problems
can not be solved and in that case, I will remain calm and report the issue to the
supervisor to seek for a solution.
- Complement/criticism/complement
- Remain calm, use calm tone of voice, talk about the problem, instead of blaming
others, reserve the relationship
- Choose to listen, show respect

13. Overcome a challenge in the last year

- Covid 19 outbreak, it is a challenge for students
- School wants to ensure the safety of the students, therefore we are not allowed to
go to emergency and isolation room which require N95 mask
- It is very challenge as I still have a lot of CBOs required to be signed off and because
of these restrictions, I miss chances to get those CBOs done
- Meanwhile, first time experience this crisis, not fully prepared, very concerned
working in the hospital, my parents currently live with me together because they
move back to Edmonton from Vancouver, very concerned about the risk I can bring
home
- Solution, keep checking and communicating with schools, school very supportive,
offer some online CBOs signoff, some virtual simulations and other strategies
- At practicum site, even not allow to into the isolation room, always standby for my
preceptor, I can watch how they perform the procedure and I can offer xtra help
- Get any chances to get my CBOs sign off, like ABG, they require 7, I will take any
chances for the ABG attempts and get it done. Same for the others CBOs
- I will communicate with my preceptor regarding to the update from my school,
explain them some difficulties I experienced so far and let them help me go through
my CBOs and practices.
- I make sure while I am working in the hospital, I practice social distance and hand
washing and other skills, like my scrub is always sealed in a plastic bag while I’m
done my practicum and wash them everyday. I leave my shoes outside of my house
and etc… move to the basement and keep distance even with my family members
during this difficult time.
- Therefore, after so many effort, I got majority of my CBOs sign off and my practicum
successfully end last week. After that, I remained at home and avoid unnecessary
outdoor activities and focus on my interview, my job application and my final exam
at this stage.

14. How did you prepare for the interview

- When I applied, I read the job qualifications and make some match to my current
cirtical skills
- Research on the ahs/covenant website, check the mission and values
- Ask my preceptor through the practicum about what type of questions they ask for
the interview and do some research
 - Review my notes for some disease process and ventilation strategy and how to
manage them
- Attend brains meetings
- Practice with my classmates to ask interview questions and give each other
feedbacks
15. Working in the hospital is stressful, how to manage that
- Seek for help, talk about stress and seek for emotional support
- Staff get together and talk and support each other
- Life style changes, regular gym, yoga…
- Seek help from close family members
- Think about happy side of the life, something or someone you love to try to stay
away from the negative emotion
- Fight compassion fatigue, which is stress from caring too much. Stay away from
feelings of self blame or guilt, participating in community events or charitable
events.

16. Any questions for us?

- Education very important for me and what ahs has in place for rt to continue
education, CARTA require certain hours of continuing competences, how can I
achieve that while working
- How is the casual shift in the past years? Like how many shifts per shift cycle I can
pick up? For me, the more I can pick up the better
- How long is the training period
- Anything in the interview that I said would go against your requirements for the job
17. Neonates bad air entry
- MRSOPA
- Mask adjustment
- Reposition the airway , remove mask and align airway then start bagging
- Suction nose and mouth
- Open the mouth
- Increase pressure for ventilation, 20-25-30
- Alternative airway, intubate
-
- DOPE
- Displacement, right mainstem intubation, dislodgement
- Obstruction, mucus plug, require suction, kinked tube
- Pneumo, xray, sudden spike in pressure
- Equipement, disconnection from vent, start bag mannuly
18. Collaboration team work
- Patient centered care
- Key elements,
- role clarity,
- trust and confidence- between team members
- ability to overcome adversity,
 - collective leadership
- Collaboration improve patient care and outcomes, reduce the errors, improve staff
relationship and job satisfaction
- Example, if patient is in the intensive care unit, we do rounds every day including the
intensiviniest, residence, specialist, RN, pharmacist, RT and etc………each of these
people has a unique perspective and valuable insights about the patient. We notices
different symptoms and consider different possibilities, together, we have a more
comprehensive view of the patient. Patient goc change frequently and we all need to
collaborate to come up with a plan with this.
- Another example is shared responsibilities, I don’t know about other professions, but
for RT and RN, I remember we have some shared responsibilities, like meds given or
mouth care, or repostion the patient who is ventilated. For example, if RN is very busy, I
can give puffers and draw gas from arline and do mouth care for them.
19. 4 hand sanitizing moment
- Before contact with patient or patient environment, for example, before enter patient
room and providing patient care
- Before clean or aseptic procedure, for example, before donning or specimen collection
- After body fluid exposure risk, for example, after doffing or handling a specimen
- After contact with patient or patient environment, for example, after conduct patient
care/leaving the room
DONNING, hand hygiene, gown, mask, eye protection or face shield, glove
DOFFING, gloves, hand hygiene, gown, hand hygiene, eye protection or face shield, N95
mask, hand hygiene.

