Content Outline and Competencies:

I. Lung Structure and Function

A. Review terms and symbols pertinent to respiratory physiology.

B. Classify the fetal lung developmental stages of viability.

C. Attribute specific facts about the anatomy of the tracheobronchial tree to include:

1. Tracheal length

2. Tracheal structure

3. Tracheal bifurcation

D. Distinguish the anatomy and physiology of the alveolocapillary region including:

1. Pores of Kohn

2. Alveolar cells

3. Canals of Lambert

4. Sphingomyelin

5. Phospholipids

6. Alveolar cells

a. Type I

b. Type II

c. Macrophages

E. Relate the physiological humidification of inspired gas.

F. Describe internal and external gas exchanges.

G. Explain how the lung clears itself of foreign particles via the mucociliary apparatus.

H. Define metabolism and Basal Metabolic Rate.

I. Identify metabolic functions of the lung.

J. Articulate the respiratory quotient and its normal value.

II. Ventilation and Diffusion

A. Describe diffusion of gas across the alveolar-capillary membrane.

B. Identify factors affecting diffusion to include:

1. Time of exposure

2. Membrane integrity

3. Solubility of the gas

4. Temperature

5. Pressure gradients

C. Compare the rate of diffusion across the alveolocapillary membrane for carbon dioxide (CO2) and oxygen (O2.)

D. Describe the measurement of lung diffusion (DL).

E. Interpret lung diffusion measurements in lung disease.

F. Calculate the respiratory quotient (RQ).

G. Interpret normal values for O2 consumption (VO2) and CO2 production (VCO2).

H. Define internal and external respiration.

I. Determine normal lung volume and capacity factors.

J. Determine normal lung volumes and the relationship with lung capacities.

K. Explain the significance of functional residual capacity (FRC) and increased or decreased FRC.

L. Describe the changes in lung volumes and capacities with restrictive or obstructive lung disease.

M. Define anatomical and physiological deadspace.

N. Calculate minute ventilation, alveolar tidal volume and alveolar minute ventilation.

O. Compare normal and abnormal breathing patterns.

III. Lung Mechanics

A. Characterize the mechanics of normal inspiration and expiration of gas flow into and out of the thorax.

B. Classify the maximal inspiratory pressure created with negative inspiratory force (NIF) or maximal inspiratory pressure (MIP), and the MIP created with the Valsalva maneuver or maximal expiratory pressure (MEP).

C. Identify normal values of lung compliance (CL) and elastance.

D. Calculate lung compliance when changing pressures and volumes.

E. Identify normal values of airway resistance (Raw.)

F. Define time constants.

G. Describe the relationship of surfactant and surface tension to lung compliance.

H. Describe the changes in lung compliance for respiratory diseases.

I. Define Laplace’s law.

J. Discuss the following factors as they relate to airway pressure:

1. Transairway pressure

2. Transpulmonary pressure

3. Time constants

4. CL and Raw

K. Describe the significance of work of breathing in disease states.

L. Compare CL and Raw in adult and infant lungs.

M. Apply each of the following gas laws to ventilation and lung mechanics.

1. Graham’s law

2. Boyle’s law

3. Henry’s law

4. Dalton’s law

5. Avogadro’s law

6. Poiseuille’s law

7. Fick’s law

IV. Blood Flow

A. Trace blood flow through the heart.

B. Identify pressure at various points in the systemic and pulmonary circulation to include:

1. Right Atrium Pressure

2. Right Ventricle Pressure

3. Pulmonary Artery Pressure (PAP)

4. Pulmonary Artery Wedge Pressure (PAWP)

C. Define systolic, diastolic, and pulse pressures.

D. Identify the normal Central Venous Pressure (CVP).

E. Describe the balance of forces affecting fluid volumes within blood capillaries.

F. Describe causes of systemic and pulmonary edema.

G. Identify the effects of O2 and CO2 on pulmonary and systemic vasculature.

V. Hemodynamics

A. Describe values obtained with a pulmonary artery catheter and the clinical significance of increases or decreases in their values to:

1. CVP

2. PAP

3. PAWP

4. Cardiac Output (CO)

B. Review the pulmonary artery pressure tracing and wedging of a balloon in the pulmonary artery.

C. Identify methods for determining cardiac output.

D. Identify factors which influence cardiac output including:

1. Preload/afterload

2. Intrathoracic pressure

3. Inotropism

E. Describe the pressure differences between pulmonary vessels in the apex versus the base of the lung in an upright individual (zones 1-3).

F. Identify the relationship between alveolar pressure and pulmonary blood flow.

G. Explain how systemic and pulmonary blood flow can be changed by variations in mean intrathoracic pressure.

H. Identify the Fick Principle.

VI. Ventilation Perfusion Relationships

A. Define shunt and deadspace.

B. Review the normal distribution of blood in the upright lung.

C. Review the normal distribution of ventilation in the upright lung.

D. Explain pathological causes for uneven distribution of ventilation or perfusion within the lung.

E. Define normal ventilation to perfusion ratios.

F. Review tests used to identify regional ventilation and perfusion in the lung.

G. Identify bronchiolar and vascular responses to mismatch.

H. Compare the effect of inequality on arterial and alveolar oxygenation.

I. Describe the effects of an inequality on arterial and alveolar CO2 levels.

J. Describe pulmonary and systemic responses to hypoxia, hypocapnia, and hypercapnia.

K. Describe the factors that can affect oxygen uptake by the tissues.

L. Describe performance of a shunt study.

VII. Oxygen Transport

A. Explain causes of hypoxemia.

B. Articulate the four types of hypoxia.

C. Describe normal binding of oxygen to hemoglobin.

D. List the two components of oxygen transport.

E. List abnormal types of hemoglobin.

F. Calculate oxygen content.

G. Describe cyanosis in terms of oxygen content.

H. Discuss the significance differences in  arterial-venous content.

I. State the normal value for the partial pressure of oxygen in venous blood (PvO2.)

J. Calculate predicted alveolar oxygen levels.

K. Compare the partial pressure of oxygen in arterial blood (PaO2) and partial pressure of carbon dioxide in arterial blood (CaO2) to their roles in oxygen delivery.

L. Identify the importance of given points on the oxyhemoglobin dissociation curve (OHDC.)

M. List factors causing OHDC to shift left or right.

N. Identify the changes in O2 and hemoglobin (Hb) affinity occurring with an OHDC shift to the left or right.

O. Describe the effect of 2,3Diphosphoglycerate (2,3DPG) on the OHDC.

P. Describe the effect of carbon monoxide (CO) on the OHDC.

Q. Define P50 and state its clinical significance.

R. Describe the Bohr effect.

VIII. Carbon Dioxide Transport

A. Identify CO2 transport from the cells to the lungs.

B. Describe the process of CO2 uptake at the cell level and CO2 release at the lungs.

C. Describe the conversion of CO2 to bicarbonate (HCO3.)

D. Describe the Haldane effect.

E. Describe the Bohr effect.

F. Compare the CO2 and O2 dissociation curves.

G. Define and calculate total CO2.

IX. Acid-Base Balance

A. Define acid and base.

B. Define buffers and their physiological role.

C. Recall the four body buffers.

D. Define pH and its relationship to hydrogen ion concentration measured in nanomoles.

E. Define acidosis and alkalosis.

F. Perform calculations using the Henderson-Hasselbalch equation.

G. Review basic kidney function.

H. Describe how hydrogen (H+) and HCO3 are regulated by the kidney in acid-base states.

I. Demonstrate the ability to identify the types and causes of acid-base disturbances.

J. Contrast how the lungs and kidneys compensate for imbalances in the acidity or alkalinity (pH. )

K. Interpret arterial blood gas studies.

L. Contrast buffer base and base excess.

M. Calculate the anion gap and total CO2.

X. Control of Ventilation

A. Describe the role of the Gamma-efferent system in modifying breathing patterns:

1. Obstructive disease pattern

2. Restrictive disease pattern

B. Demonstrate the ability to define state the effect on breathing:

1. Hering-Breuer reflex

2. Paradoxic reflex of the head

3. Deflation reflex

4. J receptors

5. Irritant receptors

C. Identify the physiological responses to hyperventilation.

D. Contrast Biot’s and Cheyne-Stokes Breathing.

XII. Chemical regulation of ventilation

A. Identify the chemoreceptor area of the medulla.

B. Describe the effects of carbon dioxide on the central chemoreceptors.

C. Explain the role of the blood–brain barrier in chronic hyperventilation.

D. State the response of peripheral chemoreceptors to carbon dioxide.

E. State the effect of free H+ on respiration.

F. Identify the locations of the peripheral chemoreceptors.

G. Describe the effect of low oxygen levels on peripheral chemoreceptors.

H. Describe the mechanisms involved with oxygen-induced hypoventilation.

I. Calculate the partial pressure of inspired oxygen (PIO2) and the partial pressure of alveolar oxygen (PAO2) under various barometric conditions.

XIII. Cardiac Conduction and Blood Components

A. Describe the function of the following specialized cells of plasma:

1. Erythrocytes

2. Leukocytes

3. Thrombocytes

B. Identify chemical components of the plasma.

C. Describe the effect of blood volume on cardiac output.

D. Compare the components of the pulmonary and systemic vascular systems.

E. Trace blood flow from the superior and inferior vena cava through the valves and chambers of the heart.

F. Explain systole and diastole in relation to on the cardiac cycle.

G. Contrast the sympathetic and parasympathetic effects on the heart.

H. Explain the relationship between coronary circulation and the cardiac cycle.

I. Describe the electrical forces involved in membrane potentials of the heart.

J. Describe the relationship of ECG impulses and electrical conduction within the heart.

K. Calculate heart rate from an ECG strip.

L. Describe the placement of electrodes for ECGs.

M. Describe ECG changes in disease states.

XIV. Unusual Atmospheres and Environments

A. Calculate expected PaO2 and PAO2 at different altitudes.

B. Describe the following physiologic responses to living at high altitude:

1. Hyperventilation

2. Pulmonary hypertension

3. Increased red blood cells (RBC’s)

4. Increased 2,3–DPG

5. Increase in pulmonary vascularity

6. Right axis deviation (cardiac)

C. Demonstrate the ability to review the pressure changes and physiologic events involved with hyperbaric conditions:

1. Quantity of gas in the lung under pressure

2. Increase in gas dissolved in tissue

3. Explanation of “the bends”

4. Explanation of nitrogen narcosis

D. Review the pathophysiological effects of oxygen toxicity.

E. Describe the normal ventilatory response to increased inspired concentrations of CO2.

F. Describe the effects of tobacco smoke and pollution on the respiratory system.

G. Explain absorption atelectasis.

Content Outline and Competencies:

I. Recordkeeping

A. Review records

1. Patient demographics

2. Chief complaint/diagnosis

3. History of present illness

4. Past medical history

5. Social history

6. Occupational history

7. Current medications

8. Results of diagnostic procedures

9. Recent progress notes

10. Physician orders

B. Review documentation

1. Procedure for verbal and telephone orders.

2. Process for charting errors.

3. Methods of written recordkeeping.

4. Electronic applications of recordkeeping.

II. General Safety and Patient Comfort Considerations

A. Demonstrate the ability to apply proper body mechanics in the following:

1. Lifting and carrying an object

2. Moving a patient to the head of the bed with and without aid

3. Moving a patient from bed to stretcher with assistance

4. Assisting a patient from bed to chair

5. Assisting a patient walking

6. Assisting a falling patient

7. Turning a patient

B. Demonstrate the ability to position a patient for therapeutic procedures and patient comfort:

1. Supine

2. Prone

3. Fowler's

4. Semi-Fowler's

5. Trendelenburg

C. Describe methods of eliminating safety hazards in the patient care setting.

D. Explain the general rules for responding to emergencies in the patient care setting.

E. Demonstrate the appropriate measures to treat cardiopulmonary collapse according to Basic Life Support (BLS) protocols.

