Volume 1, Issue 2 The First Breath of News March, 2010

RESPIRATORY CARE
All the News You Can Inhale

Brief Notes from the Editor Employee in Focus

Terry Nuttall Terry Nuttall

Spring ostensibly begins on March
20, 2010, at 12:32 P.M. EDT when
the Sun passes directly over the
Earth's equator. This moment is
also known as the vernal equinox in
the Northern Hemisphere, when
day and night are about equal in
length. For those of us living in Wisconsin, this usually only
means that the sky is mostly grey with cool drizzle falling on our
heads. However, at least there is an emerging hope that the
light and warmth of summer is within reach once more. The
onset of Spring also usually means the beginning of a decline
of RSV and Bronchiolitis cases in the hospital for which we
have to wear those much loved isolation gowns that endlessly
overfill the tiny trash bins. Perhaps we will also see an
attendant decline in the use of PEP therapy which we all 'know'
is so very effective for those with Bronchiolitis but for which
there is a marked paucity of reliable evidence. Well, perhaps
we won't. In any event, this is also the month of Saint Patrick's
Day. So enjoy and may trouble avoid you! 
1 Brief Notes & Employee in Focus
2 Creative Cooking Corner with the Krazy Kook
3 Night Shift News
4 Managing with Rhonda & Employee Anniversaries
5/6 Essential Education / Respiratory Technology Update
7/8 Prairie Dawn / Respiratory High Fives
9 Credits and Other Stuff
In our monthly newsletter's ongoing quest to recognize
each invaluable employee who doesn't mind the attention,
Wendy Sinjakovic has kindly consented to being the
second victim, (I mean employee) in our series, Employee
in Focus .
Wendy's motivation for working at Children's Hospital of
Wisconsin was borne from more than mere financial or
situational consideration. Her lovely daughter, Megan,
began having respiratory problems more than eight years
ago at ten months of age when she was hospitalized at
CHW for a couple days, for the first of multiple
admissions. Two weeks later Megan was again admitted,
this time to the Pediatric Intensive Care Unit where her
respiratory distress was so severe that she required
intubation and emergency bronchoscopy. For the next
three years Megan was visiting CHW every couple of
months for continuous
albuterol aerosols and even
Heliox once to avoid another
intubation. Megan's last
hospitalization occurred just
prior to her fourth birthday.
Wendy has managed to control
her asthma at home for the last Wendy Sinjakovic
four years successfully. Wendy
began attending college about eight months after
Megan's first hospitalization and then decided to become
a respiratory therapist after her fourth admission to CHW.
Her daughter's respiratory issues played a large role in
her decision to learn respiratory care and has helped her
manage Megan's asthma symptoms. In coming to our
Respiratory Care Services department at Children's
Hospital of Wisconsin two years ago, Wendy is fulfilling

Continued on page 2

Happy Saint Patrick's Day, March 17! Page 1

Volume 1, Issue 2 The First Breath of News March, 2010

Employee in Focus cont' Continued from page 1

Creative Cooking Corner her goal of caring for children with respiratory difficulties in the
same way that her own child, Megan, had been cared for at
CHW during her acute exacerbations of asthma. It is Wendy's
way of giving back to the hospital that has helped her daughter
By
through some very challenging times.
Karen Jones
our Krazy For Wendy's courage in consenting to be the focus of this
Kook column and for her two years of service to the Respiratory
Services Department at CHW we are happy to present her
with a personalized shot glass, filled with her favorite green
beverage (if you print this out
Luscious Lasagna in color, that is.)
1 lb ground Italian sausage Congratulations Wendy
1 lb ground turkey in keeping your daughter's