20. One thing you did over and beyond for patient
- During PFT rotation, some patient has language barrier
- There is one patient who come to PFT lab and cant speak English at all
- Regardless the teaching, the patient cannot perform the maneuver correctly
- The patient because very anxious and appears to be very upset
- Then I told the family who is a translator, reassure the patient it is ok, it is a challenge
test, require a lot of effort, appreciate his good effort, keep encouraging patient until
he appears less anxious
- Come up with a solution, use hand signal, rise my hand, big breath in, lower my hand,
big breath out….. hold my hand at upper, means keep inhaling, hold my hand at lower,
means keep exhaling….
- Couple practice without mouth piece on, he now fully understand the instructor
- He did the PFT test perfectly and he appreciate my help
- Makes me realize what truly means to be an RT, not only a job, but is a patient care

21. Patient dyssynchrony

- Lack of the coordination between patient effort and mechanically delivered breath
 - Check connection, maybe condensation in the tubing, drain water back to the
humidifier
- Check patient, is patient appears anxious? Biting the tube require bite block? More
sedation?
- Suction patient?
- Waveform
- Tigger issue, over sensitive or less sensitive? Over sensitive causing auto trigger, less
sensitive can see patient trigger but vent wont deliver a breath
- How about ti, too long or too short? Ti too long, patient may start exhale, see bump
up….
22. Unpopular decision

23. What is PRVG

- Dual control mode, use adjustable pressure to delivery target tidal volume
- Fully support, patient or time triggered, pressure controlled, volume target, time cycled
- Set RR, PEEP, VT, Ti, max safety pressure, high pressure alarm
- Max safety pressure, is the pressure level safe for patient ventilate, if reach, still
ventilate but will alarm to tell the clinician. For servo, 5 below, PB, 3 below, Hamilton,
10 below
- First breath use VC to give a breath, get plateau pressure. 2nd breath, ventilate pressure
to plateae pressure, 3rd breath, automatically adjust pressure.
- Benefits
o Less risk for barotrauma because has control over the pressure, peak
pressure is low
o Adapts to change in lung dynamics, will adjust pressure to lung dynamics
o Improve patient comfort, volume guarantee, still pressure control/regulate,
patient has access to flow
o Guarantee minute ventilation because of set rr and vt, help with co2
clearance
o Wont cycle off breath suddenly, still ventilate patient
o Downside: -- patient getting too comfortable with it, hard to wean, muscle
atrophy
 Tidal volume change breath to breath, shearing injury