III. Infection Control and Standard Precautions

A. Identify sources of common nosocomial or iatrogenic infections.

B. Identify respiratory pathogens by their morphology, colony structure and characteristics.

C. Demonstrate the ability to perform appropriate infection control and standard precaution measures including:

1. Appropriate hand washing

2. Use of personal protective equipment

3. Handling of non-disposable and disposable equipment.

D. Describe the potential risks to healthcare workers in caring for patients with blood borne infectious diseases.

E. Describe the measures taken if a healthcare worker is exposed to blood or other body fluids.

F. Describe infection control measures used to minimize airborne contamination, and wound and skin infections.

III. Gas Physics

A. Demonstrate the ability to calculate and define:

1. Density of a gas or gas mixture based on its molecular weight

2. Critical temperature and critical pressure

3. Molecular weight, mass, density, boiling point, critical temperature and critical pressure for frequently used medical gases

4. Basic gas laws

a. Boyle's

b. Charles'

c. Dalton's

B. Describe the behaviors of gases.

1. Kinetic activity

2. Flow of gas

a. Laminar flow

b. Turbulent flow

c. Tracheobronchial flow

d. The Reynolds Number

IV. Gas Production and Storage

A. Describe and identify:

1. Gas production for frequently used medical gases

2. Purity requirements for medical gases

3. Agencies which regulate medical gas production

B. Recognize and describe:

1. Bulk storage as it applies to medical gases

2. Bulk systems found in hospitals.

3. Hospital piping systems with zone valves and alarms

4. Gas cylinder identification and safety issues for:

a. U.S. and international color coding

b. Proper labeling of contents

c. Cylinder construction

d. Cylinder testing

e. Cylinder maintenance codes

f. Safety systems

5. Agencies which regulate medical gas storage and transport

C. Compute the possible duration for liquid or gas cylinders based on the liter flow to be used.

D. Review the medical gas systems used in the home environment.

1. Oxygen concentrators

2. Liquid systems

3. Cylinder options

V. Reducing Valves, Regulators and Flowmeters

A. Describe the function of a reducing valve.

1. Preset versus adjustable

2. Single stage versus multi-stage

3. Working pressures

B. Describe and identify safety systems used in conjunction with reducing valves.

C. Define a regulator and describe its function.

1. Preset (Thorpe tube) versus adjustable (Bourdon gauge)

2. Single stage versus multi-stage

3. Working pressures

4. Differences between regulators and reducing valves.

5. Safety systems used in conjunction with regulators.

D. Describe:

1. Function of a flowmeter

2. Presence of pressure compensation in flowmeters.

3. Types of flow metering devices

a. Bourdon gauges

b. Thorpe tubes

c. Kinetic tubes

E. Describe the safety systems used in conjunction with flowmeters.

VI. Assessment of Overall Patient Cardiopulmonary Status

A. Recommend additional cardiopulmonary information needed to complete a patient assessment.

B. Recognize signs and symptoms in a patient interview indicating a cardiopulmonary disorder.

C. Apply appropriate medical terminology in describing a patient's:

1. Level of consciousness

2. Level of cooperation

3. Orientation to time, place, and person

4. Irregular breathing patterns

5. Cough and sputum characteristics

6. Education level

7. Knowledge of past medical history

8. Age and language

D. Demonstrate the ability of effective communication when obtaining a patient's medical history.

E. Locate the following structures on a patient model or diagram:

1. Suprasternal notch

2. Manubrium of sternum

3. Body of sternum

4. Xiphoid process

5. Sternal angle

6. Costal margin

7. Costal angle

8. Costochondral junctions

9. Ribs 1-12

10. Intercostal spaces 1-8

11. C7; T1; T6 vertebrae

12. Clavicles

13. Scapulae

14. Carina

15. Transverse fissure

16. Oblique fissure

F. Locate the following topographical marks on a patient model or diagram:

1. Mid-clavicular lines

2. Anterior, mid-, and posterior axillary lines

3. Mid-scapular lines

4. Vertebral line

5. Mid-sternal line

G. Demonstrate the ability to locate the lung lobes, transverse fissure, and oblique fissure on a patient model or diagram using appropriate thorax anatomy and terminology.

H. Identify the use of accessory muscles during inspiration and expiration.

I. Demonstrate the ability to obtain the following measures:

1. Respiratory rate

2. Pulse

3. Blood pressure

4. Pulse Oximetry

J. Demonstrate the ability to apply the normal ranges, units of measure, related abbreviations, and the medical terms indicating abnormal results for:

1. Temperature

2. Blood pressure

3. Pulse

4. Respiratory rate

5. Pulse Oximetry

K. Convert temperatures to alternate units.

L. Demonstrate a complete chest inspection on a patient model

M. Describe each of the following terms relating to inspection of the patient:

1. General appearance

2. Muscle wasting

3. Venous distention

4. Peripheral edema

5. Diaphoresis

6. Clubbing

7. Cyanosis

8. Capillary refill

9. Chest configuration

10. Diaphragmatic movement

11. Breathing pattern

12. Accessory muscle use

13. Asymmetrical chest movement

14. Retractions

15. Nasal flaring

16. Quality of cough

17. Sputum characteristics

18. Chronic obstructive pulmonary disease (COPD) posturing

19. Room observation

N. Describe the appropriate palpation technique and outcomes in pulmonary disorders including:

1. Tracheal location

2. Chest wall excursion

3. Fremitus

4. Apical pulse

5. Peripheral pulses

6. Airway secretions

7. Crepitus

8. Areas of tenderness

O. Describe the appropriate percussion techniques and percussion notes for identified pulmonary disorders.

P. Demonstrate the appropriate auscultation technique used to determine:

1. Vesicular sounds

2. Bronchial sounds

3. Bronchovesicular sounds

4. Blood pressure

Q. Recognize the causes for the adventitious (abnormal) chest sounds for:

1. Crackles

2. Coarse (previously termed Rhonchi)

3. Wheezes

4. Stridor

5. Pleural rub

6. Bronchophony

7. Egophony

8. Whispered pectoriloquy

R. Apply the various abnormal breathing patterns to specific patient scenarios:

1. Hypoventilation

2. Hyperventilation

3. Kussmaul's breathing

4. Biot's breathing

5. Cheyne-Stoke's breathing

6. Tachypnea

7. Bradypnea

8. Orthopnea

9. Dyspnea

10. Eupnea

11. Apnea

S. Apply appropriate terms and abbreviations relating to patient interview and assessment.

VII. Pulmonary Lab Assessment

A. Demonstrate the ability to recall the basic anatomy and function of the following structures:

1. Nose

2. Conducting airways

3. Alveolocapillary membrane

4. Heart

5. Arterial and venous vessels

B. Describe the mechanical movement of air on inspiration and expiration.

C. Diagram blood flow through the heart and lungs.

D. Explain the process of internal and external gas exchange.

E. Identify normal arterial blood gas values with correct units of measurement.

F. Interpret arterial blood gas examples.

G. Relate pulse oximetry to patient oxygenation status.

H. Recall normal lung volumes and capacities.

I. Appropriately label lung volumes and capacities on a diagram.

J. Identify normal and abnormal findings on pulmonary function tests.

K. Demonstrate the ability to obtain the following measures:

1. Bedside pulmonary function measurements

2. Pulse oximetry

L. Demonstrate bedside pulmonary function measurements.

M. Identify terms and abbreviations for bedside pulmonary function measurements.

N. Apply terms and abbreviations related to pulmonary lab assessment.

VIII. Introduction to Cardiopulmonary Pathophysiological States

A. Differentiate between the pathophysiological states

1. Hypoxia and hypoxemia

2. Types of hypoxia and hypoxemia

3. Clinical manifestations of hypoxia

4. List shunt and deadspace disorders.

5. Apply appropriate terms relating to patient interview and assessment.

B. Demonstrate the ability to spell, describe, and apply descriptions of the following pulmonary disorders:

1. Asthma

2. Bronchitis

3. Emphysema

4. Tuberculosis

5. Bronchiectasis

6. Pneumonia

7. Atelectasis

8. Cor pulmonale

9. Croup

10. Bronchiolitis

11. Epiglottitis

12. Cystic fibrosis

13. Acute Respiratory Distress Syndrome (ARDS)

14. Pulmonary edema

15. Pulmonary embolism

16. Flail chest

17. Pneumothorax

18. Pleural effusion

19. Hemothorax

20. Empyema

IX. Gas and Humidity Therapy

A. Demonstrate the ability to identify the rationale, clinical indications, contraindications, possible hazards, and complications for:

1. Oxygen therapy

2. Humidity therapy

3. Gas mixture therapy

B. Determine therapeutic plans for given patient scenarios including goals and modifications.

C. Interpret terminology relating to gas and humidity therapy.

X. Instruction and Application Techniques

A. Select the appropriate gas and humidity equipment for the implementation of the respiratory care plan.

B. Assemble functioning equipment forthe following axygen administration devices:

1. Nasal cannula

2. Simple mask

3. Non-rebreathing masks (NRB)

4. Face shield or tent

5. Air entrainment devices

6. Aerosol masks, trach masks or collars, and t-pieces

7. Titration accessories

8. Oxygen tents

9. Oxygen hoods

10. Transtracheal oxygen

11. Oxygen conserving devices including reservoir and demand systems

12. Continuous Positive Airway Pressure (CPAP)

C. Assemble functioning equipment for the following humidification devices:

1. Bubble

2. Passover

3. Cascade

4. Wick

5. Heat moisture exchange

D. Describe and operate gas delivery systems including:

1. Cylinders or bulk systems

2. Oxygen concentrator

3. Air compressors

4. Liquid oxygen system

5. Regulators and reducing valves

6. Flowmeter

7. Blenders

8. Oxygen analyzer

9. Pulse oximeter

E. Describe concentrations available for all oxygen and gas mixture administration devices.

F. Identify the oxygen administration devices for aerosol generators.

G. Compute total flow and ratios delivered by air entrainment devices.

H. Demonstrate the ability to explain planned therapy and goals to patient in understandable terms.

I. Demonstrate the ability to appropriately deliver gas and humidity therapy.

J. Adjust equipment following patient's responses to therapy.

K. Record therapy results in the patient record.

L. Communicate clinical status information to members of the healthcare team.

XI. Humidity Equipment

A. Define the terms related to humidity equipment:

1. Humidity

2. Humidifier

3. Absolute humidity

4. Relative humidity

5. Body humidity

6. Percent body humidity

7. Humidity deficit

8. Dew point

9. Saturation

10. Super saturation

11. Vapor pressure

B. Describe each of the following used to provide humidity:

1. Bubblers

2. Passover humidifiers

3. Large reservoir heated humidifiers

4. Heat moisture exchangers

C. Identify oxygen and gas mixture administration devices used with humidifiers.

D. Demonstrate the ability to assemble and adjust humidifiers.

XII. Aerosol Equipment and Therapy

A. Define the terms related to aerosol equipment:

1. Aerosol

2. Atomizer

3. Nebulizer

4. Baffle

5. Output

6. Total flow

7. Bernoulli effect

8. Venturi principle

9. Piezoelectric

B. Describe and adjust aerosol generators for particle size, output, and total flow.

1. Jet capillary nebulizers

a. Large reservoir airway hydration nebulizers

b. Small reservoir medication nebulizers

c. Large reservoir medication nebulizers

d. Tents

2. Ultrasonic nebulizers

3. Small particle aerosol generator (SPAG) nebulizers

C. Compute air entrainment ratios and total patient flow for large reservoir nebulizers.

D. List factors which determine aerosol deposition, stability, and particle size production.

E. Demonstrate the ability to assemble and adjust aerosol generators.

F. Identify oxygen and gas mixture administration devices used with the nebulizers.

G. Identify the rationale, clinical indications, contraindications, and complications for aerosol therapy.

H. Demonstrate the ability to determine therapeutic goals and modifications in the therapeutic plan.

I. Define terms and abbreviations related to aerosol therapy.

J. Select the appropriate aerosol equipment for the respiratory care plan.

K. Assemble equipment to include:

1. Small and large volume medication nebulizers

2. Metered Dose Inhalers (MDI) with spacer

3. Large reservoir nebulizers

4. Ultrasonic nebulizers

5. Oxygen mist tents

L. Explain planned therapy and goals to patient in understandable terms.

M. Demonstrate the ability to appropriately deliver aerosol therapy.

N. Demonstrate the ability to evaluate patient's responses, equipment operation, and modifications of delivered therapy.

O. Record therapy in the patient record using conventional terminology.

P. Communicate information regarding clinical status to appropriate members of the healthcare team.

XIII. Analyzers, Pulse Oximeters, and Blenders

A. Discuss the rationale for the use of analyzers.

B. Demonstrate the ability to assemble, calibrate, and troubleshoot analyzers.

C. Describe the appropriate use of oxygen analyzers for:

1. Placement of analyzers in patient circuits

2. Effect of humidity on analyzer accuracy

3. Appropriate alarm settings on analyzers for all patient populations

D. Describe the blender indications and operation.

E. Demonstrate the ability to identify pulse oximeters and their principles of operation.

F. Demonstrate the ability to set up and troubleshoot pulse oximeters.

XIV. Titration

A. Demonstrate the ability to assemble the appropriate equipment for the required fractional inspired oxygen (FiO2.)

B. Demonstrate the ability to calculate the liter flow requirements of air and oxygen required for a given FiO2 with adequate patient flow.

C. Demonstrate the ability to assemble equipment at a specified FiO2 to ensure adequate patient flow.

XV. Airway Clearance Techniques

A. Demonstrate the ability to identify the rationale, clinical indications, contraindications, possible hazards, and complications for airway clearance techniques.

B. Determine therapeutic goals and modifications to the therapeutic plan.

C. Discuss the requirements of an effective cough.

D. Demonstrate obtaining a sputum sample.

E. Describe possible macroscopic and microscopic findings of sputum examination.

F. Identify terms and abbreviations related to airway clearance techniques.

G. Demonstrate the ability to select the appropriate airway clearance equipment to implement the respiratory care plan.

H. Assemble the equipment for:

1. Vacuum systems

2. Open and in-line suction catheters

3. Mechanical vibrators/percussors

4. Flutter valves

5. High frequency chest wall oscillation (HFCWO)

6. Specimen collectors or traps

7. Oral suction devices

8. Intrapulmonary percussive ventilation (IPV)

9. Positive expiratory pressure (PEP) or other positive airway pressure (PAP) therapy

I. Explain planned therapy and goals to patients in understandable terms.

J. Demonstrate the ability to appropriately deliver the various therapies for airway clearance including:

1. Splinting

2. Deep breathing and coughing

3. Oropharyngeal, nasotracheal, endotracheal, and tracheal suction

4. Chest physiotherapy

5. Flutter

6. High Frequency Chest Wall Oscillation (HFCWO)

7. Autogenic drainage

8. Intrapulmonary Percussive Ventilation (IPV)

9. PEP or other PAP therapy

K. Demonstrate the ability to evaluate the patient's response and modifications to the operation of equipment for delivered therapy.

L. Record therapy in the patient record using appropriate medical terminology.

M. Communicate a patient's clinical status to appropriate members of the healthcare team.

XVI. Hyperinflation Equipment

A. Contrast the function of flow and volume oriented IS devices.

B. Identify the parts of basic continuous PAP and Bilevel PAP setups.

C. List the components checked on CPAP and Bilevel PAP equipment used with oxygen administration devices.

D. Demonstrate the ability to assemble and modify CPAP and Bilevel PAP devices.

XVII. Intermittent Positive Pressure Breathing (IPPB)

A. List the indications, hazards, and complications that may occur with IPPB

B. Demonstrate the ability to summarize the most common situations warranting modification of treatment techniques with recommended actions.

C. Demonstrate the ability to select appropriate lung expansion equipment used to implement the respiratory care plan.

D. Assemble equipment with modifications for:

1. IPPB

2. CPAP/BiLevel PAP

3. Incentive Spirometry (IS)

4. Intermittent positive pressure breathing (IPPB) and CPAP/BiLevel PAP breathing circuits

E. Explain planned therapy and goals to patients in understandable terms.

F. Demonstrate the ability to appropriately deliver the various therapies for lung expansion.

G. Demonstrate the ability to evaluate the patient's responses and modifications to equipment and respiratory care therapies.

H. Record therapy and results in the patient record.

I. Communicate clinical status to appropriate members of the healthcare team.

XVIII. Cleaning and Sterilization

A. Describe physical and chemical methods of disinfection or sterilization.

B. Identify procedures and agents used in sterilization and disinfection including:

1. Mode of action

2. Time requirements

3. Temperature requirements

4. Organisms disinfected or sterilized

5. Concentrations

6. Advantages and disadvantages of use

7. Precautions of use

C. Demonstrate the ability to outline equipment cleaning, disinfecting, and sterilizing procedures.

D. Contrast the sampling techniques used to determine equipment cleanliness or sterility.

E. Demonstrate the ability to describe the appropriate cleaning, disinfecting, and sterilization procedures for:

1. Flowmeters

2. Pulse oximeters

3. Resuscitation bags

4. Main flow filters

5. Peak flow meters

6. Large bore tubing

7. Respirometers/pneumotachs

8. Bronchoscopes

XIX. Hospital Safety Measures for Quality Improvement and Equipment Performance

A. Demonstrate the ability to discuss the selection and purchase of respiratory care equipment.

B. Identify the Respiratory Care Services' responsibilities for preventive maintenance and quality control of equipment.

C. List the current agencies monitoring equipment defects.

D. List compliance standards for equipment safety.

E. Demonstrate the ability to discuss evaluation methods for assessing respiratory care practitioner competencies, and the requirements for recordkeeping.

XX. Respiratory Care and the Healthcare System

A. Contrast ethical and legal behavior.

B. Discuss ways to address possible ethical and legal situations.

C. State the role of ethics in the delivery of respiratory care.

D. Demonstrate the ability to describe ethics committees and role of the respiratory therapist.

E. Discuss the way that technology has increased the incidence of confidentiality violations.

F. Interpret an ethical dilemma.

G. Describe the role of various members of the healthcare team.

H. Recognize the respiratory care practitioner's role in advancing the individual, institutional, and the profession's perceptions.

I. Discuss the skills necessary for effective communication with all customers.

J. Demonstrate the ability to identify stress factors that may be part of a Respiratory Care Practitioner's (RCP's) work, and possible mechanisms for relief.

K. Demonstrate appropriate nonverbal, verbal, and written communication with all customers.

L. Describe a typical hospital organization chart from student through administration.

M. Identify the role of each of the following members of a respiratory department:

1. Medical director

2. Department director or manager

3. Staff Supervisor

4. Staff therapist

5. Student

N. Describe the scheduling process that may be used in respiratory services.

O. Define the following terms:

1. Full-time Employee (FTE)

2. Job description

3. Triage

4. Patient evaluation system

5. Protocols

6. Outcome measures

P. Describe how respiratory employers are typically evaluated.

Q. Demonstrate the ability to describe how workloads may be assigned, and how productivity is determined.

R. Identify the scope of services that may be offered in large, medium, and small patient care arenas.

XXI. Introduction to the Healthcare Delivery System

A. Define the following terms:

1. Preferred provider organization (PPO)

2. Health Maintenance Organization (HMO)

3. Medicare/Medicaid

4. Diagnostic related groupings (DRGs)

5. Capitation

6. Gatekeeping

B. Describe the evolution of healthcare in the United States.

C. Evaluate today's healthcare picture.

D. Discuss the Respiratory Care Practitioner's status and responsibilities in today's healthcare delivery system.

Content Outline and Competencies:

I. Non-invasive oxygen and carbon dioxide monitoring

A. Demonstrate the ability to determine the indications, equipment, and normal parameters for the following non-invasive oxygen and carbon dioxide monitors:

1. Pulse oximeter

2. End-Tidal carbon dioxide (CO2) monitor

3. Transcutaneous CO2 monitor

B. Demonstrate the ability to calculate and interpret noninvasive blood oxygen and carbon dioxide measurements.

II. Arterial Blood Gas Procurement, Analysis, and Interpretation

A. Demonstrate the ability to identify anatomy of the wrist, groin and antecubital fossa in terms of nerve, artery and vein locations.

B. Describe a detailed procedure for obtaining arterial blood samples from:

1. Adult arterial blood gas (ABG) sites

a. Radial artery

b. Femoral artery

c. Brachial artery

d. Arterial lines

2. Infant

3. Neonates

C. Demonstrate the ability to state the indications, contraindications and hazards associated with arterial blood gas acquisition.

D. Discuss the importance of extracting data from a patient’s chart prior to obtaining arterial blood samples.

E. Briefly describe how each of the following function in the analysis of blood samples:

1. PO2 electrode

2. PCO2 electrode

3. pH electrode

4. Co-oximeter

F. Identify normal values for arterial and venous blood gases for adults and children.

G. State the mechanisms that cause the following conditions:

1. Respiratory acidosis

2. Respiratory alkalosis

3. Metabolic acidosis

4. Metabolic alkalosis

H. Interpret blood gas values with clinical impressions.

I. Demonstrate the ability to describe levels and methods of compensation that occur with respiratory acidosis, respiratory alkalosis, metabolic acidosis, metabolic alkalosis, and combined states of respiratory and metabolic acidosis and alkalosis.

