What are the initial steps for a respiratory therapist during a rapid response?

Role of a Respiratory Therapist During a Rapid Response

During a rapid response, respiratory therapists should immediately assess airway patency, breathing effectiveness, and oxygen saturation, then provide appropriate respiratory support including oxygen therapy, airway management, and ventilation assistance as needed to prevent patient deterioration.

Initial Assessment and Actions

When responding to a rapid response call, respiratory therapists should:

1. Immediate Assessment:

   • Assess airway patency and breathing effectiveness
   • Check oxygen saturation via pulse oximetry
   • Evaluate work of breathing and respiratory pattern
   • Set up end-tidal CO2 monitoring if available 1

2. Oxygen Therapy:

   • Immediately provide supplemental oxygen if indicated
   • Target SpO2 94-98% for most patients (88-92% for COPD patients) 2
   • Consider high-flow oxygen therapy for patients with significant respiratory distress 2

3. Airway Management:

   • Position patient appropriately (head-up 25-30° when possible) to optimize airway patency 3
   • Prepare airway equipment (bag-mask, suction, intubation supplies)
   • Perform suctioning and artificial airway maintenance as needed 3

Advanced Respiratory Support

If the patient requires advanced respiratory support:

1. Non-invasive Ventilation:

   • Consider CPAP/NIV for hypoxemic patients who can protect their airway 3
   • Apply CPAP (5-10 cm H2O) with supported breaths for preoxygenation if intubation is anticipated 3

2. Intubation Preparation (if needed):

   • Assist with preoxygenation using appropriate technique 3
   • Prepare equipment for rapid sequence intubation
   • Assist with medication-assisted preoxygenation for agitated patients 3
   • Set up waveform capnography for tube confirmation 3

3. Post-Intubation Management:

   • Confirm proper tube placement with waveform capnography 3
   • Initiate lung-protective ventilation strategies
   • Monitor for signs of auto-PEEP or barotrauma 1

Team Collaboration

1. Communication:

   • Report respiratory assessment findings to team leader
   • Recommend appropriate respiratory interventions
   • Document respiratory care provided during the event

2. Role Integration:

   • Work closely with the critical care team 3
   • Coordinate with nursing staff for medication delivery related to respiratory care
   • Assist with patient positioning to optimize oxygenation

Common Pitfalls to Avoid

• Delayed intervention: Recognize early signs of respiratory failure requiring escalation of care
• Inadequate preoxygenation: Ensure proper technique and appropriate device selection
• Poor mask seal: Use two-handed technique for bag-mask ventilation when needed 3
• Excessive ventilation: Avoid rapid or forceful bagging which can cause gastric insufflation
• Missing equipment: Ensure all necessary respiratory equipment is readily available

Special Considerations

• Pediatric patients: Follow age-appropriate protocols for respiratory support 3
• Patients with difficult airways: Be prepared with alternative airway devices
• Patients with COPD: Target lower oxygen saturation (88-92%) to prevent hypercapnia 2
• Immunocompromised patients: Consider early initiation of high-flow nasal oxygen 4

By following these guidelines, respiratory therapists can effectively contribute to the rapid response team and help prevent further patient deterioration through timely and appropriate respiratory interventions.