Egan*s Fundamentals of Respiratory Care
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Transcript Egan*s Fundamentals of Respiratory Care
Instructor: Michael Haines, MPH, RRT-NPS, AE-C
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Introduction to the class and respiratory
therapy
History of respiratory care
Respiratory care organizations
Hospital organization
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This class is used as an introduction to the
profession
We will touch on a variety of subjects as an
introduction to the concepts. In depth
information will be given in future classes.
We will have a midterm, final exam along with
quizzes and HW. All of which will help you in
your understanding of the profession.
There is no textbook requirement for this
class…but suggested textbooks include:
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Egan's Fundamentals of Respiratory Care 10th edition
Respiratory Care: Principles and Practice, by
Dean R. Hess
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We work with adults, children, neonates to
help them breath utilizing such things as:
Patient assessment
Oxygen therapy
Bronchodilator medications
Hand held nebulizer devices
Mechanical ventilation
Airway management
Hyperinflation devices
Chest physiotherapy/bronchial hygeine
Diagnostic procedures such as bronchscopy, pulmonary
function testing
◦ Disease management education, rehab and home care
◦ CPR
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We listen to patients lungs, check vital signs,
oxygen levels using pulse oximetry
We draw and assess arterial blood
From this assessment we determine level of
respiratory distress or failure
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Hyperbaric chamber
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Medications such as Albuterol and Xopenex
are used to open constricted lungs caused by
Asthma and COPD
These drugs are administered through either
a nebulizer or as a MDI or DPI
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We intubate or assist in intubation of
patients, and place and manage them on
ventilators.
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Besides managing endotracheal intubation we
also manage trachestomys
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We give patients devices that increase their
lung volume to prevent their lungs from
collapsing, and also help with mucus
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We teach breathing techniques such as
pursed lip breathing, diaphramatic breathing
We teach smoking cessation, CPR, COPD,
asthma and other lung disease management
techniques to our patients
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1943: Edwin R. Levine, MD, establishes a primitive
inhalation therapy program using on-the-job
trained technicians to manage post-surgical
patients at Michael Reese Hospital in Chicago
July 13, 1946: Dr. Levine’s students and other
interested doctors, nurses, and oxygen orderlies
meet at the University of Chicago Hospital to form
the Inhalation Therapy Association (ITA).
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April 15, 1947: The ITA is formally chartered as a
not-for-profit entity in the state of Illinois. The new
Association boasts 59 members, 17 of whom are
from various religious orders.
1947: Albert Andrews, MD, outlines the structure
and purpose of a hospital-based inhalation therapy
department in his book, Manual of Oxygen Therapy
Techniques.
1950: The New York Academy of Medicine
publishes a report, “Standard of Effective
Administration of Inhalation Therapy,” setting the
stage for formal education for people in the field
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March 16, 1954: The ITA is renamed the American
Association of Inhalation Therapists (AAIT). In
February 1966, it was again renamed the American
Association for Inhalation Therapy (still, AAIT).
May 11, 1954: The New York State Society of
Anesthesiologists and the Medical Society of the
State of New York form a Special Joint Committee
in Inhalation Therapy to establish “the essentials of
acceptable schools of inhalation therapy.”
November 7-11, 1955: The AAIT holds its first
annual meeting (now the AARC International
Respiratory Congress) at the Hotel St. Clair in
Chicago.
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June 1956: The American Medical Association
(AMA) House of Delegates adopts a resolution
calling for the use of the New York Essentials in the
creation of schools of inhalation therapy.
1956: The AAIT begins publishing a science
journal, Inhalation Therapy (now RESPIRATORY
CARE).
October 1957: The AAIT, AMA, American College of
Chest Physicians, and American Society of
Anesthesiologists jointly adopt the Essentials for an
Approved School of Inhalation Therapy Technicians;
the Essentials begin a three year trial period.
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1960: The American Registry of Inhalation
Therapists (ARIT) is formed to oversee a new
examination leading to a formal credential for
people in the field.
November 18, 1960: The ARIT administers the first
Registry exams in Minneapolis.
December 1962: The AMA House of Delegates
grants formal approval for the “Essentials for an
Approved School of Inhalation Therapy
Technicians.”
October 8, 1963: The Board of Schools of
Inhalation Therapy Technicians is formed in
Chicago.
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1969: The AAIT launches the Technician Certification
Program to offer a credential to people working in the
field who do not qualify to take the Registry exams.
January 9, 1970: The Board of Schools of Inhalation
Therapy Technicians becomes the Joint Review
Committee for Respiratory Therapy Education (JRCRTE).
1973: The AAIT becomes the American Association for
Respiratory Therapy (AART).
1974: The profession’s two credentialing programs
merge into the National Board for Respiratory Therapy
(NBRT); the AAIT forms the American Respiratory
Therapy Foundation (ARTF) to support research,
education, and charitable activities in the profession.
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1982: California passes the first modern licensure law
governing the profession of respiratory care; President Ronald
Reagan proclaims the first National Respiratory Care Week.