J. Recognize erroneous blood gas results and possible causes for the errors.

K. Estimate the bicarbonate (HCO3) value when given the pH and PCO2.

L. Estimate the oxygen saturation on the hemoglobin when given the PO2 and HbO2 values.

M. Demonstrate the ability to identify the following abbreviations, normal values, units of measure and calculations for:

1. Alveolar-arterial gradient (P(A-a)O2)

2. Capillary oxygen content (CcO2)

3. Arterial oxygen content (CaO2)

4. Oxygen content of mixed venous blood (CvO2)

5. Shunt (Qs/Qt)

6. Dead space (Vd)

7. Minute Ventilation (VE)

8. Tidal Volume (Vt)

9. Deadspace to tidal volume ratio (Vd/Vt)

III. Pulmonary Function Testing

A. Define respiratory obstruction and restriction in pulmonary disease states.

B. Identify the criteria used to establish patient normal values for pulmonary function testing.

C. Identify the pulmonary function tests available to assist in the diagnosis of pulmonary disorders to include:

1. Spirometry (lung mechanics)

2. Lung volumes

3. Diffusing capacity

D. Describe the maneuvers utilized to obtain lung flow rates, lung volume, and diffusing capacity.

E. Relate the American Thoracic Society (ATS) criteria for pulmonary function reproducibility.

F. Define the following expiratory flow rate measurements:

1. Forced expiratory volume 1 second (FEV1)

2. Forced expiratory flow 25%-75% (FEF25-75)

3. Peak expiratory flow rate (PEFR)

4. Maximum voluntary ventilation (MVV)

G. Define the following Lung volumes and capacities

1. Total lung capacity

2. Vital Capacity

3. Inspiratory capacity

4. Functional residual capacity

5. Tidal volume

6. Inspiratory reserve volume

7. Expiratory reserve volume

8. Residual volume

H. Demonstrate the ability to define abbreviations used for pulmonary function testing to include:

1. Forced vital capacity (FVC)

2. Forced expiratory volume in one second (FEV1)

3. Forced expiratory flow from 25% to 75% of vital capacity (FEF 25-75)

4. Peak expiratory flow rate (PEFR)

5. Ratio of your forced expiratory volume in one second (FEV1) to your forced vital capacity (FVC). (FEV1/FVC)

6. Total Lung Capacity (TLC)

7. Residual volume (RV)

8. Functional Residual Capacity (FRC)

9. Diffusing Capacity (DLCO)

I. Demonstrate the ability to perform and interpret pulmonary function studies.

IV. Introduction to Radiology

A. Locate the following on normal and abnormal chest X-rays:

1. Position

2. Translucency

3. Soft tissue and thoracic cage

4. Diaphragm

5. Lung fields

6. Mediastinum

7. Hilum

8. Tracheal bifurcation

9. Heart and vasculature

10. Shadows

11. Fissures

12. Costophrenic angle

B. Describe the purpose of the following radiologic procedures:

1. Lordotic/oblique views

2. Inspiratory/expiratory views

3. Decubitus views

4. Tomograms

5. Fluoroscopy

6. Bronchograms

7. Angiograms

8. Lung scans

9. V/Q scans

10. Magnetic Resonance Imaging (MRI)

11. Computerized tomography (CT) scan

C. Demonstrate the ability to contrast normal radiologic findings for interpretation of the following disorders or conditions:

1. Atelectasis

2. Infectious diseases

3. Chronic Obstructive Pulmonary Disease (COPD)

4. Pleural effusion

5. Pneumothorax

6. Pneumonectomy

7. Pulmonary edema

8. Pulmonary embolism

9. Tumors

10. Tuberculosis

11. Chest tube placement

12. Endotracheal tube placement

13. Fractured ribs

D. Describe the impact of acute and chronic radiation exposures.

V. Introduction to Clinical Laboratory Medicine

A. Describe the clinical implications for each of the following hematological assessments:

1. Hemoglobin (Hb)

2. Red Blood Cell (RBC)

3. Hematocrit (Hct)

4. Indices

5. Reticulocyte count

6. White blood cell (WBC) differential

7. Platelet count

8. Bleeding time assessments

a. Prothrombin Time (PT)

b. Partial Thromboplastin Time (PTT)

c. International Normalized Ratio (INR)

9. Blood groups

B. Describe the clinical implications for each of the following tests:

1. Renal

a. Urea and Creatinine clearance

b. Blood, Urea, Nitrogen (BUN)

c. Urinalysis

2. Liver

a. Bilirubin

b. Alkaline phosphate

c. Cholesterol

d. Serum glutamic oxaloacetic transaminase (SGOT)

e. Serum glutamic pyruvic transaminase (SGPT)

f. Lactic acid dehydrogenase (LDH)

3. Endocrine

a. Glucose

b. Glucose Tolerance Test (GTT)

c. Thyroid

d. Parathyroid

e. Adrenal

4. Cardiac

a. SGOT

b. Lactate Dehydrogenase (LDH)

c. Creatine phosphokinase (CPK)

d. Erythrocyte sedimentation rate (ESR)

e. Troponin

5. Cerebral fluid

a. Pressures

b. Appearance

c. Analysis (sugar, protein, cell count)

C. Describe the clinical implications of the following analysis of serum electrolytes and proteins:

1. Electrolytes

a. Sodium (Na+)

b. Potassium (K+)

c. Calcium (Ca++)

d. Chloride (Cl-)

e. Carbon dioxide (CO2)

f. Phosphorus (PO4)

2. Proteins

a. Albumin

b. Alpha 1 and alpha 2

c. Gamma globulins

d. Immunoglobulins

VI. Introduction to Electrocardiography

A. Review the anatomy and physiology of the heart and electrophysiology.

B. Demonstrate the ability to deduce the proper lead placement for monitoring 12 lead electrocardiogram (ECG) evaluations.

C. Identify the normal components of an ECG tracing.

D. Determine the heart rate when provided an ECG tracing.

E. Identify the following ECG rhythms:

1. Normal sinus rhythm

2. Sinus arrhythmia

3. Sinus tachycardia

4. Sinus bradycardia

5. Pacemaker

6. Premature ventricular contractions

7. Ventricular tachycardia

8. Ventricular fibrillation

9. Paroxysmal atrial tachycardia

10. Premature atrial contractions

11. Atrial flutter

12. Atrial fibrillation

13. 1, 2, 3 degree heart blocks

14. Bundle branch blocks

15. Asystole

16. Pacemaker

17. Changes associated with the following conditions:

a. Pulmonary disease

b. Heart hypertrophy

c. K+ or Ca++ electrolyte changes

d. Myocardial ischemia

e. Myocardial injury

f. Myocardial infarction

VII. Bronchoscopy and Thoracentesis

A. Identify the indications for bronchoscopy.

B. Describe the potential complications and hazards of bronchoscopy.

C. Identify the need for rigid scope bronchoscopy.

D. List the steps for preparing a patient for a bronchoscopy.

E. List the steps for preparing a bronchoscope and specimen acquiring tools for a bronchoscopy.

F. Describe the therapist’s responsibilities during a bronchoscopy to include:

1. Bronchial washings and lavage

2. Bronchial tissue biopsy

3. Transbronchial biopsy

4. Brush biopsy

5. Needle biopsy

6. Patient monitoring and comfort

G. Discuss bronchoscopy sample preparation for laboratory analysis.

H. Describe the procedure for cleanup after a bronchoscopy.

I. List typical post bronchoscopy physician orders to include:

1. Respiratory Therapy (RT) orders

2. Nursing orders

J. Identify reasons for performing a thoracentesis.

K. Define transudate and exudate as they apply to thoracentesis fluids.

VIII. Cardiopulmonary Stress Testing

A. Describe the indications for a pulmonary exercise stress test.

B. Describe the parameters measured during a pulmonary exercise test.

C. Demonstrate the ability to define terminology or equations associated with pulmonary exercise testing:

1. Aerobic and anaerobic metabolism

2. Anaerobic threshold

3. Carbon dioxide production

4. Minute ventilation

5. Ergometer

6. Heart and breathing reserves

7. Oxygen consumption

8. Oxygen pulse

9. Respiratory exchange ratio

10. Respiratory quotient

D. Relate cardiac (heart rate) and respiratory response (O2 consumption) to exercise.

E. Identify the pulmonary response to exercise with regard to ventilation and O2 consumption.

F. Identify cardiac response to exercise in heart disease in terms of heart rate and O2 consumption.

G. Identify the use of pulmonary exercise testing in a pulmonary rehabilitation program.

IX. Sleep Studies

A. Demonstrate the ability to identify the types of sleep studies to rule out, diagnose, and treat sleep related breathing disorders.

B. Demonstrate the ability to list the indications and performance protocols for the following types of sleep studies:

1. Nocturnal oximetry

2. Baseline polysomnogram

3. Positive airway pressure (PAP) titration study

4. Split night polysomnogram

C. Identify the diagnostic criteria for the following sleep related breathing disorders:

1. Obstructive sleep apnea

2. Primary Central sleep apnea

3. Cheyne stokes

4. Sleep related hypoventilation

a. Caused by pulmonary disease

b. Obesity related

c. Caused by neuromuscular disease

D. Discuss the PAP desensitization procedure

1. State the types of masks available

2. Relate the modalities of pressure delivery and the settings associated with each.

E. Define the values related to sleep architecture including:

1. Total Study Time (TST)

2. Autonomic Arousal Index (AAI)

3. Sleep Latency

F. Using the sleep study results categorize the severity of the sleep related breathing disorder.

G. Demonstrate the ability to determine the optimal pressure and modality for treatment of sleep related breathing disorders using PAP titration results.

Content Outline and Competencies:

I. Introduction to Disease

A. Describe the potential contributing factors in developing disease.

B. Explain the physiological response to disease to include:

1. Inflammation

2. The healing process

3. Retrograde changes

4. Circulation changes

5. Growth disturbances

C. Compare the infective process of the following:

1. Host-parasite relationship

2. Defense mechanisms

3. Infectivity of organisms

4. Natural and acquired immunity

5. Immunizations

6. Use of antibiotics

7. Role of bacteria, viruses, fungi and parasites in the infective process

II. Pulmonary Diseases and Other Disorders with Respiratory Implications

A. Explore the etiology, pathology, diagnosis, management and prognosis for the following pulmonary diseases and other disorders with respiratory implications.

1. Chronic Obstructive Pulmonary Disease (COPD)

a. Bronchitis

b. Emphysema

c. Asthma

d. Other obstructive disorders

2. Allergic disorders

a. Asthma

b. Hay fever

c. Hypersensitivity lung disease

d. Status Asthmaticus

3. Respiratory failure

a. Acute respiratory failure

b. Chronic respiratory failure

4. Respiratory diseases due to infection

a. Common cold/other viral infections

b. Influenza

c. Pneumonia

d. Bronchiectasis

e. Tuberculosis

f. Fungal infections

g. Abscess

h. Parasitic infections

i. Granulomatous disease

j. Autoimmune diseases

5. Occupational/environmental pulmonary disorders

a. Pneumoconiosis

b. Organic lung disease

c. Noxious gases

d. Interstitial lung disease

6. Tumors of the lung

a. Neoplasia

b. Role of tobacco products

c. Benign and malignant pulmonary disorders

7. Chest trauma

a. Upper airway

b. Lower airway

c. Chest cage

d. Muscle

e. Hemothorax

f. Pneumothorax

g. Cardiac/circulatory

h. Contusion

i. Fat emboli

j. Acute Respiratory Distress Syndrome (ARDS)

8. Heredity and congenital disorders

a. Alpha 1 antitrypsin

b. Cystic fibrosis

c. Immunoglobulin deficiencies

d. Cysts

9. Pleural disorders

a. Effusion

b. Pleurisy

c. Pneumothorax

10. Other system disorders with respiratory implications

a. Cardiac

1) Pulmonary edema

2) Embolic disorders

3) Hypertension

4) Congestive Heart Failure (CHF)

b. Collagen

c. Central nervous system

d. Drug induced pulmonary disorders

11. Neuromuscular diseases

a. Gulliane Barre

b. Myastinia Gravis

III. Chest X-Ray Interpretation

A. Interpret presented chest X-rays using a systematic examination.

B. Demonstrate the ability to interpret the presented chest X-rays of the above respiratory diseases and disorders using a systematic examination.

Content Outline and Competencies:

I. General Principles of Pharmacology

A. Define the following terms:

1. Drug

2. Pharmacology

3. Therapeutic index

4. Tachyphylaxis

5. Side effect

6. Agonist

7. Antagonist

8. Synergism

9. Placebo

10. Affinity

11. Efficacy

12. Median lethal dose (LD50)

13. Principal effect

14. Half-life

B. Define the following abbreviations:

1. a.c. and p.c.

