Introduction to respiratory therapy for RT students

For Respiratory Therapy Students

1. Introduction To Respiratory Therapy Instructor: Behramand Shah, MPH, RCP, CRT, 1

2. RESPIRATORY THERAPY DEPARTMENT LRH-MTI, PESHAWAR 2

3. Introduction to Respiratory Therapy Scope of Respiratory therapy RT Job Descriptions History of R espiratory care Respiratory care organizations Respiratory care in Pakistan RT Future Plan Objectives 3

4. Egan's Fundamentals of Respiratory Care - 14th edition Respiratory Care: Principles and Practice, by Dean R. Hess Suggested But N ot R equired 4

5. Respiratory therapist also known as respiratory care practitioners, evaluate, treat and care for patients with breathing and other cardiopulmonary disorders. Practicing under the direction of physician, respiratory therapists assume primary responsibility for all respiratory care therapeutic treatments and diagnostic procedures, including the supervision of respiratory therapy technicians. They consult with physician and other health care staff to help develop and modify patient care plans. Therapists also provide complex therapy requiring considerable independent judgment, such as caring for patients on life support in intensive care units of hospital. WHO IS RT / RCP ? 5

6. WHO IS RT / RCP ? 6

7. WHO IS RT / RCP ? 7

8. WHO IS RT / RCP ? 8

9. WHO IS RT / RCP ? 9

10. WHO IS RT / RCP ? 10

11. WHO IS RT / RCP ? 11

12. WHO IS RT / RCP ? 12

13. WHO IS RT / RCP ? 13

14. Respiratory Therapist Works in: Medical ICU Surgical ICU Cardiac ICU Neurosurgical ICU Peads ICU Neonatal ICU HDU Emergency Pulmonology ward Resus PFTs Lab Sleep Lab RRT and Code Blue Rehabilitation Centers Consultant Clinics Home Respiratory Care Air Ambulance Educational institutes and Universities Many More ( SCOPE OF RTs) Where We Do As RT 14

15. We work with adults, children, neonates to help them breath utilizing such things as: Patient assessment, Interviewing Aerosol and Medical Gas Therapy Mechanical ventilation(Invasive & Noninvasive) Airway management ABGs Lung Expansion Therapy (Hyperinflation devices) Chest physiotherapy/bronchial hygiene (Suction ) Tracheostomy Care Home Respiratory Care Transport of Critically ill patient Diagnostic procedures such as bronchoscopy, pulmonary function testing Sleep Study (Polysomnography) Disease management education, Rehab and home care CPR (Code Blue Member) RT JOB DESCRIPTION What We Do As RT 15

16. Work as part of a team of physicians, nurses and other health care professionals to manage patient care. Enforce safety rules and ensure careful adherence to physicians' orders. Apply scientific principles for the identification, prevention, treatment and rehabilitation of acute and chronic cardiopulmonary disorders. Set up and operate devices such as mechanical ventilators, therapeutic gas administration apparatus, environmental control systems, and aerosol generators, following specified parameters of treatment. Provide emergency care, including artificial respiration, external cardiac massage and assistance with cardiopulmonary resuscitation. Determine requirements for treatment, such as type, method and duration of therapy, precautions to be taken, and medication and dosages, compatible with physicians' orders. Monitor patient's physiological responses to therapy, such as vital signs, arterial blood gases, and blood chemistry changes, and consult with physician if adverse reactions occur. AFTER PGDRT YOU WILL BE ABLE TO: 16

17. Read prescription, measure arterial blood gases, and review patient information to assess patient condition. Inspect , clean, test and maintain respiratory therapy equipment to ensure equipment is functioning safely and efficiently, ordering repairs when necessary . Educate patients and their families about their conditions and teach appropriate disease management techniques, such as breathing exercises and the use of medications and respiratory equipment. Administer medical gases, humidification and aerosol medications, postural drainage, Broncho pulmonary hygiene, cardiopulmonary resuscitation, monitor mechanically ventilated patients, maintain artificial airways and perform pulmonary function testing. Practice infection control procedures and personal hygiene consistent with professionals in close contact with patients. AFTER PGDRT YOU WILL BE ABLE TO: 17

18. Perform diagnostic procedures, interpret results, determine pathophysiological state, and perform continuous quality improvement. Assist the physician and surgeons with special procedures. Apply Respiratory Care Protocols appropriately in the clinical settings. Conduct research relevant to the field of respiratory therapy. Endotracheal and Nasotracheal suction according to AARC guidelines. Chest Tube and Tracheostomy Care. Demonstrate respiratory care procedures to trainees and other health care personnel. Apply Noninvasive ventilation such as BIPAP and CPAP etc. Perform Sleep study. Perform PFTs AFTER PGDRT YOU WILL BE ABLE TO: 18