24. Multitasking/ time management

For example, RT work in ER and 3 things come up, asthma patient/intubated
patient/procedural sedation/ vent ringing/patient self extubate/ physician on the phone
- Be calm, don’t panic, do the best I can
- Establish my priority, patient safety is number 1
- Know the resources, ask for help, nurse/other rts, shared duties, patient/family can
do it
25. Weakness
 - Rotational shifts at the beginning of the practicum, hard to cope, very exhausted,
however, make some life style changes, work out, cut caffine and melatonin, feels
more better and able to do rotation shifts
- Second guess, even with strong knowledge, build some confidence
- Hard to confront patient family about bad news, like discuss goal of care change,
withdraw of care, difficult and sad, but found ways to cope with it, think about what
is best for the patient, sometimes tell the news is better than hiding because they
can make the best decision for the patient, like palliative care….
- Make sure to tell those around that I have a hard time if things went beyond.
26. Time team member not benefit you
- Patient emergency, has to stay overtime and maybe exhausted
- Cover for break, team member on specific eating schedule, religious /diet, has to
accommodate for them, staving
27. Rt in adult ICU, few incidents surrounding intubation, supervisor ask to create a policy and
procedure for assisting intubation
- Indication for intubation, resp insufficiency, like prolonged severe apnea, co2 greater
than 60 or severe acidosis, high fio2 requirement, delivery room resuscitation,
meconium infant….
- Max attempts to avoid unnecessary airway damage
- Presence of RT, RN, certified intubator
- Pre med requirement, analgesic, sedation and muscle relaxant, dosage and when to
administer
- Pre oxy, baseline fio2 for remask
- Equipement gather, weight and size of the patient, size of ett and tube depth,
lubricant, steth, larygo, etco2, suction, tape and etc…
- Procedure including action and rationale
- Assisting breathing until intubation accomplished, procedure inform, hand hygine,
PPE, assemple equieoemtns, adequate monitor, feed hold, med admin, assist
intubation as necessary, monitor tolerance, etco2, vent parameters, ABG monitor,
document procedure and etc…
- Important point, guidelines specific, communication, team work effort, role
clarification, trouble shooting, back up plans
28. Goals
- Learning new set of skills, site specific, provide best hospital experience for patients
- Gaining experience in patient care, team building, patient relationship building
- Being a great preceptor, pass skills to next generation
- ECMO
29. Air trapping , what to do
- Xray and waveform
- Cause by dynamic compression and high exp raw, lung hyperinflate
- COPD patient and asthma patient
- to get air out more, decrease ti to do so
- Set rr lower side, obstructive disease, longer time for exhalation
- Suction maybe if high resistance caused by increasing secretion
 - Expiratory maneuver, Match auto peep, 80% to set peep, close the gap, easy to
trigger
- Peep study
- Change the mode of ventilation, NAVA, easier to trigger, better ventilation
- Worst, establish baseline, protective lung strategy
30. VAP management
- Pneumonia acquired from vent
- By pass body normal defense, loss gag and cough reflex
- Biofim in the ett, lots of bacterial grows in humidity
- Micro aspiration
- Prevent
o Hand hygiene
o Temp, heated wire help prevent condensation
o HOB 30-45 degree
o Inline suctipn
o Gastric suction in place
o Mouth care
o Evac suction
o Maintain adequate cuff pressure between 25-30
o Early nutrition to boost immune system
o Sedation vacation and early extubation
o Circuit gravity dependent, tube not come from top , prevent condensation
o Early extubate
31. Vent not function, what to do
- Quickly check if connection is loose or easy to fix the problem
- If not, take off the vent and start bagging, call for help, team base and patient safety
- While bagging, ask for help to check the ventilator and fix problem, if not working,
grab a new ventilator and set parameters and hook patient up with new vent
- Recheck patient vital status after that, tube position, chest rise and etc
- Take old vent out, clean, trouble shoot, chart, and report to supervisor

