What is the thought process of a respiratory therapist during a rapid response?

From the Guidelines

During a rapid response, a respiratory therapist's thought process focuses on quickly assessing and stabilizing the patient's airway, breathing, and oxygenation status, as recommended by the Society of Critical Care Medicine guidelines 1. The respiratory therapist first evaluates the patient's respiratory rate, work of breathing, oxygen saturation, and breath sounds to determine the severity of respiratory distress.

• They immediately consider whether supplemental oxygen is needed, starting with nasal cannula at 2-6 L/min for mild hypoxemia or advancing to high-flow nasal cannula at 30-60 L/min or non-rebreather mask at 10-15 L/min for more severe cases.
• If the patient shows signs of respiratory failure, the therapist prepares for possible non-invasive ventilation (CPAP/BiPAP) with initial settings of CPAP 5-10 cmH2O or BiPAP with inspiratory pressure 10-16 cmH2O and expiratory pressure 4-8 cmH2O, as suggested by recent guidelines 1.
• They simultaneously consider the need for bronchodilator therapy such as albuterol 2.5-5 mg via nebulizer or 4-8 puffs via MDI with spacer for bronchospasm. Throughout this process, the respiratory therapist communicates findings to the response team, helps position the patient appropriately (often in semi-Fowler's or upright position to optimize lung expansion), and prepares for potential intubation by ensuring equipment readiness including appropriate ETT sizes (typically 7.0-8.0 mm for adults), functioning laryngoscope, and suction apparatus, in line with the recommendations for rapid sequence intubation 1. This systematic approach allows the respiratory therapist to provide critical interventions while continuously reassessing the patient's response to treatment, which is crucial for recognizing and responding to clinical deterioration outside the ICU, as emphasized by the Society of Critical Care Medicine guidelines 1.

From the Research

Thought Process of a Respiratory Therapist During a Rapid Response

The thought process of a respiratory therapist during a rapid response involves several key considerations, including:

• Assessing the patient's airway, breathing, and circulation (ABCs) to identify any potential issues that may be contributing to the rapid response situation 2
• Evaluating the patient's respiratory status, including their oxygen saturation, respiratory rate, and lung sounds, to determine the severity of their condition 3, 4
• Considering the patient's medical history and any underlying conditions that may be relevant to their current situation, such as chronic bronchitis or reactive airways disease 5, 6
• Developing a plan to stabilize the patient and address any immediate concerns, which may include administering oxygen, medications, or other interventions as needed 3, 4, 5, 6

Key Factors to Consider

Some key factors that a respiratory therapist may consider during a rapid response situation include:

• The patient's breathing pattern and any signs of distress or difficulty breathing 4
• The patient's oxygen saturation and any signs of hypoxia or respiratory failure 3, 4
• The patient's medical history and any underlying conditions that may be relevant to their current situation 5, 6
• The potential need for intubation or other advanced respiratory support 4

Potential Interventions

Some potential interventions that a respiratory therapist may consider during a rapid response situation include:

• Administering oxygen or other respiratory medications, such as albuterol or ipratropium bromide 5, 6
• Providing non-invasive ventilation or other forms of respiratory support 3, 4
• Assisting with intubation or other advanced respiratory procedures, if necessary 4