1/2 cup onion asthma under control and

fulfilling your goal. We are
2 cloves garlic
glad you are a part of our
1(28oz) can crushed tomatoes
team!
2(6oz) cans tomato paste
2(6oz) cans tomato sauce
1/2 cup water
2 tablespoons sugar Creative Cooking cont'
1 1/2 teaspoon basil
Spread meat sauce over bottom of greased dish. Arrange six
1/2 teaspoon fennel seeds
noodles over meat sauce. Spread with 1/2 ricotta mixture. Top
1 teaspoon Italian seasoning
with 1/2 mozzarella cheese. Spoon meat sauce over
1 tablespoon salt
mozzarella and repeat layers until done. Top with remaining
1/2 teaspoon pepper mozzarella and parmesan cheeses. Spray aluminum foil,
1 tablespoon minced parsley or 3 tablespoons fresh cover and bake for 25 minutes, uncover and bake
chopped parsley an additional 25 minutes or until cheese is melted and top is
12 lasagna noodles browned.
16 oz ricotta cheese
This recipe is easily doubled so you may bake one and freeze
1 egg another for up to 2 months. Just unthaw in fridge and bake
1/2 teaspoon salt according to directions. Great for those busy working days
3/4 cups sliced mozzarella cheese when you want a nice home cooked meal without the hassle!
3/4 cup parmesan cheese
Preheat oven to 375 degrees Watch for next month's delicious
recipe by the Krazy Kook.
Cook sausage, turkey, onion and garlic until brown. Stir in
Till next time, bon appétit! 
tomatoes, tomato sauce, tomato paste and water. Season
with sugar, basil, fennel, Italian seasoning, pepper and 1/2
the parsley. Simmer for 1 1/2 hours. Meanwhile soak lasagna
noodles in hot water and in small bowl, mix the ricotta cheese
with the egg, salt and remaining parsley, set aside.

Creative Cooking continued at right

Happy Saint Patrick's Day, March 17! Page 2

As a slightly more tangible reward for her long year of service

 Volume 1, Issue 2 The First Breath of News
Night Shift Newzzz…
By Anthony Martinez
My Weekend is Better than
Your Weekend!
I can remember, back in grade school, having this squishy lunch
box that looked like a fire station. Pretty cool I thought. Until I
realized that the Force was not with me and everyone, who was
someone, had a Star Wars lunch box to hold their Jedi enhancing
lunch morsels. It didn’t take long, after the heckling I endured, to
see my fire station squishy lunch box being hurdled around the
room like R2D2 at Dagobah!
The first annual RCS Night Shift We Survived Viral Season and
Now We Need to Do Something Fun Wii Bowling Tournament is
upon us! Alright, maybe we’ll shorten that a bit. Now that our staff
is in place, it’s time to pick up your controller, grab some snacks
and have at it!
You don’t have to have a Wii System to play.
Teams now forming! If you’re interested in playing or being a team
captain, if you have a Wii System and if you’re willing to host a
meeting, send an Email to: Frickin.10.Pin@gmail.com
Happy Saint Patrick's Day, March 17!
March, 2010
Awesome Job!
I just want to thank all you guys who helped out and who
th
were working the weekend of February 26 ! Those who
could help did and I appreciate all the efforts that you gave.
We truly can’t be successful without all of us working
together and I commend you guys for the job you did.
Awesome job!
Oh I Got This!
In the 2010 Vancouver Winter Olympics, Steven Holcomb lead
his team with USA Sled 1 to a gold medal in the 4 man bobsled.
What nickname did they have for their sled?
The first correct answer wins a large box of Cinnamon Toast
Crunch! Unopened of course! Send your answer to:
Ohigotthis@gmail.com
(Don’t tell my son!)
Page 3
Volume 1, Issue 2 The First Breath of News March, 2010