19. Demonstrate advance competence in critical care setting. The respiratory therapist must be able to think critically, communicate effectively, demonstrate judgment and provide self‑direction. Demonstrate knowledge of the physiological bases for all therapeutic interventions and diagnostic procedures in all areas of respiratory therapy practice. Practice as an Advanced Critical Care Practitioner. Demonstrate advanced knowledge in one of three specialization areas in respiratory therapy: (1) professional education; (2) hospital department administrative leadership; or (3) a clinical specialty practice area. AFTER PGDRT YOU WILL BE ABLE TO: 19

20. The U.S. Bureau of Labor Statistics estimates that employment opportunities for respiratory therapists will grow 19 percent through 2022. Govt and Private Hospitals, Clinics and physicians’ offices Critical care units Transportation of critically ill patients (Air ambulance) Diagnostic Laboratories Sleep Centers Pulmonary function test labs Awareness projects TB, COPD, Asthma etc. Centers Home care and extended-care facilities Colleges, Universities and Research facilities Respiratory therapist career options 20

21. Respiratory Therapy Assistant / Associate /Professor Manager Respiratory Therapy Chief Respiratory Therapist Respiratory Therapist Manager ICU Pulmonary Function Technologist Sleep Study technologist (Polysomnography Technologist) Lecturer in Respiratory Therapy Project Manager in (Tb, COPD, Asthma, Pneumonia) Manager Pulmonary L ab Sleep study educator Manager/ In charge sleep study center Research or project manager Respiratory therapist job types 21

22. We listen to Patient's 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 Patient assessment 22

23. Oxygen Therapy 23

24. 24 Hyperbaric chamber

25. Medications such as Albuterol and Others are used to open constricted lungs caused by Asthma and COPD These drugs are administered through either a nebulizer or as MDI or DPI Bronchodilator medications 25

26. Handheld Nebulizer Devices 26

27. We intubate or assist in intubation of patients, and place and manage them on ventilators. Mechanical Ventilation 27

28. 28

29. Besides managing endotracheal intubation, we also manage tracheostomy Airway Management 29

30. We give patients devices that increase their lung volume to prevent their lungs from collapsing, and help with mucus Hyperinflation 30

31. Chest Physiotherapy/Bronchial hygiene 31

32. Bronchoscopy 32

33. Pulmonary Function Testing 33

34. We teach breathing techniques such as pursed lip breathing, diaphragmatic breathing We teach smoking cessation, CPR, COPD, asthma and other lung disease management techniques to our patients Pulmonary Rehab/education 34

35. CPR (CODE BLUE) 35

36. 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). The History Of Respiratory Care 36

37. 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 The History Of Respiratory Care 37

38. 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. The History Of Respiratory Care 38

39. 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. The History Of Respiratory Care 39

40. 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. The History Of Respiratory Care 40

41. 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. The History Of Respiratory Care 41

42. 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. The History Of Respiratory Care 42

43. 43 Development of the Respiratory Care Profession 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 O 2 cylinders and apply O 2 delivery devices. In the 1950s, positive-pressure breathing devices were applied to patients. Formal education programs for inhalation therapists began in the 1960s.

44. 44 Development of the Respiratory Care Profession (cont.) 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.

45. 45 Development of the Respiratory Care Profession (cont.) Oxygen Therapy Large-scale production of O 2 was developed in 1907 by Karl von Linde. Oxygen tents were first used in 1910, and O 2 masks, in 1918. O 2 therapy was widely prescribed in the 1940s.

46. 46 Development of the Respiratory Care Profession (cont.) The Clark electrode was first developed in the 1960s and allow measurement of arterial P O 2 . The ear oximeter was invented in 1974, and pulse oximeter, in the 1980s. The Venturi mask to deliver a specific F IO 2 was introduced in 1960. Portable liquid O 2 systems were introduced in the1970s.

47. 47 Development of the Respiratory Care Profession (cont.) 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.

48. 48 Development of the Respiratory Care Profession (cont.) 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.

49. 49 Mechanical Ventilation Originally, positive pressure ventilation was used during anesthesia. The Drager Pulmotor (1911), the Spiro pulsator (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.

50. 50 Mechanical Ventilation (cont.) 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.

51. 51 Airway Management 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.

52. 52 Cardiopulmonary Diagnostics 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.

