MIAMI DADE COLLEGE MEDICAL CAMPUS SCHOOL OF HEALTH SCIENCES RESPIRATORY CARE PROGRAM RET 2284L – PRINCIPLES OF MECHANICAL VENTILATION LABORATORY COURSE DESCRIPTION: Laboratory for RET 2284. This course is designed to provide training in the skills and practical application associated with critical care procedures and mechanical ventilation utilized in respiratory care. Instructor: Office: Phone: Class Day/Time: Office Hours: E-Mail: REQUIRED TEXTBOOKS/SUPPLIES: 1. Cairo, J.M. (2016). Pilbeam’s Mechanical Ventilation: Physiological & Clinical Applications, 6th edition. Mosby. 2. Oakes, D., Shortall, S., Jone, S. (2016). Ventilator Management: A Bedside Reference Guide. Health Educator Publications, Inc. Be sure to purchase the MOST recent edition available for each text. All required texts are available in the Campus Bookstore. Students with documented disabilities should contact the campus ACCESS office in advance for information on appropriate policies and procedures for obtaining assistance. No retroactive accommodations can be provided. The ACCESS office is located in room # 1345-1 at 305 2374048. Additional information can be obtained at http://www.mdc.edu/medical/studentservices/access Any changes to this syllabus, the class schedule, testing, assignments, etc., will be communicated via e-mail - it is each student’s responsibility to monitor these regularly. Revised April 2016 RET 2284L – PRINCIPLES OF MECHANICAL VENTILATION LABORATORY Miami Dade College Learning Outcomes Miami Dade College has adopted the General Education Outcomes listed below. Upon completion of a program of study at the Medical Center Campus, graduates from Miami Dade College should emulate these outcomes. 1. Communicate effectively using listening, speaking, reading and writing skills. 2. Use quantitative analytical skills to evaluate and process numerical data. 3. Solve problems using critical and creative thinking and scientific reasoning. 4. Formulate strategies to locate, evaluate, and apply information. 5. Demonstrate knowledge of diverse cultures, including global and historical perspectives. 6. Create strategies that can be used to fulfill personal, civic, and social responsibilities. 7. Demonstrate knowledge of ethical thinking and its application to issues in society. 8. Use computer and emerging technologies effectively. 9. Demonstrate an appreciation for aesthetics and creative activities. 10. Describe how natural systems function and recognize the impact of humans on the environment. This course provides intentional learning experiences to address outcomes (I, 2, 3, 4, 6 and 8). 2 RET 2284L – PRINCIPLES OF MECHANICAL VENTILATION LABORATORY SPECIFIC COURSE OBJECTIVES: 1. The course work will be divided into modules, with specific objectives for each module. 2. You will be responsible for completing all module assignments, lab activities, competencies, and practicum exams in order to satisfy all course objectives. 3. Practica and/or exams will be given following the completion of each module, and any time the instructor deems appropriate. 4. It is the student’s responsibility to be present for all scheduled laboratories and practica/exams. Each laboratory absence will result in a 3.5% deduction from the final course grade, and a 1.75% deduction for each tardy. Students who are absent from laboratories, but provide suitable justification with accompanying documentation (physician’s note, court appearance document, etc.) will not lose grade percentage points. All laboratories must be made up by the next available laboratory. Missed makeup laboratories will be considered an absence and will result in a deduction of 3.5% from the final course grade. 5. Should a student fail or miss a practicum, one opportunity to retake the practicum at the end of the semester will be provided; however, the maximum attainable grade on a retake will be 80%. There will be no provision given to retake a second failed or missed practicum. 6. The final grade will be computed based on the following: I. Practica/Exams 100% GRADING SCALE A = 100 - 94 B = 93 - 87 C = 86 - 80 -----------------------D = 79 - 73 F = 72 - below 3 RET 2284L – PRINCIPLES OF MECHANICAL VENTILATION LABORATORY TABLE OF CONTENTS - MODULE MODULE 1.0 – NON-INVASIVE POSITIVE PRESSURE VENTILATION (NPPV) MODULE 2.0 – INITIATING MECHANICAL VENTILATION MODULE 3.0 – MANAGEMENT OF MECHANICAL VENTILATION MODULE 4.0 – VENTILATIOR DISCONTINUATION 4 RET 2284L – PRINCIPLES OF MECHANICAL VENTILATION LABORATORY MODULE 1.0 – NONINVASIVE POSITIVE PRESSURE VENTILATION (NPPV) General Objective: Upon completion of this module, the student will demonstrate procedures for initiating noninvasive positive pressure ventilation. Specific Objectives: 1.1 Gather and assemble the equipment needed to initiate NPPV (ventilator, circuit, humidification device, and patient adjunct) 1.2 Perform an Operation Verification Procedure (OVP) to verify the functionality of the ventilator and the integrity of the breathing circuit (commonly referred to as “system leak test.” 1.3 Identify and manipulate all controls and alarms on