36. Patient desat, what to do

- Make sure monitor is correct
- Call for help, check goal of care
- Make sure tube sitting in the right place, check marking on the lip
- Increase fio2 see if help , suction
- Switch patient to bagger, check air entry, MRSOPA
- DOPE
- Suction patient, maybe tube obstruction
- get ABG
- patient recover, when put patient back on vent, can give Ventolin, maybe
bronchospasm, see if high pip
- increase fio2, if heart defect, don’t use 100% fio2, increase 20% then before maybe
 - lung recruitment
- check tube position
32. Ped/neos, what is high frequency oscillation
- Ventilation using open lung strategy
- Ventilate in the safe zone in the pressure volume waveform, reduce atelectasis and
over distention, reduce the barotrauma, volutrauma and shearing injury
- Lung protective strategy, recruit and protect acutely injured lungs, increase lung
compliance, decrease PVR and improve gas exchange
- Small delta p, less risk for VALI
- Indication, conventional ventilation threshold met already, pip>35, fio2 >60, and etc,
disease process, BPD, NEC, CDH
- Contraindication, low bp, high MAP increase thoracic pressure and decrease venous
return, patient need to tolerate it, acute head injury because will increase ICP,
severe obstratucive airway because IE is 1:2
- VB500
- Oxygen, MAP and FIO2, vent, Hz and power(amplitude or delta p)
- Some settings, flow 20lpm, MAP 2-3 above, Fio2 current or 1, IE 1:2, Hz 8-12,
amplitude 30-40
33. Jet ventilation
34. Neonates ventilation, mode PCACVG, PCPSV
Pip 20 to adjust to chest excursion
VT 4-6ml/kg
Fio2 0.4-0.6
RR, 25-40
PEEP, 6
Ti 0.25-0.35 for pre, 0.35-0.4 for term
Slope 0.05-0.1
PS 6
Trigger, flow as sensitive

Peds, mode SIMV PRVG/PC

PIP VT, 20cnh2o, 6-8ml/kg
Peep 5-6
Ps 6, aim for 4-6ml/kg
Fio2 0.4-0.6
Ti 0.5-1
Rr 12-30
Slope 0.05 – 0.2
35. Childhood asthma management
- Proper education, what cause asthma, expose to trigger, smooth muscle
contraction, airway inflammation, increase mucus, increase airway resistance,
increase WOB
- Triggers, dust, furred animals, cold air, stress, exercise, smoke
- Avoid trigger
 - Rescue meds, trach proper technique to family and patients
- Watch for signs and symptoms
- Peak flow tracking
- Asthma action plan(green, yellow, red zone)
- In hospital, PRAM score, suprasternal, scalene, wheezy, A/E, spo2…. Mild, moderate
and severe
- Supplement o2, salbutamol and ipratropium, MID/neb, oral steroid, IV fluids
- Regular monitor
36. 13 year old, ABG, PH 7.02, 70, 50, 12, -14.3
Current PRVG, vt 6ml/kg, rr 18, peep 8, fio2 80, spo2 92
Define ABG, combined rr and metabolic acidosis
Suggestion on vent, increase tidal volume, increase rr for co2
Increase peep for lo2 o2
After this, pip 35-40, sat 89
- Suction
- Switch to bagger
- Lung recruitment
- Change to PC
- DOPE
- Bronchodilator
- Order chest xray
- Establish lung protective strategy ventilation
37. Tell when listening and understanding help with clinical skilss, outcomes
- Example, working in ICU, doing rounds, patient condition changed, O2 deterioate,
constant dipping down to 88-89 depite fio2 high
- Summarize patient report to physician, the physician not from local, some accent,
verbal order peep increase by 9
- Original setting peep is 6
- Not fully understand, need to get a clear order before make changes
- Talk to physician politely after rounds, ask her what she meant by peep increase by
9, peep from 6-9 or delta p change
- Physician glad I comfirmt with him and he write down an order for me, peep change
from 6 to 9 to recruit
- Avoid misunderstanding, I need to confirm before I make any parameters change,
fully understand
- Patient safety #1, clinical judgement, cant cause injury to patient like barotrauma,
volutrauma, shearing injury
- Help to avoid conflict
- Important message not dismissed
- Build trust relationship
- Improve health care outcome through active listening between health care worker
and patients
38. How to chart
- SOAP
 - Subjective, information patient tell me, chief complain
- Objective, factual measured data during assessment, signs symptoms, vital signs,
vent patameters
- Assessment, conclusion based on the above data
- Plan, strategy for relieving patient problems, incdluing both immediate action or
long term action
Example,
Called by RN to assess patient to desat to 74% on 6LPM NC. RT instrued RN place
patient on NRB and will be up to assess. Upon arrival patient in high fowler postion,
spo2 96 on BRB, RR 34 and HR 118. Patient awake and alert, SOB noted with
accessory muscle usage. OA, air entry decrease to base and fine cracleks t/o. Patient
changed to HFNC 15LPM, spo2 increase to 94 and RR decrease to 28. Patient states
still having SOB but slightly better. RRT discussed patient condition and assessment
and increase o2 requirement with Dr. Smith. CXR ordered. Bedside nurse aware and
will reassess Q4H and PRN.
39. A typical day at work
- Start with getting report from last rt
New admission, patient condition change, pending order
- Quickly review patient med history, charting, xtray
- Divide workflow
- Start with morning assessment
o Equipment, BVM, PEPP, O2 cylinder, spare tubes, spare inline, suction…
o Patient, auscultation, suction, tube position, mask release
o ETT, secure, tube tape integrity, skin integrity, evac suction, cuff pressure
o Circuit, HME, ETCO2 adaptor, inline MDI, circuit position, humidifier
o Ventilator, waveform, airtrap, trigger, flow adequate, parameters, weaning
plans, extubate plans
o Exsiting order, ABG, medication
o Communicate with RN regard to patient condition
- Chart patient condition, assessment, changes
- Rounds
- Other duties, side duties like check code crush cart and stock
- Show motivation to perform hard work, always look for tasks when down time
40. How to deal with angry patient
- Never blame patient
- Compassion and empathy for patient
- Patient has physical and emotional strain
- Understand the occasional burst of anger
- Stay calm and cheerful, do the best for the patient regard to following therapy,
regardless the attitude
- Listen to their concern
- Criticism and negative wont have any significant impact on the qualify of my work or
my attitude to the patient
41. IBW calculation/BMI calculation

