INTRO TO RESPIRATORY CARE EXAM ONE!

Imhotep

First physician 2600 BC - Egypt

Hippocrates

Greek physician 440 BC - Oath

Who invented nursing ?

Florence Nightingale (first nursse 1840 - London)

When did Respiratory care start?

1940

Who and When discovered oxygen (O2)?

Joseph Priestly discovered oxygen in 1774.

When was O2 given as “therapuetic treatment”

1798

1898??

Low O2 shown to cause hyperventilation

1900’s??

O2 therapy finally recognized

What does “Hypoxia” mean?

Low Oxygen

Define “hypoxia” or “low oxygen”.

Abnormal deficiency of O2 in arterial blood.

What did Airforce begin to use with pilots?

Airforce began to use the Puritan-Bennett Oxygen mask with pilots.

What was the need for trained respiratory technicians established by?

The Standards of Effective Administration of Inhalation Therapy

What does Polio epidemic creates need for?

Iron Lung

1960s..

O2 and Air piping systems in hospitals

What year was the first respiratory therapists credentialed?

1961

When was Tracheostomy mask introduced?

Late 1950s - 1960s

1960s….

• Pediatric therapy introduced

• 12 month RT training programs accepted by the American Medical Association

• Mechanical ventilator becoming more complex and evolving

• College sponsorship now required for therapist programs; 1 year technician programs approved

• Name change — American Association for respiratory therapy

• Peak flow meter introduced

• National board exams given as “pencil-paper” exams across the nation (no more oral exams)

What year was RTs starting to be paid on a credentialed level with nurses?

1980s..

When was the first national respiratory care week?

1982. Was recognized by Congress and President Reagan.

Pulmonary Function Testing certification exam?

1982

What year did National Board for Respiratory Therapy (NBRT) become National Board for Respiratory Care (NBRC)?

In 1983

What year was the Texas licensure law enacted?

In 1985

AART becomes the American Association for Respiratory Care (AARC) what year?

1985

State licensure in Texas?

Respiratory Care Practitioners (RCP) have to show proof of passing CRT/RRT examination. $160/year

Can Rt students work in patient care if enrolled as RT student?

YES

In Texas, MD’s, nurses, PT’s, OT’s, most all healthcare providers are state licensed only RC is licensed and nationally credentialed.

TRUE

Accreditation

All RC Programs (AS/BS/MS) MUST br accredited by CoARC in order for graduates to sit for the NBRC national credentialing exams and become licensed in their state.

What is AARC?

The AARC is a non-profit professional organization representing therapists nation-wide through lobby efforts for beneficial legialation nationally and locally.

What does the AARC do?

• Lobby for the profession nationally

• support state RC societies — Texas society for Respiratory Care (TSRC)

• Educate the public about the profession

When was the Department of Respiratory Care at Texas State University become a thing?

The Department of Respiratory Care at Texas State University in September 1972.

What happened after it’s first site visit in 1974?

It has maintained full accreditation since its first site visit in 1974.

What does the Department offer?

• Bachelor of Science in Respiratory Care

• Master of Science in Respiratory Care

• RRT-to-BSRC Online Degree Completion Program

Where are clinical rotations taught?

Austin, Round Rock, and Temple

What year was the Department name changed from Respiratory Therapy to Respiratory Care

1992.

What year was the Texas Higher education Coordinating Board approved the university’s request to add a Bachelor of Science in Respiratory Care and to remove the Associate of Applied Science

1993

What year did the last AAS students graduate?

1994

Oxygen

• Is a drug

Oxygen

• Can prolong the life of a patient

Oxygen

• Can be overdosed - oxygen toxicity

Oxygen

• Supports combustion

What is the percentage for room air ?

21% (20.95%) oxygen and 78% nitrogen

What are the goals for oxygen?

• Correct hypoxemia

• Decreased symptoms of hypoxemia

• Minimize cardiopulmonary workload

What is the general goal for Oxygen therapy?