Managing with Rhonda, cont'

and every one of you! I am so excited to have all of you as

Managing With members of my team.
Rhonda "To dream anything that you want to dream. That's the
beauty of the human mind. To do anything that you want to
by Rhonda Duerst
do. That is the strength of the human will. To trust yourself
to test your limits. That is the courage to succeed."
I can’t believe another month has gone by. The good thought is
winter is almost over. I have really enjoyed watching the Winter --- Bernard Edmonds 
Olympics over the past 2 weeks. It is amazing what some
people can do when they put their mind to it. It fascinates me Employee Anniversaries
when I hear the stories of how the athletes get to where they are.
Congratulations to these invaluable individuals!
Most have faced many challenges during their journey but never
gave up. Some worked for years and others not as long. They
Employee Name Years of Service
did not do it alone but had both family and team members to
encourage them along the way. The will and determination is Heather D Knez 3
what carried them through their journey. They never lost sight of Laurie Smrz 4
where they were trying to go and now they are at the Olympics.
Russell R Haeuser 2
As they look forward I am sure they have many more visions of
Terry K Nuttall 18
what they want to do. We are not much different than these
athletes except our personal visions are on a different path. We Wendy R Sinjakovic 2
each have our good times and our bad times but we seem to
never give up. Each person is driven by their own goals. Only This occasion would not be complete without awarding
the person can make the choice of how they will grow and what these exemplary employees
they will strive for. a complimentary
personalized stein to be
Without a vision it is hard to imagine what the future will hold.
filled with the beverage
Over the past month I have had the opportunity to participate in
of their choice. However
strategic planning at the organization level as well as at the
due to budgetary
department level. This has been a fun experience and I am
constraints which we are
excited for our future. I believe we have a great team within our
still working under, we
department as well as within our organization and we will
can only offer you one.
continue to strive to be the best! No structure can be held up
We hope you don't mind
with only one post or pillar, it takes many foundation supports to
sharing in the spirit of the
make the structure sound. Our organization and department are
teamwork which you are
no different. We will be describing our vision in vivid detail over
so noted for.
the next few months. We have a mission and vision which will
guide us to excellence. We begin with a foundation of five pillars
of excellence: People, Service, Quality, Finance, and Growth.
Eye hear it's your
Each month I will update on where we are, what we have
birthday.
accomplished and where we are going.
Have fun!
I have submitted an application to the AARC's Quality Employee Name Birthday
Respiratory Care Recognition Program to be recognized as a Karen March 11
quality department. This is something we would not be eligible Wendy S. March 12
for without each and every member of our team. I thank each Jamie March 31
Angela March 28

Happy Saint Patrick's Day, March 17! Page 4

Volume 1, Issue 2 The First Breath of News March, 2010

Fun with the NBRC

Essential Education I have had many lengthy discussions with the NBRC lately
regarding the now, 8 year old continuing competency
program. There are many things at stake here and the
process is not the easiest – but I can and will help you in any
way that you need. Any of you who graduated after July 1,
2001 fall into the CCP requirements set forth by the NBRC.
Now, whereas the state of WI does not require that you take
any CEU’s in order to maintain your license – the NBRC is

by Heather Knez requiring that you take 30 CEU’s in a 5 year time frame in
order to maintain your credential. Please don’t confuse the

This is a bronchial cast retrieved from a patient recently. two. Also, along with the CEU’s that you have to take, you

Thank you Rick also have to pay them $125/5 years to be a part of this

Nelson, who gave program – even though it’s mandatory. I know, I know, it’s

this to me after it all very confusing! You have an “exempt” period for 1 year
nd
was given by the after you graduate, but starting the 2 year, you have to