42. Ventilate with ARDS *********

Ventilation parameters
- Goals of ventilaton, unload WOB, establish safe ABG, permissive hypercapnia, gain
back lost lung unit with recruitment, limit and minimize further lung injury
- Control mode, PRVG, PCV, VC- lung protective ventilation strategy
- VT 6-8ml/kg , low tidal volume, don’t get volu trauma or baro trauma, don’t damage
the healthy lung. If pressure elevate, drop the volume down to 4ml/kg. side effect,
dead space ventilation 2.2ml/kg
- Rr 15-20, high rr to compensate for low tidal volume, start with this and increase up
to 26-28. Side effect, exhale can be limit even with drop ti down, air trapping and
ineffective ventilation can happen
- Peep 8-10, can increase to 12-18, high peep, get rid of the shear injury. Note, peep is
based on oxygenation, high fio2 probably require high peep. We also use peep to
recuit the lung, improve in compliance, open up more aveoli, more place to put
volume in. peep also help with gas exchange and push fluid away. side effect, is that
delta p above is limited, not enough pressure to ventilate aveoli.
- Ti 1,increase mean airway pressure, more oxygenation. if increase rr, we need to
decrese ti to 0.7-0.8 range to allow exhalation, however, with ti too short, may not
enough time to achive equilibrium, less time for gas exchange
- Fio2 start at 50-80% to keep pao2 >60
- Aim for sats of 88-92, spo2
- We allow permissive hypercapnia, initially target normal range, with increase rr and
shorten ti, cant actually ventilate at normal cell function, co2 spike up, we accept
co2 at 55-60. Ph wise, initially ventilate to normal, 7.35, can allow to drop down to
7.2- 7.25
- Accept low pao2, side effect is pulmonary vaso constriction, tissue hypoxia
- If intubation doenst go well, put on 100 fio2 and titrate down
- Tighten alarm so we know whats going on
- Optimization of ventilation in response to assessment C stat, p plat, auto peep,
blood gas
- Pao2/fio2, less than 300 - Permissive hypercapnia, protective strategy
- Ph 7.2-7.25
- Pao2 60-80
- Co2 50-60 - Can bring fio2 down if sat at 100
Discuss further respiratory and medical management Durgs, other options, sedation issue,
risk for penumo… once they get better, what you do, inotropes or diuretics? Extubate with
what parameters
- Keep pt sedated if we need to take control of the ventilation, Propofol or fentanyl
- Give neuromuscular blockage if ventilation cant be fixed, short term solution
 - Get chest xray to check tube placement
- Ecg, monitor heart function
- Art line for continue monitor bp
- Bllod work and sputum cultures
- Antibiotics if infection
- Diuretics and monitor U/O, don’t want fluid overload, kidney function and fluid balance
is important
- Peep study, look at the PV curve
- NG/OG to feed
- If aspiration, get bronch ready, then increase the peep up and recrut …. For aspiration pt
, 3 components, acidotic aspirate, obstructive and bacterial gi track.