2. bid, qid, tid

4. gtt

3. g or gm

5. p.o.

6. prn

7. stat

8. MDI

9. noc

10. cc

11. mL

12. hs

13. IM

14. IV

15. I and O

16. DPI

17. mg

18. NPO

19. q2, q3, q4

20. OTC

21. SQ and SC

22. WA

23. SPAG

24. SVN and HHN

C. Differentiate between a generic and trade name.

D. Use the following resources to gain drug information:

1. Digital Physician’s Desk Reference (EPDR)

2. Hospital formulary

3. Product inserts

4. Pharmacist

5. Other reputable websites

E. Describe the pharmaceutical phase of drug action in terms of dosage forms and routes of administration.

F. Explain the pharmacokinetic phase of drug action to include:

1. Mechanisms of absorption

2. Distribution

3. Metabolism

4. Elimination

5. Application to inhaled aerosols

G. Explain the drug receptor model relating to the pharmacodynamics phase of drug action that leads to a drug effect.

H. Review metric to English measurement conversions.

I. Calculate doses from prepared-strength liquids, tablets and capsules.

J. Calculate doses from percentage-strength solutions.

K. Calculate intravenous infusion rates.

II. Administration of Aerosolized Agents

A. Select the equipment appropriate to the respiratory care plan in delivering pharmacological agents.

1. Small- and large-volume medication nebulizers

2. Metered dose inhaler with and without spacers and holding chambers

3. Dry powder inhaler

4. Large-volume bland nebulizers

5. Ultrasonic nebulizers

B. Describe proper aerosolized medication administration to include:

1. Assembling functioning equipment with modifications as needed

2. Drawing medication and diluent with a syringe or dropper

3. Patient instruction for the selected equipment

4. In-line therapy administration for the ventilated patient

5. Documentation

C. Compare the devices used for aerosol delivery and the factors that affect medication delivery to targeted areas of the airways and lung periphery.

III. Sympathomimetic (Adrenergic) Agents

A. Review the sympathetic branch of the autonomic nervous system to include:

1. Anatomy

2. Preganglionic and postganglionic neurotransmitters

3. Receptors

B. Describe the sympathetic response on the following organs/sites:

1. Heart

2. Bronchi smooth muscle

3. Bronchial mucus glands

4. Vascular smooth muscle

C. Describe the effects of alpha, beta 1 and beta 2 receptor stimulation.

D. Differentiate between sympathomimetic and sympatholytic agents.

E. Explain how the chemical structure of a drug may affect bronchodilation.

F. Evaluate clinical scenarios to determine the following for sympathomimetic bronchodilators:

1. Mode of action

2. Indication for use

3. Routes of administration

4. Associated adverse effects

5. Assessment of expected outcomes

G. Determine the most appropriate sympathomimetic bronchodilator for a patient respiratory care plan considering the following factors:

1. Onset and duration of action

2. Dosage form

3. Dosage amounts

4. Recommended frequency of administration

5. Signs and symptoms of the patient

H. Recognize the drug class, generic name and trade name for the currently used short and long acting sympathomimetic bronchodilator agents.

I. Review the pathophysiology of Chronic Obstructive Pulmonary Disease (COPD) and asthma, and relate this drug class to the management of COPD and asthma.

IV. Cholinergic and Anticholinergic

A. Review the parasympathetic branch of the autonomic nervous system to include:

1. Anatomy

2. Preganglionic and postganglionic neurotransmitters

3. Receptors

B. Describe the parasympathetic response on the following organs/sites:

1. Heart

2. Bronchi smooth muscle

3. Bronchial mucus glands

4. Vascular smooth muscle

C. Describe the effects of muscarinic receptor stimulation.

D. Differentiate between parasympathomimetic and parasympatholytic agents.

E. Evaluate clinical scenarios to determine the following or parasympathomimetic (e.g., methacholine) and parasympatholytic (e.g., atropine and ipratropium) agents:

1. Mode of action

2. Indication for use

3. Routes of administration

4. Associated adverse effects

5. Assessment of expected outcomes

F. Determine the most appropriate parasympatholytic bronchodilator for a patient respiratory care plan considering the following factors:

1. Onset and duration of action

2. Dosage form

3. Dosage amounts

4. Recommended frequency of administration

5. Signs and symptoms of the patient

G. Recognize the drug class, generic name, and trade name for the currently used short and long acting parasympatholytic bronchodilator agents.

H. Review the pathophysiology of COPD and asthma and the relationship of this drug class to the management of COPD and asthma.

V. Methylxanthine Agents

A. Critique clinical scenarios to determine the following for xanthine agents:

1. Mode of action

2. Indication for use

3. Routes of administration

4. Associated adverse effects and other physiological effects

5. Assessment of expected outcomes

B. Determine the most appropriate xanthine agent for a patient respiratory care plan considering the following factors:

1. Onset and duration of action

2. Dosage form

3. Dosage amounts

4. Recommended frequency of administration

5. Signs and symptoms of the patient

C. Recognize the drug class, generic name, and trade name for the currently used methylxanthine agents.

D. Discuss the use and role of caffeine in respiratory care practice.

E. Evaluate serum theophylline levels for determination of the anticipated effects of these levels.

F. Recognize factors that affect theophylline effectiveness and clearance for determination of possible therapeutic dosing or frequency adjustments..

G. Review the pathophysiology of COPD and asthma and the relationship of this drug class to the management of COPD and asthma.

VI. Mediator Antagonists (Anti-Asthmatic) Agents

A. Evaluate clinical scenarios to determine the following for mediator antagonist agents:

1. Mode of action

2. Indication for use

3. Routes of administration

4. Associated adverse effects and other physiological effects

5. Assessment of expected outcomes

B. Determine the most appropriate mediator antagonist agent for a patient respiratory care plan considering the following factors:

1. Onset and duration of action

2. Dosage form

3. Dosage amounts

4. Recommended frequency of administration

5. Signs and symptoms of the patient

C. Recognize the drug class, generic name and trade name for the currently used anti-asthmatic agents.

D. Review the pathophysiology of COPD and asthma and the relationship of this drug class to the management of COPD and asthma.

VII. Corticosteroids

A. Evaluate clinical scenarios to determine the following for steroidal agents:

1. Mode of action

2. Indication for use

3. Routes of administration

4. Associated adverse effects and other physiological effects

5. Assessment of expected outcomes

B. Determine the most appropriate steroidal agent for a patient respiratory care plan considering the following factors:

1. Onset and duration of action

2. Dosage form

3. Dosage amounts

4. Recommended frequency of administration

5. Signs and symptoms of the patient

C. Recognize the drug class, generic name and trade name for the currently used corticosteroid agents.

D. Review the pathophysiology of COPD and asthma and the relationship of this drug class to the management of COPD and asthma.

VIII. Mucokinetic, Surface Active and Cough-and-Cold Agents

A. Describe mucociliary transport in the lung and factors that affect this transport.

B. Describe the nature and physical properties of mucus.

C. Evaluate clinical scenarios to determine the following for mucokinetic, surface active and cough-and-cold agents:

1. Mode of action

2. Indication for use

3. Routes of administration

4. Associated adverse effects and other physiological effects

5. Assessment of expected outcomes

D. Determine the most appropriate mucokinetic, surface active and cough-and-cold agent for a patient respiratory care plan considering the following factors:

1. Onset and duration of action

2. Dosage form

3. Dosage amounts

4. Recommended frequency of administration

5. Signs and symptoms of the patient

E. Recognize the drug class, generic name and trade name for the currently used mucokinetic, surfactant and expectorant agents.

F. Discuss the role of bland aerosols and other mucolytic and expectorant agents that may be used in mucus control.

G. Relate these drug classes to respiratory clinical applications.

IX. Anti-Infective Agents

A. Define the following terms:

1. Antibiotic

2. Broad spectrum

3. Narrow spectrum

4. Bacteriocidal

5. Bacteriostatic

6. Anti-fungal

7. Anti-tuberculosis

8. Anti-viral

9. Vancomycin-resistant enterococcus (VRE)

10. Methicillin-resistant staphylococcus aureus (MRSA)

11. Pneumocystis Carinii Pneumonia (PCP)

B. Evaluate clinical scenarios to determine the following anti-infective agents:

1. Mode of action

2. Indication for use

3. Routes of administration

4. Associated adverse effects and other physiological effects

5. Assessment of expected outcomes

C. Determine the most appropriate inhaled anti-infective agent for a patient respiratory care plan considering the following factors:

1. Dosage form

2. Dosage amounts

3. Recommended frequency of administration

4. Signs and symptoms of the patient

5. Infective organism

D. Recognize the drug class, generic name and trade name for the currently used inhaled anti-infective agents.

E. Provide examples, mode of action, clinical indication, general contraindications, precautions and adverse reactions associated with following classes of antibiotics:

1. Penicillins

2. Cephalosporins

3. Carbapenems

4. Aminoglycosides

5. Tetracyclines

6. Quinolones

7. Polymixins

8. Erythromycins

9. Sulfonamides

10. Misc. antibiotics

11. Anti-tuberculosis

12. Anti-fungal

13. Anti-viral

14. Interferons

X. Cardiovascular and Diuretic Agents

A. Define the following terms:

1. Chronotropic

2. Inotropic

3. Cardiotonic

4. Preload

5. Afterload

B. Describe factors that affect blood pressure and cardiac function.

C. Provide examples, drug class, mode of action and general clinical indications for the following agents:

1. Cardiac glycosides

2. Phosphodiesterase inhibitors

3. Beta adrenergic stimulants

4. Anti-arrhythmics

5. Vasodilators/anti-hypertensive agents

6. Antianginal agents

7. Vasopressors

8. Antithrombotics

9. Diuretics

D. Manage common cardiac emergencies according to ACLS protocol.

E. Apply the appropriate class of agent to the cardiac patient scenario and recommendations of a drug or drugs in each class.

XI. Skeletal Muscle Relaxants

A. Describe the physiology of the neuromuscular junction and the nondepolarizing and depolarizing neuromuscular blocking agents.

B. Provide examples, mode of action, clinical indication, general contraindications, precautions, adverse reactions and possible reversal agents associated with the use of nondepolarizing and depolarizing neuromuscular blocking agents.

C. Relate these agents to respiratory clinical applications.

XII. Agents Affecting the Central Nervous System

A. Describe the clinical uses, principal effects and adverse effects associated with the following drug classes:

1. Sedatives and hypnotics

2. Barbiturates

3. Nonbarbiturate hypnotics

4. General anesthetics

5. Local anesthetics

6. Psychotherapeutic agents

7. Narcotic and non-narcotic analgesics

8. Respiratory stimulants

B. Provide examples, mode of action, clinical indication, precautions, adverse reactions and possible reversal agents associated with the drug classes identified.

C. Relate these agents to respiratory clinical applications.

D. Describe the clinical manifestations and management of barbiturate and narcotic overdoses.

E. Briefly describe malignant hyperthermia.

F. Briefly describe conscious sedation and the respiratory clinical applications.

Content Outline and Competencies:

I. Respiratory Failure

A. Define respiratory failure.

B. Describe the etiologies of respiratory failure.

C. Differentiate between acute hypoxemic respiratory failure, acute hypercapnic respiratory failure and chronic respiratory failure.

D. Analyze patient assessment, radiological, pulmonary function and laboratory findings associated with respiratory failure.

E. Develop a treatment plan for acute or chronic respiratory failure to include:

1. Oxygen therapy

2. Therapeutic procedures

3. Need for mechanical ventilation

II. Airway Care

A. Identify the following types of manual resuscitators:

1. Flow-inflating

2. Self-inflating

3. T-piece

B. Determine the average minute volume delivered to the patient with a manual resuscitator as it relates to the patient ventilatory needs during resuscitation situations.

