History of Respiratory Care
http://www.youtube.com/watch?v=sh5BKkAo0Xg
1
Introduction to the class and respiratory therapy
History of respiratory care Respiratory care organizations Hospital organization Homework
Objectives
2
Review Syllabus
Introduction to the class
3
4
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
What we do as RT’s
5
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
Patient assessment
6
Oxygen Therapy
7
8
Hyperbaric chamber
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
Bronchodilator medications
9
Hand held nebulizer devices
10
We intubate or assist in intubation of patients, and place and manage them on ventilators.
Mechanical ventilation
11
12
Besides managing endotracheal intubation we also manage trachestomys
Airway management
13
We give patients devices that increase their lung volume to prevent their lungs from collapsing, and also help with mucus
Hyperinflation
14
Chest physiotherapy/bronchial hygeine
15
http://www.youtube.com/watch?v=_Y_sBYr-VE8&feature=related
Bronchoscopy
16
Pulmonary Function Testing
17
18
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
Pulmonary Rehab/education
19
Early Biblical description- “And he put his mouth upon his mouth..... And the flesh of the child became warm”
Second Kings 4:34
The History Of Respiratory Care
20
21
History of Respiratory Medicine and Science
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.
22
History of Respiratory Medicine and Science (cont.)
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
23
History of Respiratory Medicine and Science (cont.)
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.
24
History of Respiratory Medicine and Science (cont.)
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.
25
Sketch of human lungs by Da Vinci
26
History of Respiratory Medicine and Science (cont.)
Enlightenment Period• 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.
27
History of Respiratory Medicine and Science (cont.)
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.
28
History of Respiratory Medicine and Science (cont.)
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
29
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 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.
30
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.
31
Development of the Respiratory Care Profession (cont.)
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.
32
Development of the Respiratory Care Profession (cont.)
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.
33
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.
34
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.
35
Mechanical Ventilation
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.
36
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.
37
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.
http://www.youtube.com/watch?v=N3rTV2GdCWE
38
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.
39
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/
40
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/
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
CSRC
State Professional Organization
Sponsors Educational Activities Including
Annual State Meeting
Provides Courses on Ethics for License
Renewal
www.csrc.org
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
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
Scope of Practice
List of The Functions Performed by
Respiratory Therapists
◦ Recognized by The AARC
◦ CLINICAL PRACTICE GUIDELINES
◦ Listed by The RCB
Scope of Practice
Must Operate Within The Scope of Practice;
Performing Functions Outside The Scope of
Practice May Result in Malpractice Lawsuits
And Loss of Licensure
47
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.
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
Summary of RT organizations
48
Future of Respiratory Care
Expanded Scope of Practice (e.g.,
Polysomnography)
Greater Use of Therapist Driven Protocols
Increased Role as Pulmonary Physician
Extender (Physician Assistant)
Hospital Structure
Chief Executive Officer (CEO) –
Administrator
Medical Director of Hospital
Medical Staff
Hospital Departments
Hospital Departments
Administration (CEO, directors…)
Admissions (admit patients)
Support Staff (includes healthcare
providers)
Support Staff
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)
Support Staff
Medical Records (keep track of all patient
records)
Medical Billing
Quality Assurance/Utilization Review
Education (typically nursing)
Support Staff
Social Services (helps with financial
issues and family issues, grieving)
Discharge Planning
Clinical Departments
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
Clinical Departments
Occupational Therapy
Speech Therapy
Pharmacy
Respiratory Therapy
Respiratory Therapy Department Structure
Department Manager
Receptionist/Administrative Assistant
Equipment Specialist
Clinical Educator
Respiratory Therapy Department Structure
Supervisor/Lead Therapist
Staff Therapists
Oxygen Technicians
Functions of the Respiratory Therapy Department
Administration of Therapy
◦Physician’s Orders
◦Protocols
Functions of the Respiratory Therapy Department
Administration of Therapy
◦ Triage of Work Load
Cardiac Arrest
Emergency Department
Mechanical Ventilation
Routine Therapy
Diagnostic Testing
Functions of the Respiratory Therapy Department
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
What to Know about RT Departments
62
Respiratory care
Respiratory therapist
Scope of practice
Clinical protocol
Definitions to Remember
63
Professional organizations◦ AARC◦ CSRC
Educational organizations◦ NBRC◦ CoARC
Licensing organization◦ RCB
Know functions of each organization
Organizations to Know
64