Other method
- Recruiemt, 3 method, APRV, open lung, sustained inflation
Open lung, pc increase by 2 every 2-5 breath, peep increase by 2
Sustained inflation, cpap of 30 for 30s and cpap of 40 for 40s
Need to perform peep study afterwards
- Prone the pt, do it early rather than late. Flip the triangle around, perfusion doenst layer
but spread out, bit higher on the point part, ventilation get better match, ventilate the
lung unit which we weren’t ventilate before, secretion mobilize
- Pulmonary vasodilators, nitric oxide and flolan… improve vq matching, improve in o2
- ECMO, replace heart and lung. Last resort. Vein to vein or vein to artery.
-
43. Heart effect questions for neonates, how to ventilate them

44. Who is the customer for RT to serve in this department

- Everyone is our customer
- Patients
- Patients family
- Bedside RN and physician and other health care workers
- End of the day we provide service to the health care hospital and communities
45. What does the term patient centered care mean to you?
- Strong relationship between patient and health care providers
- Empowers patient, instead of making decision for patient
- Consist a lot of Moments of human connection
- AICU rotation, trach patient, not really coop with the weaning procedure, involving
my understand why not want to do it, understand, benefit, encourage, later on
family member present, involve in rounds, etc… patient succefully plugged and
decannulate
46. Baby is on CPAP, show wob, what you do
- Physically assess the patient, see signs of WOB, like trachea tug, intercostcal muscle
usage
- Check the seal of the mask or nasal pillow, see if proper sealed and actually get the
cpap level
 - Increase the flow to increase cpap levels
- Finally, tell nurse and physician and get an order for BIPAP, escalate support, IPAP 8-
10 and EPAP 5-7, depend on the disease process, wob use high pressure level and
short rr, aop use low pressure and more rr
47. Set up caripul, how to check after set up
- Used as an inhale pulmonary vasodilators to treat pulmonary hypertension
- Delivery by continuous SVN
- Use ultrasonic neb or low flow SVN
- Nebulizer placed before the humidifier in the vent circuit
- Neb is refilled from a syringe IV pump, Comes with a dry powder, last 8 hours once
mixed…. Slowly push the plugger in to deliver the medication… after 8 hours all IV
tubing’s need to be replaced
- Continuously measure the cvp??? To see effect
48. Nitric oxide
- 2 reasons, reverse or decreae pulmonary hypertension….. improve oxygenation
- When delivering, need to provide a controlled therapeutic dose…. Continually
monitor delivered levels…. Continually monitor for NO2….. Allow for simple and dose
alteration…..
- Start with 20 ppm, wean by half…. While weaning, also need to increase fio2 to
compensate
- INOMax
- Some hazards, bind with o2 to create NO2, bind to create met Hgb, may have
rebound pulmonary hypertension
49. You are working in a trauma center ER department and are informed you are expecting a
patient whose face smashed into the steering wheel during a collision. Tell us about how
you would prepare to care for this patient.