C. Identify factors that affect fraction of inspired oxygen (FIO2) delivery when using manual resuscitators.

D. Demonstrate effective techniques of bag/mask and bag/endotracheal or tracheal tube ventilation.

E. Describe corrective action for potential problems that may arise with manual resuscitators.

F. Discuss the advantages and disadvantages that may be encountered with different types of manual resuscitators.

G. Review the anatomy of the airway.

H. Identify the features, indications, applications, advantages, disadvantages and possible complications of each of the following:

1. Oropharyngeal airways

2. Nasopharyngeal airways

3. Orotracheal airways

4. Nasotracheal airways

5. Double lumen endotracheal (ET) tubes

6. Trach tubes and buttons

7. Cricothyroidotomy

8. Supraglottic airway devices

9. Esophageal/tracheal tubes

10. Esophageal obturator

11. Specialty tubes

12. Pediatric/neonatal tubes

I. Describe the features and applications of each of the following that may be used in inserting and assessing artificial airways:

1. Laryngoscope blades

2. Laryngoscope handles

3. Stylets

4. Fiber optic laryngoscopes

5. Exhaled carbon dioxide (CO2) detection devices

6. Cuff pressure manometers

J. Determine appropriate techniques for disinfection and/or sterilization of non-disposable airway care items to include:

1. Resuscitation bags

2. Laryngoscope blades

3. Laryngoscope handles

4. Stylets

K. Describe for each of the airways identified above:

1. Proper head position

2. Appropriate type and size of airway

3. Proper artificial airway insertion

4. Assessment techniques verifying airway placement

5. Stabilization of the artificial airway, as indicated

6. Removal of the artificial airway

L. Describe the proper procedure for trach care.

M. Articulate the appropriate application of oxygen, aerosol and humidity to the patient with the artificial airways identified above.

N. Demonstrate proper airway cuff assessments and maintenance.

O. Compare endotracheal tube sizes and the appropriate suction catheter size.

P. Recognize the indications and complications of suctioning the airway.

Q. Describe design characteristics and application of different types of suction catheters.

R. Demonstrate proper equipment selection and preparation for suctioning a patient.

III. Mechanical Ventilation

A. Differentiate different types of ventilators using a classification system.

B. Describe ventilator breathing circuits and related equipment.

C. Determine the implications of compliance and resistance of the patient on a ventilator.

D. Describe the mechanics of normal breathing.

E. Describe the modes of ventilation that may be available on mechanical ventilators.

F. Determine the clinical indications for mechanical ventilation.

G. Describe clinical conditions that may require mechanical ventilation.

H. Describe the physiological effects of positive and negative pressure ventilation.

I. Discuss potential complications or hazards associated with mechanical ventilation.

J. Perform serial compliance curves with application to patient conditions.

K. Set up a ventilator with initial parameters.

L. Establish initial alarm settings with appropriate adjustments upon patient application.

M. Troubleshoot ventilator alarms and corrective actions.

N. Adjust the ventilator parameters as indicated by ABGs and other clinical data.

O. Describe methods to maintain adequate humidification of the airway for mechanically ventilated patients.

P. Describe methods to deliver respiratory pharmacological agents to the mechanically ventilated patient.

Q. Assemble additional equipment that may be associated with the mechanically ventilated patient.

R. Describe hemodynamic changes with Positive Pressure Ventilation (PPV) to include estimation of pulmonary artery wedge pressure (PAWP) with PPV.

S. Calculate volume delivered for alveolar exchange in a patient being mechanically ventilated based on tubing and anatomical deadspace loss.

T. Review monitoring techniques and devices used when ventilating a patient to include:

1. Arterial Blood Gases (ABGs)

2. Vital signs

3. Lab values

4. Urine output

5. Pulmonary artery pressure monitoring

6. Routine ventilator checks

7. Compliance curves

8. External alarms

9. Cuff pressure monitoring

U. Describe the performance of pressure/volume/time curves.

V. Correlate changes in pressure/volume/time curves to clinical conditions.

W. Indicate the ventilator adjustments indicated for specific patient findings.

X. Calculate FIO2 needed for a desired partial pressure of arterial oxygen (PaO2), and the PaO2 that will result from a given FIO2.

Y. Identify total ventilatory and partial ventilatory support modes.

Z. Calculate the following in SIMV mode:

1. Spontaneous tidal volume

2. Spontaneous minute volume

3. Spontaneous respiratory rate

4. Machine minute volume

AA. Calculate minute volume needs to change a given partial pressure of arterial carbon dioxide (PaCO2.)

BB. Define optimal positive end expiratory pressure (PEEP) with hemodynamic and compliance curve information.

CC. Measure AUTO-PEEP.

DD. Discuss application of noninvasive ventilation (NIV).

EE. Troubleshoot a ventilator to include:

1. Correction of ventilator alarm conditions

2. Systematic approach to identifying a leak

3. Performance of pre-application safety checks

FF. Describe the evaluation of ventilator patients for weaning to include:

1. ABGs

2. Vital signs

3. Weaning parameters

GG. Contrast artificial airways to include the advantages, disadvantages and complications in the management of the ventilator patient.

HH. Describe criteria for selection and the technique for weaning a patient using the following:

1. Synchronized Intermittent Mandatory Ventilation (SIMV)

2. Tracheal tube (T-tube) trials

3. Flow-by

4. Talking tracheostomy tube

5. Vocalization devices

6. Continuous Positive Airway Pressure (CPAP)

II. Describe the nutritional implications of ventilation and weaning.

JJ. Describe the nontraditional ventilator modes, adjuncts and techniques to include:

1. Airway Pressure Release Ventilation (APRV)

2. Inverse I: E ratio ventilation

3. Permissive hypercapnia

4. Negative pressure ventilation

5. High frequency positive pressure ventilation

6. High frequency jet ventilation

7. High frequency oscillation

8. Differential lung ventilation

9. Prone position ventilation

KK. Suggest initial settings for nontraditional ventilator techniques.

IV. Critical Care Monitoring

A. State the indications and possible complications associated with pulmonary artery catheters, central venous pressure (CVP) catheters and arterial catheters.

B. Describe the insertion procedure and anatomic placement of each of the catheters listed above.

C. Describe the information that may be obtained from the blood samples and pressure tracings from pulmonary artery, CVP and arterial catheters.

D. Define (pulmonary artery pressure) PAP, PAWP, CVP and cardiac output (CO), with normal values for each.

E. Describe the set-up for arterial lines including transducer calibration, pulmonary artery catheters and CVP lines.

F. Identify pressure tracings for each of the above monitoring lines.

G. Describe the different methods of obtaining cardiac output.

H. Describe the use of pulmonary artery, CVP and arterial catheters in patient/ventilator management.

I. Describe the use and function of the ear/pulse oximeters, transcutaneous monitoring and end-tidal CO2 monitoring.

J. Describe the procedures and anatomical placement of each item listed above.

K. Identify abnormal capnography tracings and the potential causes.

L. State advantages and disadvantages for each of the above monitoring techniques.

M. Describe factors that may cause errors in the information from each of these monitoring devices with recommendations for correcting malfunctions.

N. Identify patient conditions needing treatment based on information from these assessment sources.

Content Outline and Competencies:

I. Embryology and Fetal/Neonatal Transition

A. Compare the blood gas values of umbilical arteries and the umbilical veins.

B. Describe the development of the lung and when the development is compatible with maintaining life outside the uterus.

C. Describe the development of the heart and when the heart is fully formed.

D. Describe the development of lung fluids and surfactant in relationship to the following:

1. Sources

2. Composition

3. Time appearance in the developmental stage

4. Physiological importance

E. Describe the methods that may be used to stimulate surfactant development in utero.

F. Describe fetal circulation in relationship to the following:

1. Placental role in fetal blood flow and gas exchange

2. Pathway of blood flow and limited circulation to the lungs in utero

3. Oxygen levels

4. Anatomical differences between fetal and adult circulation

5. Physiological changes of the cardiovascular system at birth

6. Anatomical changes of the cardiovascular system at birth

G. Interpret arterial blood gas levels at the following stages:

1. Fetal

2. At birth

3. 24 hours after birth

H. Describe the physiologic events that must occur with the first breath, to include:

1. Inflation pressures

2. Stimulus to breathe

3. Role of the lung fluids

I. Describe the compliance and resistance of the newborn lung.

J. Compare the OHDC relationship of the newborn with that of the adult.

K. Compare fetal hemoglobin to adult hemoglobin and the implications for oxygenation.

II. Maternal and Fetal Assessment

A. Describe factors relating to high-risk pregnancies and deliveries that may result in an increased potential for respiratory distress of the neonate.

B. Describe the following assessment techniques used to determine fetal status:

1. Amniocentesis

2. Ultrasound

3. Fetal heart monitoring

C. Compare and contrast studies that determine lung maturity.

D. Describe early, late, and variable decelerations, and the implications for delivery.

E. Apply the APGAR scoring system to clinical descriptions of a newborn.

F. Describe the methods used to determine gestational age.

G. Analyze the respiratory rate, heart rate and blood pressure for presented scenarios.

H. Differentiate between periodic breathing and apnea.

I. Describe thermoregulation for newborns and the implications of heat loss or cold stress of the newborn.

J. Identify factors that will contribute to newborn heat loss or cold stress, given presented scenarios.

K. Describe the causes and basic management of hyperbilirubinemia.

L. Analyze clinical lab findings and radiologic findings for presented scenarios.

M. Describe why and how aseptic conditions are maintained in the nursery.

N. Differentiate between Level I, Level II and Level III nurseries.

III. Neonatology

A. Describe the assessments made in the physical and neurological exam of the neonate.

B. Describe the etiology, pathophysiology, signs, symptoms and clinical findings for the following neonatal disorders:

1. Respiratory distress syndrome (RDS)/Hyaline Membrane Disease (HMD)

2. Transient Tachypnea of Newborn (TTN or TTNB)

3. Bronchopulmonary Dysplasia (BPD)/Chronic Lung Disease (CLD)

4. Meconium Aspiration Syndrome (MAS)

5. Air leaks (pneumothorax, Pneumomediastinum and Pulmonary Interstitial Emphysema (PIE)

6. Pneumonia/Infection/Sepsis

7. Asphyxia

8. Intraventricular Hemorrhage (IVH)

9. Apnea of prematurity

10. Persistent Pulmonary Hypertension (PPHN)/Persistent Fetal Circulation (PFC)

11. Retinopathy of Prematurity (ROP)

C. Analyze the available clinical data to determine the disease or pathophysiological state for presented neonatal scenarios.

D. Develop a respiratory care plan for the neonatal disorders identified in presented neonatal disorders.

E. Describe the technique(s), equipment selection and characteristics, and patient applications necessary to conduct pediatric resuscitation efforts according to established protocols.

F. Describe the potential developmental outcomes that are associated with the care of infants with early respiratory difficulties.

