Egan’s Fundamentals of Respiratory Care
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Transcript Egan’s Fundamentals of Respiratory Care
Chapter 1
History of Respiratory Care
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
Learning Objectives
1. Define “respiratory care.”
2. Summarize some of the major events in the
history of science & medicine.
3. Explain how the respiratory care profession got
started.
4. Describe the historical development of the
major clinical areas of respiratory care.
5. Name some of the important historical figures in
respiratory care.
6. Describe the major respiratory care educational,
credentialing, & professional associations.
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
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Learning Objectives
7. Explain how the important respiratory care
organizations got started.
8. Describe the development of respiratory care
education.
9. Predict future trends for respiratory care.
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
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History of Respiratory Medicine &
Science
Ancient Times
Early cultures developed herbal remedies for
many diseases
Foundation of modern medicine: attributed to
“father of medicine,” Hippocrates, Greek physician
living during 5th & 4th centuries BC
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
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History of Respiratory Medicine &
Science (cont.)
Ancient Times (cont.)
Hippocratic medicine:based on four essential
fluids: phlegm, blood, yellow bile, & black bile
Hippocrates believed air contained essential
substance distributed to body via heart
The Hippocratic oath: calls for physicians to follow
certain ethical principles
• Given to most medical students at graduation
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
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History of Respiratory Medicine &
Science (cont.)
Ancient Times (cont.)
Other great scientists of this time period
• Aristotle (342322 BC)first great biologist
• Erasistratus (330240 BC)developed pneumatic theory
of respiration in Egypt
• Galen (130199 AD)anatomist who believed air had
substance vital to life
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
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History of Respiratory Medicine &
Science (cont.)
Middle Ages
Fall of Roman empire (476 AD): resulted in period
of slow scientific progress
Intellectual rebirth in Europe began in 12th century
Leonardo da Vinci (14531519) determined
subatmospheric pressures inflated lungs
Andreas Vesalius (15141564) performed human
dissections & experimented with resuscitation
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
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History of Respiratory Medicine &
Science (cont.)
Enlightenment Period
1754: Joseph Black described properties of CO2
1774: Joseph Priestley describes his discovery of
oxygen - “dephlogisticated air”
• Lazzaro Spallazani describes tissue respiration
1787: Jacques Charles describes relationship
between gas temperature & volume - “Charles
law”
1778: Thomas Beddoes uses oxygen to treat
various conditions at Pneumatic Institute
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
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History of Respiratory Medicine &
Science (cont.)
19th & Early 20th Century
1801: John Dalton describes his law of partial
pressures
1808: Joseph Louis Gay-Lussac describes
relationship between gas temperature & pressure
1831: Thomas Graham describes law of diffusion
for gases (Graham’s law)
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
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History of Respiratory Medicine &
Science (cont.)
19th & Early 20th Century (cont.)
1865: Louis Pasteur advanced his “germ theory” &
suggestes that some diseases were result of
microorganisms
1846: spirometer & ether anesthesia invented
1896: William Roentgen discoveres x-ray - opens
door for modern field of radiology
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
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Which scientist described his law of diffusion for
gases in the 19th century?
A. John Dalton
B. Thomas Graham
C. Jacques Charles
D. Joseph Louis Gay-Lussac
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
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Development of the Respiratory Care
Profession
1940s: technicians hauled O2 cylinders &
apply O2 delivery devices
1950s: positive-pressure breathing devices
applied to patients
1960s: Formal education programs for
inhalation therapists
Development of sophisticated mechanical
ventilators in the 1960s expanded role of
respiratory therapist (RT)
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
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Development of the Respiratory Care
Profession (cont.)
RTs responsible for arterial blood gas &
pulmonary function laboratories
1974: designation “respiratory therapist”
becomes standard
Practice of Respiratory Therapy, originally
U.S. & Canada now expands globally
1980: Respiratory Care Week established
nationally to promote profession &
importance of good lung health
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
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How long after initially applying positive pressure
breathing devices to patients did the first
sophisticated mechanical ventilator become
available, expanding the role of Respiratory
Therapists?
A. 10 years
B. 20 years
C. 30 years
D. 40 years
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
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Development of the Respiratory Care
Profession (cont.)
Oxygen Therapy
1907: Large-scale production of O2 developed by
Karl von Linde.
1910: Oxygen tents first used
1918: O2 masks first used
1940s: O2 therapy widely prescribed
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
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Development of the Respiratory Care
Profession (cont.)
1960s: Clark electrode first developed allows measurement of arterial PO2
1974: Ear oximeter invented
1980s: Pulse oximeter invented
1960: Venti mask to deliver specific FIO2
introduced
1970s: Portable liquid O2 systems for longterm oxygen therapy (LTOT) in home
introduced
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
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Development of the Respiratory Care
Profession (cont.)
21st century marks further advances in home
oxygen therapy equipment
New equipment introduced for Long Term
Oxygen Therapy include:
Oxygen concentrators with pressure booster
(allows transfilling in home)
Smaller, lightweight portable oxygen concentrators
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
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Development of the Respiratory Care
Profession (cont.)
Aerosol Medications
1910: aerosolized epinephrine introduced as
treatment for asthma
1940s-1950s: Isoproterenol (1940) & isoetharine
(1951) introduced as bronchodilators
1971s: Aerosolized steroids first used to treat
acute asthma
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
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Development of the Respiratory Care
Profession (cont.)