patient's father to start paying the NBRC $25/month, or if you want, you can

him. If anyone pay the entire $125 at the back end of the 5 year window, as

would like to see long as you don’t go beyond that 5 years. When I say

this cast, it is now “beyond that 5 years,” I mean that you only have until the

in histology, end of the month in which you graduated. So, if you

preserved for teaching purposes. Just let me know. graduated May 4, 2007, then you have until May 31 2010 to
pay the money. Also, along with paying the fee every
A bronchial cast is basically sputum that has become very
month, or every 5 years, you must submit the CEU’s that
thick and sticky, falling along the walls of the bronchi and
you obtained directly onto the NBRC website. You still
taking that shape. These are very dangerous as they can
have to do this even if you are a member of the AARC. If,
completely occlude the airway causing respiratory and
at the end of your 5 years, your CEU’s are not submitted
eventually, cardiac arrest. Sometimes, they can be coughed
onto their site, then your credential will expire. Your 5 year
up by patients during an asthma attack. They can also form in
time frame is “re-set” every time you take another credential.
patients that have bronchitis and of course, plastic bronchitis.
So, for those of you getting ready to take the RRT – after
Often, they have to be removed by bronchoscopy – as in the
you do this, you will then have 5 years from the end of that
case of this one. In severe cases many bronchial casts form
month to pay the fee, obtain all of the necessary CEU’s and
almost as soon as they are removed. This particular bronchial
then record them.
cast came from a patient who had recurring problems with
bronchial casts occluding his bronchi, in particular, his right
The advantage of being an AARC member is that you just
mainstem.
have to copy the CEU’s from your transcript over to the
NBRC website and you really don’t have anything to keep
I am completely fascinated by these things as well as what
track of. All of our CEU’s are approved by the AARC and as
the body can do in general and the things that make us whole,
long as you are a member ($90/year) they will create a
or sometimes not so whole. I wanted to share this with all of
“transcript” where all of your CEU’s are kept. No need to
you as I know you have the same (or close to the same)
keep a thing unless you are just the type that keeps
passion for this kind of thing as me – otherwise, you wouldn’t
everything.
be here. 

Continued next column Continued Page 6, Left

Happy Saint Patrick's Day, March 17! Page 5

Volume 1, Issue 2 The First Breath of News March, 2010

Essential Education, cont'

I know this is very cumbersome and there are things that we Respiratory Technology
have learned along the way. It has really started to impact the
therapists here and you all need to have a good understanding Updates
of this as it’s not going anywhere. Questions –see me. 
Information Services by Deb Bakalarski
Thought of the Month by Heather
Those of you who have been working in the center tower
Despite all of the chaos that we all have on a daily basis with
(C7 and C8) may have noticed the new addition of
work, home and just plain living, let's all be positive that the
computers in the rooms. The installation has been a bit slow
outcomes of our efforts will always be favorable.
as they must wait until the room is empty before they can
drill in the walls and pull the wires through the ceiling. The
computers won’t be fully functional until the entire floor is
finished. When both floors are all done the only place still
using handhelds will be the NICU.

I am also on a committee that will be bringing you a

downtime order entry system. We are scheduled to go live
during the second quarter of this year. Demos will be starting
in March. This will enable us to place orders, see results and
documents if/when sunrise is down. It will also enable us to
place orders if the entire computer network is down. No more
paper orders! There is no worklist here so billing is still on
paper for us. We hope to never use it but they may end up
doing trial runs a few times a year just to help people not
This is in the area where
forget how to use it. It looks and acts very much like sunrise
I grew up. It is in a place
does now. 
in the Shawnee National
State Forest called Pine
Difficult Airway Cart by Khris O'brien
Hills. Inspiration point is
the top of a great big Critical care will soon have a difficult airway cart. The cart
cliff that we hiked up to includes a very cool device called a Glidescope which takes
as teenagers, sit and just look for miles. I ran across it as I the place of a laryngoscope blade. The fiberoptic blade is
was looking for positivity images and just had to share it attached to a video screen which gives a beautiful view of
as it brought back some really good memories – very the airway. It has 2 sizes of “wands” with 2 sizes of
tranquil.  disposable blades for each wand (4 blade sizes total). Each
wand costs about $6000 each (ouch!). The cart will be
housed in the bronch room on W4; you may be asked to get
it for difficult intubations. Before you take it back to the room,

Just tell be sure to wipe it down with the cleaner in the cart. LMA’s,
NP and oral airways as well as tube exchangers will be in
me where this cart. ET Tubes and tape etc will stay in the intubation
the coffee is kits. It will be out for a week for show and tell soon. I will let

please!
you know when & where so you can get familiar with it. Even
I could intubate with this thing! 