IV. Congenital Defects

A. Describe the defect, the primary means of diagnosis, and general and respiratory treatment management for the following defects:

1. Congenital pulmonary anomalies

a. Choanal atresia

b. Tracheo-esophageal anomalies

c. Pierre Robin Syndrome

d. Congenital Diaphragmatic Hernia (CDH)

2. Congenital cardiac anomalies

a. Transposition of the great vessels (TGV)

b. Tetralogy of Fallot (TOF or TET)

c. Atrial Septal Defect (ASD)

d. Ventricular Septal Defect (VSD)

e. Patent Ductus Arteriosus (PDA)

f. Coarctation of the aorta (Coarc)

g. Tricuspid/pulmonary atresia

h. Total Anomalous Pulmonary Venous Return (TAPVR)

i. Truncus Arteriosus

j. Hypoplastic left heart

k. Subaortic stenosis

3. Miscellaneous conditions

a. Necrotizing enterocolitis (NEC)

b. Gastroschisis

c. Omphalocele

d. Myelomeningocele

B. Analyze the available clinical data to determine the disease or pathophysiological state for presented congenital defect scenarios.

C. Develop a respiratory care plan for the neonatal disorders identified in presented congenital defect scenarios.

V. Care of the Pediatric Patient

A. Determine normal physical characteristics, psychosocial skills, and motor development for infants, toddlers, preschool, school age and adolescent patients.

B. Describe appropriate communication and teaching techniques for the five age groups.

C. Describe the etiology, pathophysiology, signs, symptoms and clinical findings for the following pediatric disorders:

1. Asthma

2. Bronchiolitis/Respiratory Syncytial Virus (RSV)

3. Croup/Laryngotracheobronchitis (LTB)

4. Epiglottis

5. Cystic Fibrosis

6. Sudden Infant Death Syndrome (SIDS)

7. Aspiration/Inhalation

8. Near drowning

9. Head trauma

10. Neuromuscular disorders

11. RDS

12. Reyes Syndrome

D. Analyze the available clinical data to determine the disease or pathophysiologic state for presented neonatal scenarios.

E. Develop a respiratory care plan for the neonatal disorders identified in presented neonatal disorders.

F. Describe the technique(s), equipment selection, and patient applications necessary to conduct pediatric resuscitation efforts according to established protocols.

VI. Transport

A. Compare and contrast the modes of transport.

B. Relate the effects of altitude with air transport to include patient problems, equipment problems and the effects on transport team members.

C. Describe stabilization techniques that may be performed by the transport therapist.

D. Discuss the appropriate support measures for a patient with marginally acceptable blood gas values prior to leaving on transport.

E. Describe the considerations that should be made when selecting equipment for transport.

F. Describe the considerations that should be made when determining if a patient should be transported to a major care center.

G. Calculate length of gas service for given patient transport scenarios.

VII. Home Care

A. Describe the roles and responsibilities of a discharge planning team member.

B. Determine the considerations that should be made when selecting equipment for home care.

C. Describe tracheostomy home care for patients.

D. Compare gas systems used for home care to include gas cylinders, liquid systems and concentrators and determine the most appropriate system for selected home care situations.

E. Contrast patient oxygen delivery devices and respiratory therapy equipment used for home care and determine the most appropriate equipment for selected home care situations.

F. Describe the patient/family/caregiver education that should be provided for respiratory home care situations.

VIII. Assessment and Management of Oxygenation and Ventilation

A. Describe the assessment and monitoring techniques used for the neonatal/pediatric patients and to patient scenarios.

B. Describe the principles and goals of neonatal/pediatric mechanical ventilation.

C. Describe the indications and complications associated with neonatal/pediatric mechanical ventilation.

D. Describe the relationships that exist between the following ventilatory parameters for both time-cycled/pressure limited and volume-cycled ventilators and appropriately apply them to neonatal/pediatric scenarios and specified ventilators:

1. Tidal volume

2. Peak inspiratory pressure

3. Flow rate

4. Inspiratory time

5. Mean airway pressure

6. Respiratory rate

7. I:E ratio

8. Time constants

9. Positive and expiratory pressure

E. Determine the appropriate airway type and size for given neonatal/pediatric patients.

F. Determine the appropriate humidification device for neonatal/pediatric mechanical ventilation.

G. Initiate appropriate patient parameters and alarms for given clinical data and neonatal/pediatric disorders.

H. Modify parameters as indicated by ABG’s and other clinical data.

I. Apply weaning criteria to given patient scenarios.

J. Describe weaning methods used in given patient scenarios.

K. Describe methods of assessing and monitoring the ventilated patient.

L. Describe clinical indications and delivery techniques for surfactant replacement therapy.

M. Describe extubation criteria and procedures.

N. Describe the indications, initiation of, and adjustments made for oscillating and high-frequency ventilation.

O. Describe the indications and application of extracorporeal membrane oxygenation, liquid ventilation, nitric oxide therapy and other non-conventional techniques to address oxygenation and ventilation difficulties.

P. Describe the effects of Continuous Positive Airway Pressure (CPAP) therapy on the following:

1. Functional Residual Capacity (FRC)

2. Lung compliance

3. Airway resistance

4. Respiratory rate

5. Cardiac output

6. Pulmonary blood flow

7. Cerebral blood flow

8. Arterial blood gases

Q. Describe the indications, equipment and delivery techniques, potential complications and adverse effects relating to CPAP therapy and apply to given patient scenarios.

R. Compare and contrast the various CPAP system setups for advantages and disadvantages.

Content Outline and Competencies:

I. Obstructive Lung Diseases

A. Discuss the etiology, pathophysiology and stages of the following obstructive lung diseases:

1. COPD

2. Asthma

3. Bronchiectasis

4. Cystic fibrosis

B. Distinguish patient assessment, radiological, pulmonary function and laboratory findings associated with each of the identified obstructive lung diseases to determine pathophysiological stage.

C. Discuss cor pulmonale as it relates to chronic obstructive pulmonary disease (COPD).

D. Develop a treatment plan for obstructive lung diseases to include:

1. Oxygen therapy

2. Therapeutic procedures

3. Mechanical ventilation

4. Rehabilitation

5. Sub-acute/home care

II. Perioperative Care

A. Describe pulmonary considerations for the surgical patient.

B. Discuss the pre-operative and post-operative conditions and complications of the surgical patient.

C. Distinguish patient assessment, radiological, pulmonary function and laboratory findings associated with respiratory failure.

D. Develop a treatment plan for the perioperative period of the surgical patient.

III. Chest Trauma and Emergency Care

A. Produce appropriate priority action and emergency life support techniques for management of emergency situations.

B. Review airway management techniques to include:

1. Patient positioning

2. Foreign body removal

3. Artificial oral airways

4. Artificial endotracheal airways

5. Artificial tracheal airways

6. Oropharyngeal, endotracheal and tracheal suctioning

7. Endotracheal intubation and extubation

8. Laryngeal mask airways

9. Combitube airways

10. Esophageal obturator

11. Mouth-to-mouth, mouth-to-mask, bag/mask, bag/tube resuscitation

C. Contrast the approximate fraction of oxygen in expired air (FECO2) and the fraction of expired oxygen (FEO2) values delivered with mouth-to-mouth resuscitation to the patient’s ventilation needs.

D. Discuss hazards associated with cardiac compressions and ventilation during cardiopulmonary resuscitation (CPR) with measures taken to minimize the hazards.

E. Discuss methods to achieve maximum fraction of inspired oxygen (FIO2) delivered with a manual resuscitator.

F. Describe the indications, effectiveness factors and techniques of:

1. Closed chest massage

2. Open chest massage

3. Defibrillation

4. Cardioversion

G. Discuss the initial and secondary assessment of the trauma patient for application to real and simulated patient scenarios.

H. Identify abnormal findings associated with each of the following using physical exam and topographical and anatomical landmarks:

1. Simple rib fractures or flail chest

2. Pulmonary contusion

3. Pleural effusion

4. Fat emboli

5. Sucking chest wounds

6. Simple pneumothorax

7. Tension pneumothorax

8. Hemothorax

9. Cardiac contusion

10. Cardiac tamponade

11. Rupture or laceration of:

a. Airways

b. Major vessels

c. Diaphragm

I. Determine the etiology, pathology, clinical findings and management for the identified conditions above.

J. Determine causes for respiratory failure after resuscitation or chest trauma.

K. Compare the etiology, pathology, clinical findings and management for three types of shock:

1. Hypovolemic

2. Cardiogenic

3. Distributive

L. Describe the appropriate conditions and placement of chest tubes for air and fluid evacuation.

M. Identify when a chest tube is indicated in the treatment of a pleural effusion.

N. Contrast the features, function and precautions associated with the chest drainage systems:

1. Three-bottle

2. Pleur-Evac or other disposable systems

O. Recognize improper function of chest drainage systems with identification of appropriate troubleshooting measures to correct the improper function.

IV. Lung Insults

A. Review adult and pediatric CPR to include management of the obstructed airway.

B. Describe the pathogenesis and pathophysiology for the following lung insults:

1. Status asthmaticus

2. Smoke inhalation

3. Pulmonary burns

4. Aspiration of a foreign body or gastric contents

5. Near drowning

6. Pulmonary emboli and infarcts

7. Cardiac vs. non-cardiac pulmonary edema

8. Surgery

9. Infectious diseases

10. Disseminated intravascular coagulation (DIC)

C. Describe, for the above insults, patient signs and symptoms, clinical laboratory and X-ray findings.

D. Develop, for the above insults, a prioritized respiratory management care plan.

E. Describe the pathogenesis and pathophysiology for acute respiratory distress syndrome (ARDS).

F. Describe mechanical ventilation strategies utilized in lung insult patients.

V. Cardiac Patients

A. Differentiate lipoproteins.

B. Contrast the three types of angina.

C. Identify diagnostic tests to detect myocardial infarction.

D. Describe the treatment for angina.

E. Identify diagnostic tests for chest pain.

F. List signs and symptoms of a myocardial infarction.

G. Classify cardiac disease.

H. Discuss the various cardiac enzymes and their significance.

I. Identify the coronary arteries.

J. Describe the pathophysiology and signs and symptoms of the following disease states:

1. Congestive heart failure

a. Right heart failure

b. Left heart failure

2. Cardiomyopathy

a. Hypertrophic

b. Congestive

c. Restrictive

3. Pulmonary edema

4. Valvular disease

a. Mitral

b. Tricuspid

5. Shock

a. Cardiogenic

b. Hemorrhage

c. Hypovolemic

d. Neurogenic

e. Anaphylactic

f. Traumatic

g. Septic

K. Identify the indications for coronary angioplasty.

L. Identify the indications for coronary artery bypass surgery.

M. Describe the use of cardioplesia solution.

N. Describe the pulmonary risk of thoracic surgeries to include:

1. Phrenic nerve injury

2. Impaired PFTs

3. Hemodilution

4. Respiratory depression

O. Describe ventilation and bronchial hygiene management of the cardiac patient.

P. Identify interventions for failing hearts including:

1. Heart transplants

2. Pacemakers

3. Automatic / artificial implantable cardioverter defibrillators (AICD)

4. Intra-aortic balloon pumps

5. Ventricular assist devices

VI. Neurological Management

A. Identify the abnormal breathing patterns associated with neurological conditions.

B. Describe the effects of intracranial pressure changes and cerebral edema.

C. Develop a comprehensive respiratory management plan of care for the neurological patient as it applies to each of the following conditions:

1. Cerebral edema due to head trauma

2. Hyperventilation states:

a. Reyes syndrome

b. Neurogenic pulmonary edema

c. CNS lesion

d. Viral or bacterial meningitis

e. Salicylate intoxication

3. Neurological and neuromuscular disorders resulting in hypoventilation:

a. Landry-Guillain-Barré syndrome

b. Poliomyelitis

c. Trauma of spinal cord

d. Myasthenia gravis

e. Multiple sclerosis

f. Neural infections

4. Abnormal respiratory center drive resulting in hypoventilation:

a. Drug overdose

b. Sleep-related hypoventilation

5. Respiratory muscle disorders and related conditions:

a. Polymyositis

b. Huntington’s chorea

c. Amyotrophic lateral sclerosis  

d. Muscular dystrophy

e. Seizures

f. Coma

g. Cardiovascular accidents (CVA)

D. Describe the etiology and diagnosis of each of the above conditions.

Content Outline and Competencies:

I. Knowledge, Skills and Technical Proficiency of a Respiratory Therapist

A. Demonstrate the necessary knowledge and skills related to patient data evaluation and recommendations.

1. Patient record

2. Clinical information

3. Procedures

4. Procedure results

5. Diagnostic procedures

B. Demonstrate the necessary knowledge and skills to troubleshoot and perform quality control of equipment and infection control.

