http://www.youtube.com/watch?v=sh5BKkAo0Xg
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Introduction to the class and respiratory
therapy
History of respiratory care
Respiratory care organizations
Hospital organization
Homework
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Review Syllabus
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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
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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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http://www.youtube.com/watch
?v=_Y_sBYrVE8&feature=related
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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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Early Biblical description“And he put his mouth upon his mouth.....
And the flesh of the child became warm”
Second Kings 4:34
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Ancient Times
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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
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Aristotle (342322 BC)first great biologist
Erasistratus (330240 BC)developed a pneumatic
theory of respiration in Egypt
Galen (130199 AD)anatomist who believed the air
had a substance vital to life
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Ancient Times (cont.)
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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
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The fall of the Roman empire in 476 AD resulted in a
period of slow scientific progress.
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An intellectual rebirth in Europe began in the 12th
century.
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Leonardo da Vinci (14531519) determined that
subatmospheric pressures inflated the lungs.
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Andreas Vesalius (15141564) performed human
dissections and experimented with resuscitation.
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Sketch of
human lungs
by Da Vinci
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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
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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.)
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In 1865, Louis Pasteur advanced his “germ theory” of
disease and suggested that some diseases were the
result of microorganisms.
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In 1846, the spirometer and ether anesthesia were
invented.
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In 1896, William Roentgen discovered the x-ray, which
opened the door for the modern field of radiology.
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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
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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
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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
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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.
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In 1913, the laryngoscope was introduced.
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The first suction catheter was described in 1941.
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Low-pressure cuffs for endotracheal tubes were introduced in
the 1970s.
http://www.youtube.com/watch?
v=N3rTV2GdCWE
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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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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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◦ 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
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State Professional Organization
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Sponsors Educational Activities Including
Annual State Meeting
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Provides Courses on Ethics for License
Renewal
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www.csrc.org
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Licensure Agency For State of California
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Currently Uses Results of CRT Exam as Basis
for Licensure
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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
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Requires Fifteen Hours of Continuing
Education Every Two Years For License
Renewal
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List of The Functions Performed by
Respiratory Therapists
◦ Recognized by The AARC
◦ CLINICAL PRACTICE GUIDELINES
◦ Listed by The RCB
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Must Operate Within The Scope of Practice;
Performing Functions Outside The Scope of
Practice May Result in Malpractice Lawsuits
And Loss of Licensure
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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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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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Expanded Scope of Practice (e.g.,
Polysomnography)
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Greater Use of Therapist Driven Protocols
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Increased Role as Pulmonary Physician
Extender (Physician Assistant)
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Chief Executive Officer (CEO) – Administrator
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Medical Director of Hospital
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Medical Staff
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Hospital Departments
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Administration (CEO, directors…)
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Admissions (admit patients)
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Support Staff (includes healthcare
providers)
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Dietary (licensed practitioners, some patients
are on strict diets)
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Housekeeping (very important role in
preventing disease transmission)
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Purchasing (buys supplies for the hospital)
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Maintenance (fixes non medical equipment in
hospital)
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Medical Records (keep track of all patient
records)
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Medical Billing
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Quality Assurance/Utilization Review
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Education (typically nursing)
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Social Services (helps with financial issues
and family issues, grieving)
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Discharge Planning
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Clinical Departments
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Nursing (largest in all hospitals)
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Imaging (includes x-ray, CT, MRI, cath
labs, nuclear med, ultra sound…)
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Laboratory (perform blood, urine, sputum
analysis for diagnosis)
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Physical Therapy
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Occupational Therapy
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Speech Therapy
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Pharmacy
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Respiratory Therapy
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Department Manager
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Receptionist/Administrative Assistant
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Equipment Specialist
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Clinical Educator
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Supervisor/Lead Therapist
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Staff Therapists
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Oxygen Technicians
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Administration of Therapy
◦ Physician’s Orders
◦ Protocols
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Administration of Therapy
◦ Triage of Work Load
 Cardiac Arrest
 Emergency Department
 Mechanical Ventilation
 Routine Therapy
 Diagnostic Testing
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Documentation
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Patient Assessment/Consultation
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Quality Assurance
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Patient education
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Cost Containment
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Requirements of an order
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How to deal with problem orders
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Triage of assignments
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Functions of the department
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Overall perspective of future trends
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Respiratory care
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Respiratory therapist
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Scope of practice
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Clinical protocol
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Professional organizations
◦ AARC
◦ CSRC
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Educational organizations
◦ NBRC
◦ CoARC
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Licensing organization
◦ RCB
Know functions of each organization
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