Aerosol Medications
1980: Advances in bronchodilator therapy Albuterol sulfate introduced & still used today
2000: Levalbuteral introduced
Newer aerosol medication delivery devices include
dry powder inhaler (DPI)
Innovative designs for small volume nebulizers
(SVN’s) invented
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Development of the Respiratory Care
Profession (cont.)
Mechanical Ventilation
1928: Iron lung introduced by Philip Drinker
1940s-1950s: Jack Emerson develops improved
version of iron lung used for polio victims
1950s: Negative-pressure “wrap” ventilator
introduced
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
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Development of the Respiratory Care
Profession
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
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Mechanical Ventilation
Originally, positive-pressure ventilation used
during anesthesia
The Drager Pulmotor (1911), Spiropulsator
(1934), the Bennett TV-2P (1948) & Bird Mark
7 (1958) were positive-pressure ventilators
Bennett MA-1, Ohio 560, & Engstrom 300
were introduced in 1960s as volume-cycled
ventilators.
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
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Development of the Respiratory Care
Profession
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
23
Development of the Respiratory Care
Profession
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
24
Mechanical Ventilation (cont.)
More advanced volume ventilators became available
in 1970s: Servo 900, Bourns Bear I & II, & MA II
First microprocessor-controlled ventilators developed
in 1980s (Bennett 7200)
Ventilators with capability of applying advanced
modes of ventilation became available in 21st century
Due to use of endotracheal tube, mechanical
ventilation increases risk for ventilator-associated
pneumonia (VAP)
Non-invasive ventilation, when applicable, can
prevent this risk.
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
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All of the following are true about ventilator
associated pneumonia (VAP), except:
A. it can occur in both mechanically ventilated &
spontaneously breathing patients
B. death is a potential risk of VAP
C. non-invasive ventilation may be used to avoid
VAP
D. there are very costly consequences when a
patient acquires VAP
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
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Airway Management
1980: William MacEwen successfully applied
first endotracheal tube to patient
1913: laryngoscope introduced
1941: First suction catheter described
1970s: Low-pressure cuffs for endotracheal
tubes introduced
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Cardiopulmonary Diagnostics
1800: Measurement of lung’s residual volume
first performed
1846: first water-sealed spirometer developed
by John Hutchinson
1967: rapid arterial blood gas analysis
becomes available
1980s: Polysomnography becomes routine
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
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Professional Organizations
Inhalation Therapy Association (ITA) founded
in 1947
ITA became American Association for
Inhalation Therapists (AAIT) founded in 1954
AAIT became American Association for
Respiratory Therapy (AART) founded 1973
AART became American Association for
Respiratory Care (AARC) founded in 1982
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
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Professional Organizations (cont.)
1980s: state licensure for RTs begins
State licensure based on RTs passing entry level
exam offered by National Board for Respiratory Care
(NBRC)
NBRC offers certification & registry examination for
RTs
State licensing laws set minimum educational
requirements & determine competence to practice
State licensing boards also set required amount of
continuing education credits (CEU’s) required to keep
license to practice
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Professional Organizations (cont.)
AARC advocates for profession to legislative &
regulatory bodies, insurance industry & public
AARC sponsors continuing professional educational
activities, including conferences to gain CEU’s - go to
www.AARC.org
AARC publishes monthly science journal
RESPIRATORY CARE & news magazine: AARC
Times
AARC members may join any of 10 Specialty
Sections
2002: AARC, NBRC, & CoARC formally express
support for all RT’s to seek & obtain RRT credential
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In what year did it become a requirement for
Respiratory Therapists to be licensed by the state
in which they practice?
A. 2000
B. 1990
C. 1980
D. 1970
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Respiratory Care Education
1950: First formal RT program was offered in
Chicago
1960s: Programs multiply - many hospital based
Currently: Associates (AS) Degree in Respiratory
Care (RC) is minimum educational requirement
AS Degree’s represent majority of all educational
programs
More than 350 RT education programs exist in
U.S.
2003: AARC formally encourages development
of baccalaureate & graduate education in RC
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
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Which of the following sets the minimum
educational requirements & the method of
determining competence to practice Respiratory
Care?
A. AARC
B. BOMA
C. State licensing laws
D. NBRC
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
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Respiratory Care Education
Due to aging population(baby boomers):
As baby boomers age:
Increased demand for RC services & RT’s
More will have asthma, COPD, & other
cardiopulmonary diseases
As treatments & technology continue to
advance:
RT’s will require more educational preparation
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
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Respiratory Care Education
RT’s of future will focus more on:
Prevention
Protocol administration
Care plan development
Disease management & rehabilitation
Family & patient education
Tobacco cessation counseling
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Future of Respiratory Care
“2015 & Beyond”—Special task force created
by AARC
Formed in 2007 as AARC recognized impending
overhaul of U.S. healthcare system
Task—to envision potential roles & responsibilities
of RT by 2015 & beyond
3 strategic conferences held: 2008, 2009, 2010
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Future of Respiratory Care (cont.)
Aim: to answer 5 questions about future of
profession:
How patients will receive health care services
2. How respiratory care services will be provided
3. Knowledge, skills, attributes needed by RT’s
4. Educational & credentialing systems necessary
5. How to transition with little impact on practicing
RT’s
1.
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Future of Respiratory Care (cont.)
Task force concludes: RT’s need to be
competent in 7 major areas by 2015:
1.
2.
3.
4.
5.
6.
7.
Diagnostics
Chronic disease state management
Evidence-based medicine & Respiratory Care
protocols
Patient Assessment
Leadership
Emergency & Critical Care
Therapeutics
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
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