The overall goal of Oxygen therapy is to maintain adequate tissue while optimizing cardiopulmonary work.

What are the clinical objectives for Oxygen therapy?

• Correct hypoxemia

• Decrease symptoms associated with hypoxemia (Tachypnea, Dyspnea(short of breathe), Palness).

• Decrease workload hypoxemia imposes on cardiopulmonary system. (heart rate (tachycardia), Pulmonary vasoconstriction/hypertension, chronic (blood viscosity)

What is cor pulmonale

When blood gets too thick

How does Oxygen therapy work?

• O2 therapy corrects hypoxemia by increasing alveolar and blood level O2.

Correction of hypoxemia:

The most tangible objective of O2 therapy. (Easiest to measure)

What are CPGs (Clinical Practice Guidelines)

CPGs are guides to practitioners. They practice O2 therapy with the use of CPGs.

Indications

• Documented or suspected hypoxemia

• Severe trauma

• Myocardial infarction

• Short term therapy

Contradictions:

• So specific contraindications to O2 therapy when indications are present

Precautions:

• Depression of ventilation

• Fire hazard

• Depression of ciliary function

• Absorption atelectasis

What is Assessment of need?

Need is determined by inadequate PaO2 or SaO2.

What is Assessment of Outcome:

Clinical and physiological assessment to establish

List O2 delivery devices..

• High flow

• Low flow

• Reservoir system

Low flow devices

• The device will NOT provide all of the inspired gas required by the patient.

• A patient will inhale some room air along with the delivered oxygen

• Cannot deliver a stable FiO2

What is FiO2?

fraction of inspired oxygen. FiO2 is low and variable.

What are the advantages of a nasal cannula:

• Easy to use

• light weight

• economical

What are the disadvantages of a nasal cannula?

• Instability

• Patient discomfort at higher flows

• Mucosal drying

What are the flows for nasal cannula?

Flows=liter per min (lpm)

For Neo: 0-3 lpm

For Pedi: 0-6 lpm

For Adult: 0-6 lpm

What is the formula for FiO2?

(flow*4)+ 20

FiO2: Each 1 L/min increases FiO₂ by about 4% above room air (21%).

• 4% per liter, starting at 20%

• 1 lpm cannula gives about 24% O2.

• 2 lpm cannula give about 28%

• 3 lpm cannula gives about 32% etc..

Reservoir Systems

• Allow oxygen to be stored between patient breaths

• The patient can sample from the reservoir when inspiratory demand increases

• Can sometimes supply all the inspired gas to the patient

List devices for reservoir systems:

• Simple oxygen mask

• Non-rebreathing mask

• Partial rebreathing mask

What are the advantages of simple mask?

• Higher FiO2

• Less irritating than cannula to some patients

• patients that mouth breathe

What are the disadvantages of simple mask?

• Must be removed to eat

What are the flows?

5-10 lpm (cannot go less than 5 because it can cause death)

What is the FiO2 for simple mask?

35% to 50%

Non rebreathing mask

• Mask with reservoir and 3 one-way valves

• Reservoir collects oxygen

• Valves direct gas flow and ensure no gas mixing

• Performances of mask depends on a tight seal to patient face

What is the flows?

Required enough to prevent bag from collapsing

• 10-15 lpm

What is the FiO2 for simple non-rebreathing mask?

60-100%

Partial Rebreathing Mask:

• Remove all one-way valves from the non-rebreathing valve set up

• The most important valve to remove is the one between the mask and the reservoir bag

What is the flow?

10-15 lpm (enough to prevent the bag from collapsing)

High Flow Devices:

• The device can supply all the required inspired gas to a patient

• Device is not affected by changes in the patient’s ventilatory pattern

• Can deliver a stable FiO2

List devices for high flow devices:

• Venturi mask

• High flow nasal cannula

What does a Venturi mask do?

Oxygen is delivered to device, which entrains room air through side ports and provides a precise FiO2 to the patient.

What is the advantages of a venturi mask?

• Provides a controlled oxygen concentration