History of Respiratory Care

History of Respiratory Care

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Introduction to the class and respiratory therapy

History of respiratory care Respiratory care organizations Hospital organization Homework

Objectives

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Review Syllabus

Introduction to the class

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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

What we do as RT’s

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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

Patient assessment

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Oxygen Therapy

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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

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Hand held nebulizer devices

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

Mechanical ventilation

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Besides managing endotracheal intubation we also manage trachestomys

Airway management

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

Hyperinflation

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Chest physiotherapy/bronchial hygeine

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Bronchoscopy

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Pulmonary Function Testing

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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

Pulmonary Rehab/education

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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

The History Of Respiratory Care

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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.

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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

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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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Sketch of human lungs by Da Vinci

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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.

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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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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.

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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.

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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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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.

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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.

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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.

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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.

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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/

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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

http://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

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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

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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


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

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


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

What to Know about RT Departments

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Respiratory care

Respiratory therapist

Scope of practice

Clinical protocol

Definitions to Remember

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Professional organizations◦ AARC◦ CSRC

Educational organizations◦ NBRC◦ CoARC

Licensing organization◦ RCB

Know functions of each organization

Organizations to Know

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History of Respiratory Care

Documents

Transcript of History of Respiratory Care