50. You are caring for a patient who has been on a ventilator for 2 months. Describe several
different strategies you could use to wean a chronically ventilated patient.
51. Although there are policies and procedures for most patient care tasks at this hospital there
are also instances where staff are free to do things in their own preferred way or sequence.
Sometimes we don’t always agree with the way another individual does something. Please
tell us about a time you were working with another individual and had to come to a
compromise on how to complete a procedure.
52. With the current state of the economy we are always being asked to do more but with less
resources. Describe a time you’ve used a creative or innovative idea to get a job done.
53. What strategies would you use to succeed in a hospital or a unit you are unfamiliar with?
54. What do you feel are the key elements of teamwork and how do you interact as part of a
team?
55. What do you see as the current challenges that directly affect the RT profession?
56. Our RT department is undergoing many changes. What is your perspective on change and
how do you manage it?
57. A 6 month old infant with flu like symptoms is brought into the ER you’re working in. The
triage nurse suspects it is RSV. Tell us about your approach to managing this patient.
Most recent at covenant

58. Why want this position

59. Respect
60. Accountabiliy
61. Social jiustice
62. Conflict
- dont shy away
- a sstruggle between people over a significant difference, if it left unresoleved, it can lead to
bigger problem and lead to negatives effect to profesiion relationship and even perfosnal life.
Tension, negativity, damaged relationships and toxic work enviroment
-
63. How to be a good team member and contribute
64. Collaboration
- effective interprofessional collabation optimize health services and strengthends health
systems and improve outcome
- definition: inter professional process for communicationa nd decision making that enhance
the shared knowledge and skills of all care providers to ensure the best position care and
patient outcomes
- involes respectful including patients, families and health care provides in the development of
care plans and goals.
- The quality of patient care increases when everyones vocie is being heard
- area overlap, best situation is selected
- benefits; access and coordination of health services/ use of clinical resoursecs/ health
outcomes for chronic disease/ patient satisfaction/ patient safety
- decrease complications/ length of hospital stay/ clinical error/ tension and conflict among
health care workers
- WHO: identified interprofessional education enables effective collaborative practise, optimize
health servicdes, strengthens health systems and improves health outcomes
- a single provider on their own is unable to fully address clinets with complex challeges, socuh
as multiple chornic illnes, disability or social disparities.
- by moving into interprofessional collaborative practise, where different professionals work
togerther in partnership with patient, there is a promise to achive highest quality of care,
improve patient satisfaction, effeicient by reducing duplication,. increase job satisfaction and
burnout, overall, inprove function of health system
Improve safety and outcome,
Compassion: is the feeling all we experience that we know there is somebody that really cares
about us, compassion comes from that moment when we can see the world through another
person’s eyes, in health care, i believe it comes form the person who love their work and truly
understand why they do what they do,
Compassion is about treating patient with dignity, respect and empathy, through my practial
skills, communications and actions.
Sometimes it doens mean huge but even through a small gesture we do, dealing with a patient
who is elder, drive miles away from outside of town to make to an appintment, she was cold,
mobility limited, provide blanket, hot water, two biscuts,, she was much and much more
happier. That little thing trully make a differentce.
Felling vulnerbale, physicial, phychological pian or afraid,.
Kid, bedbond, smily face, constantly checking, smiling face, spend spare time together, star
charts
It is always the smallest thing gthat make a huge differece.
Dont treat people as a number, but instead, a family member
Compassion is not only about treating patients, but instead, let them feel safe, talk to them,
make them feel the journey is not scare but they are in a clean and nice enviroment, more like
at home

Respect: show genuire care to patient without judgment, Most valueble gift we can give to each
other and patient is gift of time. Time allow patient to speak about what means most to them.
Try to find out more about their lives, tyheir belives or their values, in order to empover the
patient to make decision about their rehab and the goals that we are going to set together.
We will gain their absolutely trust, this trust imrpvoe clinical, financial, quality of life, improve
morale of our staff, number 1 priority

65. Copd pathway

66. Venting wisely
67. Ward 4l assess wob rox index
68. Patient obese, vent settings givien, po2 low and respiraotry acidosis on ABG what to adjust
69. Caripul
70. Anaconda
71. Cuff trials
72. Ards
73. Helmet cpap
74. Ram cannula
75. Covid transport
76. Difference between ram and cpap or benifits for ram
77. What is APRV