Happy Saint Patrick's Day, March 17! Page 6

Volume 1, Issue 2 The First Breath of News March, 2010

mentioned. Speak in terms of outcomes when discussing

Prairie Dawn
By Khris O'Brien
Appropriateness of Care
As we all know, hypertonic 3% saline is being used on an
increasing number of patients who do not have bronchiolitis .
3% hypertonic saline has only been studied on bronchiolitis
patients. It has not been studied in any other patient
population (or at least no published articles yet).
There is a Cochrane paper from 2008 that reviewed 4
studies of 3% hypertonic saline on bronchiolitis patients. I
was unable to find any newer articles. 3 of the studies the
hypertonic was given Q8, one study was given with a mix of
frequencies ranging from Q2-Q6. There was no difference in
Length of Stay (LOS) between the two frequencies studied.
Q8 resulted in the same LOS as the more frequent dosing.
3% hypertonic saline did show an almost full day reduction in
LOS for bronchiolitis patients. The patients were given the
hypertonic saline until discharge.
changing the frequency or discontinuation of hypertonic
saline with physicians.
For pts who do have bronchiolitis, either on chest x-ray,
positive culture or clinical picture (documented by the MD as
a viral respiratory pattern), hypertonic saline is a proven
treatment plan. Inform the physician that the research has
shown no difference in LOS between Q8 and more frequent
treatments. A Q8 frequency, for this population, would be a
cost effective way to administer the proven treatment plan.
I have the original articles at my desk and I put a copy of
each of the articles that I currently have in a folder in the
conference room. If you wish to give an article to a
particular physician, feel free to make a copy of the copy so
that it is still available for others to use as they need to. 
Cues for Effective Communication
Pay attention to your body. If you notice responses
like increased HR, sweating, fast or slow breathing or
general anxiety you are in a conversation where the
stakes are high. Noticing what is happening is the first
step to changing it. 

My recommendation would be to respectfully remind the

physicians that there is currently no evidence proving
effectiveness of hypertonic saline in any patient population
other than bronchiolitis. If they would still like to consider
using it, you may want to ask the physician what their
measures of success will be. Are they expecting less or
thinner secretions, decreased respiratory rate or improved
chest x- ray? Then consider suggesting a trial period of use,
at which time the measures of success will be evaluated to
decide if the therapy is successful. If there is no
improvement in their measures, suggest discontinuing the
treatment. It is important for us to evaluate their measures in
a non-biased way. So, be sure to pass off in report who you
spoke with and what the measures of success are. This
way, those coming after you can follow-up at the appropriate
time interval and speak to the specific points the physician Bizarre image but Wise Words

Continued next column

Happy Saint Patrick's Day, March 17! Page 7

Volume 1, Issue 2 The First Breath of News March, 2010

Respiratory Care Services

High Fives
Congratulations to All!
Honoree Submitted
Comments
Name by
Mike Mike did a fantastic job completing all necessary paperwork for the unplanned
Khris O'brien
Paquette extubation event study this past weekend - outstanding!! Thank you!! Khris & Melissa

Rebecca
Wayne Barta Thank you for assisting me with the INO in surgery. Your help was greatly appreciated!
Riederer

Angela Anthony Thanks so much Angela for picking up hours this weekend to help our staff! You efforts are
Delle-Grazie Martinez greatly appreciated!

Mary Anthony Thanks so much Mary for picking up hours this weekend to help our staff! You efforts are greatly
Multhauf Martinez appreciated!

Anthony Thanks so much Bob for picking up hours this weekend to help our staff! You efforts are greatly
Robert Todd
Martinez appreciated!

Thanks for making it so easy to work with you, Mike! I look forward to being with you every third
Michael Katherine
weekend...you are always there to help me. I especially need to thank you for being my right
Wolter Halvorson
hand for the twin delivery...I know that I can always count on you!