1986: The AART becomes the American Association for
Respiratory Care (AARC); the ARTF becomes the American
Respiratory Care Foundation (ARCF); the NBRT becomes the
National Board for Respiratory Care (NBRC).
1990: The AARC begins developing Clinical Practice
Guidelines (CPGs) for treatments and modalities common in
the field; the ARCF launches an International Fellowship
Program to bring health care professionals from around the
world to the U.S. every year to tour health care facilities in two
cites and then attend the AARC International Respiratory
Congress.
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Ancient Times
Early cultures developed herbal remedies for many
diseases.
The foundation of modern medicine is attributed
to the “father of medicine,” Hippocrates, a Greek
physician who lived during the 5th and 4th
centuries BC.
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Ancient Times (cont.)
Other great scientists of this time period
Aristotle (342322 BC)first great biologist
Erasistratus (330240 BC)developed a pneumatic
theory of respiration in Egypt
Galen (130199 AD)anatomist who believed the air
had a substance vital to life
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Ancient Times (cont.)
Hippocratic medicine was based on four
essential fluids: phlegm, blood, yellow bile, and
black bile.
Hippocrates believed that the air contained an
essential substance that was distributed to the
body by the heart.
The Hippocratic oath, which calls for physicians
to follow certain ethical principles, is given to
most medical students at graduation.
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Middle Ages
The fall of the Roman empire in 476 AD resulted in a
period of slow scientific progress.
An intellectual rebirth in Europe began in the 12th
century.
Leonardo da Vinci (14531519) determined that
subatmospheric pressures inflated the lungs.
Andreas Vesalius (15141564) performed human
dissections and experimented with resuscitation.
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Enlightenment Period
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In 1754, Joseph Black described the properties of CO2.
In 1774, Joseph Priestley described his discovery of
oxygen, which he described as “dephlogisticated air.”
Lazzaro Spallazani described tissue respiration.
In 1787, Jacques Charles described the relationship
between gas temperature and volume, which became
“Charles law.”
In 1778, Thomas Beddoes began using oxygen to treat
various conditions at his Pneumatic Institute.
* Charles Law: Under a constant pressure, the
volume and temperature of a gas vary
directly.
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19th and Early 20th Century
John Dalton described his law of partial pressures in
1801.
In 1808, Joseph Louis Gay-Lussac described the
relationship between gas temperature and pressure.
In 1831, Thomas Graham described his law of diffusion
for gases (Graham’s law).
* Daltons law of partial pressure: The total pressure
of a mixture of gases is equal to the sum of the
pressures exerted by the individual gases.
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19th and Early 20th Century (cont.)
In 1865, Louis Pasteur advanced his “germ theory” of
disease and suggested that some diseases were the
result of microorganisms.
In 1846, the spirometer and ether anesthesia were
invented.
In 1896, William Roentgen discovered the x-ray, which
opened the door for the modern field of radiology.
Thomas Guedel (1934)
developed a technique for
ether anesthesia
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An oxygen mask was developed in 1938
by 3 physicians from the Mayo Clinic for
use by Army pilots flying at high altitude.
In the 1940s, technicians were used to
haul O2 cylinders and apply O2 delivery
devices.
In the 1950s, positive-pressure breathing
devices were applied to patients.
Formal education programs for inhalation
therapists began in the 1960s.
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The development of sophisticated mechanical ventilators in the
1960s expanded the role of the respiratory therapist (RT).
RTs were soon responsible for arterial blood gas and pulmonary
function laboratories.
In 1974, the designation “respiratory therapist” became standard.
In 1983 the state of California passed the first licensure bill for
Respiratory Care Practitioners (RCP’s). Minimum entry level was
set at completion of a one year technician level training program.
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Oxygen Therapy
Large-scale production of O2
was developed in 1907 by Karl
von Linde.
Oxygen tents were first used in
1910, and O2 masks, in 1918.
O2 therapy was widely
prescribed in the 1940s.
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The Clark electrode was first
developed in the 1960s and allow
measurement of arterial PO2.
The ear oximeter was invented in
1974, and pulse oximeter, in the
1980s.
The Venti mask to deliver a specific
FIO2 was introduced in 1960.
Portable liquid O2 systems were
introduced in the1970s.
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Aerosol Medications
In 1910, aerosolized epinephrine
was introduced as a treatment for
asthma.
Later, isoproterenol (1940) and
isoetharine (1951) were
introduced as bronchodilators.
Aerosolized steroids first used in
the 1970s to treat acute asthma.
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Mechanical Ventilation
The iron lung was introduced in 1928 by Philip Drinker.
Jack Emerson developed an improved version of the iron
lung that was used for polio victims in the 1940s and
1950s.
A negative-pressure “wrap” ventilator was introduced in the
1950s.
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Originally, positive-pressure
ventilation was used during
anesthesia.
The Drager Pulmotor (1911), the
Spiropulsator (1934), the Bennett
TV-2P (1948) and Bird Mark 7
(1958) were positive-pressure
ventilators.