the ventilator 1.4 Apply the appropriate initial settings and alarms, e.g., IPAP, EPAP, FiO 2, backup rate, high/low pressure alarms, etc. 1.5 Select and fit the patient with the appropriate type/size interface (nasal or fullface mask) 1.6 Initiate NPPV and evaluate the effectiveness of ventilation via ventilator/patient synchrony, VT, system leak, vital signs, breath sounds, SpO2, and arterial blood gases (ABG) 1.7 Troubleshoot system malfunctions, e.g., circuit leak, poorly fitted patient interface, etc. 1.8 Adjust settings to correct oxygenation/ventilation abnormalities 1.9 Record relevant data in the medical record and communicate pertinent information regarding the patient’s clinical status to the appropriate members of the health care team 5 RET 2284L – PRINCIPLES OF MECHANICAL VENTILATION LABORATORY MODULE 2.0 – INITIATING MECHANICAL VENTILATION General Objective: Upon completion of this module, the student will demonstrate procedures for initiating mechanical ventilation. Specific Objectives: 2.1 Identify the controls, alarms, and monitors on various brands and types of mechanical ventilators 2.2 Gather and assemble the equipment needed to initiate mechanical ventilation (ventilator, circuit, humidification device, etc.) 2.3 Perform an Operation Verification Procedure (OVP) to verify the functionality of the ventilator and the integrity of the breathing circuit (commonly referred to as “system leak test”) 2.4 Using “ideal body weight” and patient diagnosis, be able to calculate and implement initial ventilator settings in various ventilator modes 2.5 Initiate mechanical ventilation and evaluate its effectiveness 2.6 Appropriately set monitoring alarms 2.7 Adjust ventilator settings to correct oxygenation/ventilation abnormalities 2.8 Troubleshoot system malfunctions 2.9 Record relevant data in the medical record and communicate pertinent information regarding the patient’s clinical status to the appropriate members of the health care team 6 RET 2284L – PRINCIPLES OF MECHANICAL VENTILATION LABORATORY MODULE 3.0 – MANAGEMENT OF MECHANICAL VENTILATION General Objective: Upon completion of this module, the student will demonstrate the ability to perform a patient – ventilator systems check Specific Objectives: 3.1 Be able to identify and discuss data in the patient’s medical record that would be clinically pertinent to the care of the patient on mechanical ventilation 3.2 Be able to perform an appropriate physical assessment: a. Sensorium b. Vital signs, EKG, SpO2, ETCO2, breath sounds c. Determine need for tracheal suctioning and perform if necessary d. Physical examination of the thorax and extremities e. Evaluation of urine input/output 3.3 Be able to assess and adjust cuff pressure/volume 3.4 Be able to perform humidifier maintenance 3.5 Be able to evaluate and record mechanical and spontaneous respiratory rates, volumes and pressures 3.6 Be able to analyze and interpret waveforms 3.7 Be able to calculate and evaluate dynamic compliance (CD), static compliance (CS), and airway resistance (Raw) 3.8 Be able to detect and measure auto-PEEP and recommend and / or implement strategies to correct 3.9 Be able to administer bronchodilators to a mechanically ventilated patient via SVN or MDI 3.10 Be able to change ventilator circuit for a mechanically ventilated patient 3.11 Record relevant data in the medical record and communicate pertinent information regarding the patient’s clinical status to the appropriate members of the health care team 7 RET 2284L – PRINCIPLES OF MECHANICAL VENTILATION LABORATORY MODULE 4.0 – VENTILATIOR DISCONTINUATION General Objective: Upon completion of this module, the student will demonstrate an understanding of the procedures and techniques related to the discontinuation of a mechanical ventilator Specific Objectives: 4.1 Be able to discuss data identified in the patient’s chart that would be clinically pertinent to considering ventilator discontinuation 4.2 Be able to gather and assemble the equipment needed to measure spontaneous breathing parameters (minute ventilation, respiratory rate, V T, maximum inspiratory pressure [MIP]) 4.3 Be able to measure spontaneous breathing parameters on a mechanically ventilated patient and calculate a rapid, shallow, breathing index (RSBI) 4.4 Be able to discuss the patient’s potential for successful ventilator discontinuation based on spontaneous breathing parameters, RSBI, and other clinical and laboratory findings, e.g., chest radiograph, complete blood count (CBC), electrolytes, etc. 4.5 Be able to discuss and implement strategies to begin ventilator discontinuation, e.g., spontaneous breathing trial (SBT), SIMV, pressure support ventilation (PSV) 4.6 Be able to determine if ventilator discontinuation strategies are successful or not 4.7 Be able to discuss strategies to implement should ventilator discontinuation fail 4.8 Be able to gather the necessary equipment for extubation 4.9 Be able to perform extubation Should changes to the RET 2284L Course Outline be required, the instructor will communicate those to the students in writing via email. 8