Anthony
Jason Ousey Great job Jason being in charge on Monday and managing the team with 3 sick calls!
Martinez

Danielle Thank you for always being a helping hand!! It is reassuring to know I can always count on you
Kathryn Gill to be there to lend a steady hand & do it with a smile!
Seguin

Anthony Thank you Lynn for taking a leadership role and calling people to see if they could help cover
Lynn Klich
Martinez sick calls last night.

Danielle Anthony Thank you Danielle for taking a leadership role and calling people to see if they could help cover
Seguin Martinez sick calls last night.

Wendy Anthony Thanks so much for coming in tonight and helping when we had 2 sick calls! Your help is greatly
Robinson Martinez appreciated.

Thank you Rick for coming and assessing a pt that was not in protocol. The patient's mom and I
Richard
Steph Nierode appreciate the time you took to help suction and explain the assessment data you found! Way to
Nelson
go! Glad you are a part of the CHW team!
Thank you very much for helping Mike get the UPE forms collected for our first UPE patient. He
Hilary
Khris O'brien just told me you were instrumental in getting all the forms collected. Thank you very much - the
Ledbetter
forms were completed perfectly!

Jennifer Hilary
Thank you for staying after your scheduled shift to help when we had a sick call on nights.
Posvic Ledbetter

Jackie Anthony Thanks Jackie for staying over into night shift to help NICU with first rounds. That really helped a
Schreier Martinez lot and I appreciate it!

Happy Saint Patrick's Day, March 17! Page 8

Volume 1, Issue 2
CREDITS
Thank you to everyone who has contributed material,
support and ideas to this newsletter. It is your
contributions that make this possible.
 Anthony Martinez
 Rhonda Duerst
 Khris O'Brien
 Heather Knez
 Karen Jones
 Wendy Sinjakovic
 Deb Bakalarski
CALENDAR EVENTS
American Red Cross Month
Irish-American Heritage Month
National Nutrition Month
National Kidney Month
 National Sleep Awareness Week: Mar 8-14
 Middle Name Pride Day: Mar 10
 National Pi Day: Mar 14 (it's 3.14, OK?)
 Ides of March: Mar 15
 Incredible Kid Day: Mar 15
 Everything You do is Right Day: Mar 16
 Charlene Williams Retirement Party: Mar 18
 International Earth Day: Mar 20
 Smoke & Mirrors Day: Mar 29
 Holy Week: Mar 29-Apr 3
 Passover: Sundown Mar 29-Apr 6
 Take a Walk in the Park Day: Mar 30
Happy Saint Patrick's Day, March 17!
The First Breath of News March, 2010
The month of March is National MS Education & Awareness Month.
This national campaign, spearheaded by the Multiple Sclerosis
Foundation (MSF), in cooperation with the MS Coalition and other
organizations, will promote an understanding of the disease and will
provide education, empowerment, and assistance to those living with it.
Upon request, educational literature is available for MS patients, family
members, healthcare providers, the media, and all others who wish to
broaden their understanding of this chronic, progressive neurological
disease.
MS is usually diagnosed between the ages of 20 and 50, with a risk in
the general population of approximately 1/750. Two hundred people are
diagnosed with MS every week and more than 2.5 million people are
living with this disease worldwide. Like other autoimmune diseases, MS
is more common in women than men. The most common symptoms
associated with MS include visual disturbances, balance and walking
difficulties, debilitating fatigue, weakness, numbness, and bladder
dysfunction. While there is currently no cure for MS, there is a great deal
a person can do to manage the disease and maintain their quality of life.
The best place to start is with reliable information about MS.
Further information about MS and National MS Education & Awareness
Month can be found by clicking Multiple Sclerosis Foundation or by
calling 1-888-MSFOCUS (673-6287).
The Multiple Sclerosis Foundation is a national, non-profit organization
dedicated to improving quality of life for individuals with MS through
educational programs and support services.
Article Reference: Medical News Today 
Page 9