Respiratory Therapy Fundamentals – High-Yield Review

Air Composition & Basic Gas Laws

• Air at sea level ≈ 79\% nitrogen (inert), 21\% oxygen, 0.03\% trace gases.
• Boyle’s Law: P \propto \frac{1}{V} (pressure–volume are inversely related).
• Dalton’s Law: Total gas pressure equals the sum of partial pressures (e.g., P{N2}+P{O2}+P_{trace}=760\,\text{mmHg at sea level}).

Respiratory Therapy Profession

• Primary goal: Deliver adequate O_2 to brain; manage cardio-pulmonary function.
• RT = independent “physician-extender” (consultative, protocol-driven; writes/adjusts orders that MD signs).
• Emerged 1970s; RTs attend all codes and high-acuity respiratory events.

Professional Conduct & Licensure

• Considered a “calling”; high moral & legal standards (DUIs, drug use, unpaid child support can block license).
• Licensure (CA): must hold NBRC credential (CRT or RRT) + state license; CA requires RRT to practice.
• Continuing education: 30 CEUs/2 yrs; ethics module every 4 yrs (CA).

Governing / Credentialing Bodies

• NBRC – administers national exams & credentials (TMC + Clinical Sims).
• AARC – national professional association; lobbying & CEUs.
• CSRC – state society; CA legislation & CEUs.
• CoARC – accredits RT education programs.

Key Historical Figures

• Hippocrates – “father of Western medicine”; first do no harm oath.
• Joseph Priestley – discovered oxygen.
• John Dalton – partial pressures (Dalton’s Law).
• Robert Boyle – inverse P–V (Boyle’s Law).
• Louis Pasteur – germ theory; swan-neck flask experiments showed microbes in air.

Communication Basics

• Build rapport: empathy, touch (when welcomed), eye contact, calm keywords, avoid "use of authority" tone.
• Compromise techniques (e.g., allow brief call to family before intubation).

Infection Control Essentials

• Nosocomial (hospital-acquired) vs. HAI (any healthcare setting).
• Common nosocomial pathogen: Pseudomonas aeruginosa.
• Chain of infection: pathogen + route + susceptible host.

Transmission Routes

1. Direct (person-to-person)
2. Indirect (fomite/object)
3. Droplet (>5\,\mu\text{m}) – surgical or N95 mask
4. Airborne (<5\,\mu\text{m}) – N95 mask, negative pressure
5. Vector (mosquitoes, food, water, etc.)

Standard / Isolation Precautions

• Always use hand hygiene: 15-s soap/water (visible soil or spores) or alcohol gel (preferred otherwise).
• PPE: gloves, gown, N95 for droplet & airborne; upgrade PPE at your discretion.
• Cystic Fibrosis pts: standard mask & gloves every visit.
• Transporting infected pts: patient wears surgical mask; staff N95; clear hallway.

Disinfection & Sterilization Terms

• Bactericidal – kills bacteria.
• Bacteriostatic – inhibits bacterial growth.
• Sporocidal – destroys spores (e.g., glutaraldehyde/Cidex).
• Virucidal – inactivates viruses.

RT Equipment Processing Workflow

1. Wipe equipment in room; discard disposables there.
2. Cover equipment (red biohazard bag) & wheel to RT decon room.
3. Dirty zone → wash in enzymatic soap ("doing the dishes").
4. Immerse non-disposables in 2\% glutaraldehyde (Cidex):
   • Short soak = high-level disinfection; long soak (≥10 h) = sterilization/sporicidal.
5. Rinse in clean sink → air or heat dry → store or re-assemble.
6. Daily potency check of Cidex with test strip; document on log.

• Red tape on floor separates dirty vs. clean zones—never cross dirty items into clean area.

Preventive Bundles

• VAP bundle (vented pts): oral care, deep oral suction, reposition ET tube, HOB 30$°+, etc.
• CAUTI bundle (urinary catheters): nurse-driven cleaning/irrigation schedule.

Infection Statistics & Control Oversight

• Average hospital infection rate ≈ 4\% of admissions.
• All nosocomial cases reported to CDC (Atlanta) for surveillance; CDC issues guidelines.
• Vaccination program = most effective workforce protection.

Key Numbers for Quick Recall

• Air: 79\% N2, 21\% O2.
• Sea-level barometric pressure: 760\,\text{mmHg}.
• Droplet size cutoff: 5\,\mu\text{m}.
• Hand wash: 15\,\text{s}; scrub 5\,\text{min} for surgery.