Q: What are the pros and cons of running a ventilator from the central compressed air supply versus built-in turbine/blower technology? I understand that the former helps the patient get clean air. But if you are given an option what would you choose?
A: I’ll start off by saying that it’s been a few years since I worked on some ventilators with turbine/blowers. At my last hospital I was the primary biomed trained by the manufacturers for all the respiratory care department ventilators there, which included more than 60 ventilators of various manufacturers.
The “main” advantage, in my opinion, that a turbine/blower has over compressed wall air is that not all hospitals have compressed wall air in every patient care area. Having a ventilator that only needs an oxygen tank versus one that needs both O2 and air tanks is an advantage. Also in some medical facilities the compressed wall air may not have been adequately cared for. Water (especially condensation) in the wall air could be a contamination issue for the ventilators. Without dry and clean medical air, the patient is put at risk. The engineering/plant operations department has scheduled maintenance that needs to be rigidly adhered to in order to keep the condensation from occurring within the wall piping.
The turbine/blower ventilators that I was trained on all had well-filtered “room air” and were relatively easy to maintain. If you can rely on your facilities engineering department to keep the medical air dry and clean, then either ventilator type will be a great. Be sure, though, to choose a reliable ventilator manufacturer as not all manufacturers are necessarily equal.
A: My personal preference is a self-contained ventilator, based strictly on the issue of portability. If the patient is on a self-contained ventilator (inbuilt turbine/blower/pump) with batteries and needs to be moved, the worst-case is that they are on oxygen therapy and a bottle of O2 is needed to supply the blender. If they are on a machine that is dependent on medical-grade pressurized air, this is more difficult.
A: More expensive to upkeep the turbines. I know the RT techs like them here. From a biomed-cost standpoint, the compressed air types are less expensive to upkeep. From the RT tech standpoint, they will probably go with the turbines.
Q: How do you deal with angry clinicians? Do you have any perfect responses that you use over and over to calm clinicians so that you can get the repair made? Do you have a nice way to tell them they are using the equipment wrong so you can then show them the correct way to use it?
A: Our philosophy on this is to always try to remain calm and focused on the actual issue at hand and to correct the problem without getting caught up in the drama and/or excitement of the moment. There’s nothing worth getting angry or loud about. When it is an equipment system issue, focus on fixing the problem and the drama will go away.
A: I just read an article by Roger Gil Mamft who specializes in marriage therapy. He says that just because you know you’re right, doesn’t mean getting into an actual argument is worth it. Sometimes, it’s best to just let things go. At the very least, before you set out to prove that you’re right, it’s good to check your own argument. To those ends, Mamft suggests you consider a few points before you even react.
• Don’t get emotionally overwhelmed: When you’re opposed by someone, you have an emotional response. That’s normal, but Mamft warns it’s best to keep yourself calm. “I like to tell people to be wary of passing a 5 on a scale of 1 to 10 for a given emotion when engaging in disagreements.” Essentially, you don’t want to get into a heated debate, and to do so you can’t react too aggressively.
• It’s not always necessary to change someone’s mind: Sometimes it’s just plain not worth it to try and change someone’s mind. Unless an issue is serious, it’s occasionally best to just agree to disagree and move on.
• Some issues are objective and others are subjective: With concrete issues (like the time, or the height of the tallest mountain), it’s very possible you’re right provided you have observable, objective facts. That’s not the case with subjective issues, and Mamft notes that it’s a good idea to know the real difference between the two when someone says you’re wrong. “We have to remember that opinions are usually based on a set of assumptions that are likely unique to the individual. Your ‘rightness’ (no matter how certain you are of it) may really be nothing more than a reflection of your values rather than a reflection of observable facts.”
• Your relationship should dictate how you respond: When a friend or family member says you’re wrong about something you know how to temper your response because you’ve known them for a long time. When it’s a stranger, or worse, a boss or co-worker, it’s important to weigh the usefulness of a response. If your boss is vindictive, it’s likely best to accept their wrongness and move on if you want to keep your job (unless their wrongness is a danger to you or your company).
• Make sure you’re really correct: It seems obvious to you that you’re right, but that doesn’t mean you’re not making assumptions.
A: You’ve just got to listen at first and agree with things that you can. Ask them to show you exactly how they use a particular unit so you can learn from them. Explain that this unit works this way as you were taught by the manufacturer (if that is the case) and it may be different than what you had before because it is newer/older. Use a monotone for no one likes to be lectured and especially in front of others.
Q:I need to repair some non-working OR lights. I have never actually worked on ceiling-mounted OR lights. It seems to me that they are just like the light fixture above my dining table with multiple lamps connected to a dimmer/controller on the wall. Can different controllers be used with different heads? Why or why not? Do some manufacturers use different voltage bulbs? Or are they all 110v? These are very basic questions, so you can see the level of education I need. Does anyone have a source I could read?
A: All of the older lights I have dealt with were DC voltage. The wall controller was also the transformer/rectifier. The center mast would also have a set of brushes on a commutator to keep from twisting wires when the light heads were rotated around the mast. I agree, at first glance it wouldn’t be too bad to “jury-rig” if it were all running on AC wall voltage. Sadly, I don’t believe that I’ve seen a set of OR lights that do. Since they are likely DC voltage, you may not be able to jury-rig it. I’ve had these fail from everything from bulbs, sockets, rheostats, transformers, brushes, circuit boards, you name it, and they were all proprietary other than the bulbs.
A: Just a word of caution: Most of the overheads are balanced in order to articulate in all three planes, but it takes two healthy people to disassemble or reassemble them because of the spring loading in the arms. I had an Amsco SQ240 almost take my arm off when trying to repair a commutator.