The Bennett MA-1, Ohio 560,
and Engstrom 300 were
introduced in the 1960s as
volume-cycled ventilators.
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More advanced volume ventilators became available in the
1970s: Servo 900, Bourns Bear I and II, and MA II.
The first microprocessor-controlled ventilators were developed
in the 1980s (Bennett 7200).
Ventilators with the capability of applying advanced modes of
ventilation became available in the 21st century.
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William MacEwen in 1880 applied the first endotracheal tube
to a patient successfully.
In 1913, the laryngoscope was introduced.
The first suction catheter was described in 1941.
Low-pressure cuffs for endotracheal tubes were introduced in
the 1970s.
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Measurement of the lung’s residual volume was first done in
1800.
In 1846, the first water-sealed spirometer was developed by
John Hutchinson.
In 1967, rapid arterial blood gas analysis became available.
Polysomnography became routine
In the 1980s.
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The Inhalation Therapy Association was founded in 1947.
The ITA became the American Association for Inhalation
Therapists in 1954.
The AAIT became the American Association for Respiratory
Therapy in 1973.
The AART became the American Association for
Respiratory Care in 1982.
http://www.aarc.org/
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◦ Publishes Respiratory Care Journal Monthly
◦ Issues Clinical Practice Guidelines as Guide to
Patient Procedures
◦ Serves as Advocate For The Profession to Legislative
Bodies, Regulatory Agencies, Insurance Companies,
And The General Public
During the 1980s, state licensure for RTs started.
State licensure is based on RTs passing the entry level exam
offered by the National Board for Respiratory Care.
The NBRC offers a certification and registry examination for
RTs.
http://www.nbrc.org/
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State Professional Organization
Sponsors Educational Activities Including
Annual State Meeting
Provides Courses on Ethics for License
Renewal
www.csrc.org
Licensure Agency For State of California
Currently Uses Results of CRT Exam as Basis
for Licensure
May Deny License For Legal And/or Ethical
Infractions
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Reviews Instances of Malpractice, Abuse, or
Ethical Issues; May Revoke, Suspend, or
Place on Probation
Requires Fifteen Hours of Continuing
Education Every Two Years For License
Renewal
Maintain respiratory therapy program
standardization and quality
Every program graduating RT students is
regulated by COARC
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AARC: national organization, sets national standards for
the profession, primary adovacy group
CSRC: state society for Ca, each state has one, deals
with local advocacy issues
RCB of CA: each state also has a licensing board in the
state capital. They issue you your license to practice
respiratory.
NBRC: Credentialing body, must pass this national test
to become licensed. They are responsible for all
credentialing (CRT, RRT, NPS…)
COARC: agency responsible for maintaining RT
educational programs
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List of The Functions Performed by
Respiratory Therapists
◦ Recognized by The AARC
◦ CLINICAL PRACTICE GUIDELINES
◦ Listed by The RCB
Must Operate Within The Scope of Practice;
Performing Functions Outside The Scope of
Practice May Result in Malpractice Lawsuits
And Loss of Licensure
The first formal RT program was offered in Chicago in
1950.
RT schools grew in the 1960s; many programs were
hospital based.
Today, RT programs are offered mostly at colleges and
universities.
In 2006, about 350 formal RT education programs exist
in the United States.
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Expanded Scope of Practice (e.g.,
Polysomnography)
Greater Use of Therapist Driven Protocols
Increased Role as Pulmonary Physician
Extender (Physician Assistant)
Chief Executive Officer (CEO) – Administrator
Medical Director of Hospital
Medical Staff
Hospital Departments
Administration (CEO, directors…)
Admissions (admit patients)
Support Staff (includes healthcare
providers)
Dietary (licensed practitioners, some patients
are on strict diets)
Housekeeping (very important role in
preventing disease transmission)
Purchasing (buys supplies for the hospital)
Maintenance (fixes non medical equipment in
hospital)
Medical Records (keep track of all patient
records)
Medical Billing
Quality Assurance/Utilization Review
Education (typically nursing)
Social Services (helps with financial issues
and family issues, grieving)
Discharge Planning
Clinical Departments
Nursing (largest in all hospitals)
Imaging (includes x-ray, CT, MRI, cath
labs, nuclear med, ultra sound…)
Laboratory (perform blood, urine, sputum
analysis for diagnosis)
Physical Therapy
Occupational Therapy
Speech Therapy
Pharmacy
Respiratory Therapy
Department Manager
Receptionist/Administrative Assistant
Equipment Specialist
Clinical Educator
Supervisor/Lead Therapist
Staff Therapists
Oxygen Technicians
Administration of Therapy
◦ Physician’s Orders
◦ Protocols
Administration of Therapy
◦ Triage of Work Load
Cardiac Arrest
Emergency Department
Mechanical Ventilation
Routine Therapy
Diagnostic Testing
Documentation
Patient Assessment/Consultation
Quality Assurance
Patient education
Cost Containment
Requirements of an order
How to deal with problem orders
Triage of assignments
Functions of the department
Overall perspective of future trends
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