53. 53 Professional Organizations 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/

54. AARC 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

55. 55 Professional Organizations (cont.) 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/

56. CSRC State Professional Organization Sponsors Educational Activities Including Annual State Meeting Provides Courses on Ethics for License Renewal www.csrc.org

57. RCB 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

58. RCB 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

59. Maintain respiratory therapy program standardization and quality Every program graduating RT students is regulated by COARC COARC 59

60. AARC: national organization, sets national standards for the profession, primary advocacy 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 Summary of RT organizations 60

61. Scope of Practice List of The Functions Performed by Respiratory Therapists Recognized by The AARC CLINICAL PRACTICE GUIDELINES Listed by The RCB

62. 62 Respiratory Care Education 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.

63. 63 Respiratory care in pakistan

64. 64 Pakistan was born in 1947 when British rule ended. In 1971 Pakistan’s eastern wing emerged as an independent country, Bangladesh, following a brief civil war. From 1947 to 1988, Pakistan had three military takeovers. Since 1988, the country has experienced a series of interim and elected governments that ended with the last military takeover in 1999. These historical facts help explain the persistent political instability that has adversely affected all sectors in Pakistan, including the health sector.

65. 65 The Shaukat Khanum Memorial Cancer Hospital and Research Center (SKMCH&RC) opened on December 29, 1994. It was founded by the famous Pakistani cricket player (now the Prime minister of Pakistan, Imran Khan, in honor of its namesake, his mother, who died of cancer. The hospital has up-to-date facilities for training and research. It was designed by an international team of experts in both medicine and architecture. The facility was planned as a center of excellence equipped and operated to the highest international standards.

66. 66 The hospital is a project of Shaukat Khanum Memorial Trust, a nonprofit legal entity. The hospital’s Board of Governors consists of bankers, researchers, businesspeople, and physicians who formulate policy ensuring that access is provided to the maximum number of poor patients. The hospital is currently involved in several research projects, mainly involving cancer drug research, patient treatment outcomes, and epidemiology studies. SKMCH&RC is affiliated with some of the world’s most prestigious cancer hospitals, which assist in training personnel and providing collaboration on the latest innovations in cancer treatment and research.

67. 67 Until the year 2003, SKMCH&RC was the only hospital in the country with formal qualified Respiratory Therapists (RT’s). All the major hospitals in the country, in both the government and the private sectors, have ICUs and offer all kinds of services, but they do not have formal respiratory therapists. The result is that more respiratory complications occur while providing the required aids to the patients. In many hospitals, they are unable to manage postoperative respiratory complication after surgery simply because the staff is not aware of the therapies and the instruments used to treat it.

68. 68 Many intensivists complain about delayed weaning of patients from mechanical ventilation due to a lack of RTs. Others complain about management of patients with sleep disorders, respiratory diagnostics and The main problem is their inability to ensure proper assessment of patients, delivery of therapy, and monitoring of responses to treatment—and thus shortened hospital stays. Staff responsible for carrying the job of respiratory care differs in various settings .

69. 69 The first two foreign respiratory therapists were recruited by SKMCH in 1994, with the idea to train local respiratory therapist in future. The first three local RTs were recruited by SKMCH&RC in 1996 as an on-the-job trainee respiratory therapist. It was the idea of Professor Nausherwan Burki, MD, PhD, professor of medicine at the University of Kentucky, Lexington, Dr. Mansur Javed, MD, FCCP, the then director ICU, to have RTs at SKMCH&RC.

70. 70 The local RT’s received internal training for 2 years. This was a tough time, having no model to guide, and no recognized institution around to offer degree. The interesting job description and the dedication of the hospital administration and RT’ to this profession was encouraging to continue studies.

71. 71 In 1999, the three local RTs got enrolled into a distance- learning Associate of Science degree program in advanced respiratory therapy at the California College for Health Sciences (CCHS), National City, California USA. It was once again an uphill task to complete the study requirements in a single cancer hospital. Topics for my research papers—such as ECMO and the intra-aortic balloon pump—were interesting, but it was extremely hard to find centers offering these and recent studies on them in our library. During this period, the RT’s visited various other hospitals to observe patient care and complete study requirements. The first local RT graduated successfully in May 2003 and became the first RT in the country holding a recognized degree.

72. 72 Today there are over 20 institutions in the country that offers degree level programs in Respiratory care. There are four Pakistani RT’s who hold the National Board for Respiratory Care (NBRC) RRT credential and a few RT’s who hold the NBRC RPFT credentials. The First Allied Health School was establish in 2000. There exist dozens of hospitals, both in public and private sectors with established respiratory care services across Pakistan .

73. 73 The future projects include establishment of an Association of respiratory and sleep professionals in Pakistan and a licensing body under the umbrella of the ministry of health. All the work is in final process.

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