1. Equipment

2. Infection control procedures

3. Quality control procedures

C. Demonstrate the necessary knowledge and skills to initiate and modify interventions.

1. Airways

2. Airway clearance and lung expansion techniques

3. Oxygenation and ventilation measures

4. Medications and specialty gases

5. Respiratory care plan

6. Evidence-based medicine principles

7. Respiratory care techniques in high-risk situations

8. Special procedures

9. Patient and family education

10. Patient safety

II. Professional Behavior of a Respiratory Therapist

A. Demonstrate compliance with the NBRC Standards of Conduct.

B. Demonstrate the ability to follow protocols, guidelines and standards regarding respiratory care procedures and safety and infection-control issues.

C. Demonstrate effective written, non-verbal and verbal communication skills.

D. Demonstrate professional demeanor and interactions with staff, supervisor, patients and other healthcare professionals.

E. Prioritize professional responsibilities as they relate to attendance, punctuality, appearance and conduct.

III. Career Options

A. Demonstrate the ability to administer pulmonary home care.

1. Oxygen therapy systems

2. Home O2 equipment

3. Role of the respiratory practitioner in home care

4. Living conditions and family acceptance

5. Ventilator selection

6. Apnea monitors

7. Home care provider company:

a. Proper setup procedures

b. Verbal and written instructions to patient/family

c. Visual demonstration and practice of equipment

d. Provision of round-the-clock service

e. Billing process

B. Demonstrate ability to administer pulmonary rehabilitation services.

1. Patient program goals

2. Guidelines and basic designs

3. Plan implementation

4. Rehabilitation plan selection

5. Patient compliance

6. Patient instructions for:

a. Graded exercise breathing pattern

b. Home respiratory equipment cleaning procedures

c. Breathing patterns to accommodate activities of daily living (ADL)

7. Breathing exercises

8. Multidisciplinary roles

9. Ambulation and body mechanics

10. Range of motion

11. Disease management

IV. Respiratory Care Management

A. Describe the manager’s responsibilities to patients in relation to institutional mission statements.

B. Identify the influences on reimbursement and coverage to include:

1. Medicare

2. Medicaid

3. Fee for service

4. Diagnostic Related Groupings (DRGs)

5. Health Maintenance Organizations (HMOs)

6. Managed care

7. Prospective payment

C. Describe the impact of current healthcare delivery trends on respiratory care practice to include:

1. Specialty work teams

2. Consensus teams

3. Patient-focused care

4. Protocols

5. Disease management

6. Re-engineering

7. Collaborative care

8. Clinical care pathways

9. Long-term care, rehab units, etc.

10. Multi-skilling

D. Identify the impact of The Joint Commission (TJC) and other regulatory bodies on the respiratory therapist (RT) to include:

1. Competency profiles

2. License/registration requirements

E. Identify the procedures and expectations of the respiratory care graduate hiring process to include:

1. The employer’s desired applicant qualities

2. Procedures for applicant position inquiries

3. The interview process

4. The orientation process

5. One- and five-year goal setting

F. Validate respiratory care knowledge and skills through scoring at or above the cut score for the simulated therapist multiple choice and clinical simulation examinations.

Content Outline and Competencies:

I. General Respiratory Care Implementation Objectives

A. Demonstrate the ability to gather appropriate data from the patient record in a timely manner.

B. Gather additional data from other appropriate resources.

C. Demonstrate the ability to perform, measure, interpret and analyze results for:

1. Vital signs (VS)

2. Pulse oximetry

3. ABGs, co-oximetry and other oxygenation and ventilation assessments

4. Electrocardiogram (ECG)

5. Artificial airway pressures

6. Other diagnostic tests (nutrition, sleep, stress, metabolic)

D. Demonstrate the ability to determine the appropriateness of the respiratory care plan and make modifications.

E. Demonstrate the ability to determine the disease or pathophysiological state through evaluating data and clinical evidence.

F. Demonstrate the ability to administer assigned therapeutic procedures according to established procedures or protocols with appropriate safety, dexterity and timing.

1. Obtain equipment appropriate to the respiratory care plan.

2. Assemble equipment prior to patient use with appropriate attention to safety, dexterity and timing.

3. Correct malfunctions of equipment identified, demonstrating appropriate dexterity, timing and attention to patient safety.

4. Maintain equipment cleanliness through the use of standard precautions and institution policies and procedures.

5. Demonstrate the ability to adhere to infection control procedures, proper body kinetics and patient safety at the bedside.

6. Explain planned therapy and goals to the patient and family members in understandable terms.

7. Assess patient responses to respiratory care therapies throughout the interaction with patients.

8. Modify therapeutic procedures based on patient responses and established protocols.

9. Record complete and accurate entries for therapies, procedures and diagnostic test results in patient and departmental records as required in the healthcare setting and by regulating agencies.

G. Recognize indications, contraindications and adverse effects related to administered therapies and pharmacological agents.

H. Demonstrate the ability to assist physicians in performing special procedures.

I. Demonstrate the ability to work well with peers by sharing opportunities, offering assistance and appropriately participating in discussions in a positive manner.

J. Demonstrate the ability to collaborate professionally with clinical instructors for assistance with patients and to clarify patient care practices.

K. Demonstrate the ability to practice courteous, concise and timely communication between respiratory care practitioners and all members of the  healthcare team relating to:

1. Patient assessment

2. Benefits and responses of therapy

3. Clinical indications for therapy

4. Recommendations for modification or diagnostic testing

5. Clarification of orders

L. Demonstrate the use of computer technology in patient management.

M. Demonstrate the ability to develop and practice program and professional standards for appearance and promptness in performance of assigned responsibilities.

N. Demonstrate the ability to execute patient care following clinical directions with appropriate clarifications and action.

O. Perform care in a safe manner avoiding any risk to patient, self, or other healthcare team members.

P. Demonstrate the ability to practice acquired clinical skills in all patient care areas showing competency, autonomy and professionalism.

Q. Integrate logistical approaches to improve timing, efficiency and decision making without compromising patient care.

R. Demonstrate flexibility through handling interruptions or abrupt changes in assignments with composure and professionalism.

II. Airway Care

A. Apply general respiratory care implementation objectives to all assigned therapies and activities.

B. Adhere to infection control policies and procedures relating to airway care.

C. Review X-rays for endotracheal tube (ET) or tracheal (trach) tube positioning while noting the presence of possible supra or subglottic edema, or airway narrowing.

D. Perform cuff pressures of ET or trach tubes to assure optimal respiratory care practices.

E. Demonstrate the ability to describe the function, principles of operation, characteristics and advantages and disadvantages of the equipment used in airway care and secretion clearance for:

1. Vacuum systems

2. Open and in-line suction catheters

3. Specimen collectors/traps

4. Oral suction devices

5. Oro/nasal pharyngeal airways

6. Trach tubes and buttons

F. Discuss therapeutic procedures to maintain a patent airway including:

1. Proper patient position

2. Adequate humidification

3. Proper cuff inflation

4. Proper tube placement

5. Trach insertion and care

6. Insertion of oro/nasal pharyngeal airways

7. Proper tube stabilization

G. Discuss therapeutic procedures assigned to remove bronchopulmonary secretions, specifically:

1. Nasotracheal suctioning

2. Open and closed system ETT suctioning

3. Open and closed system tracheal suctioning

H. Demonstrate the ability to evaluate, monitor and make recommendations based on the patient’s response as it applies to airway care and airway patency through:

1. Chest X-rays

2. ABGs and pulse-oximetry

3. Sputum production and consistency

4. Patient’s subjective responses

5. VS and cardiac rhythms

6. Oxygen and liter flow requirements

7. Breath sounds

8. ETT or trach cuff pressures

I. Recognize indications, contraindications and possible adverse effects related to airway care procedures.

1. Therapy-induced hypoxemia

2. Therapy-induced vagal response

3. Mucus plugging from inadequate humidification

4. Improper artificial airway placement

III. Subacute Care Areas

A. Demonstrate the ability to apply the general respiratory care implementation objectives to all assigned therapies and activities with specific applications in the subacute area.

B. Select appropriate equipment to change humidification, breathing circuit and related supplies for ventilators.

C. Assemble functioning equipment.

IV. Hyperinflation Therapy

A. Apply general respiratory care implementation objectives to all assigned therapies and activities.

B. Review X-rays for changes including presence of air, consolidation or fluid in chest fields.

C. Demonstrate the ability to review planned hyperinflation therapy to establish therapeutic goals and appropriateness of prescribed therapy.

D. Demonstrate the ability to describe the function, principles of operation, characteristics and advantages and disadvantages of the following equipment used for hyperinflation therapy:

1. Intermittent Positive Pressure Breathing (IPPB)

2. Continuous Positive Airway Pressure (CPAP) and Bilevel Positive Airway Pressure (BiPAP)

3. Incentive spirometry (IS)

4. Intrapulmonary Percussive Ventilation (IPV)and Positive Expiratory Pressure (PEP)

E. Discuss therapeutic procedures to achieve adequate hyperinflation.

1. Proper breathing techniques

2. Incentive spirometry

3. IPPB, CPAP, or BiPAP

F. Demonstrate the ability to evaluate, monitor and make recommendations based on the patient’s response as it applies to hyperinflation therapy.

1. Chest X-rays

2. ABGs and/or pulse-oximetry

3. Changes in sputum production and consistency

4. Patient’s subjective responses

5. VS and cardiac rhythms

6. Oxygen and liter flow requirements

7. Auscultation

8. Patient’s therapeutic lung volumes

G. Demonstrate the ability to recognize indications, contraindications and possible adverse effects related to hyperinflation procedures.

V. Critical Care Areas

A. Apply the general respiratory care implementation objectives to all assigned therapies and activities within the critical care areas.

B. Identify the differences in the sights, smells, pace, activity, communication and acuity of care in the critical care area.

C. Select appropriate equipment to change humidification, breathing circuits for mechanical ventilation.

D. Assemble equipment.

VI. Aerosol and Bronchial Hygiene Therapies

A. Apply general respiratory care implementation objectives to all assigned therapies and activities.

B. Review X-ray for presence of air, consolidation and fluid in chest fields.

C. Review the therapeutic plan for aerosol therapy assuring therapeutic goals and modifications.

D. Review the therapeutic plan for bronchial hygiene therapy assuring therapeutic goals and modifications.

E. Demonstrate the ability to describe the function, principles of operation, characteristics and the advantages and disadvantages of the equipment used to deliver aerosol therapies:

1. Medication nebulizers

2. Metered Dose Inhaler (MDI) with spacers

3. Large reservoir nebulizers

4. Ultrasonic nebulizers

F. Demonstrate the ability to describe the function, principles of operation, characteristics and the advantages and disadvantages of the equipment used to deliver bronchial hygiene therapies:

1. Vibrators and percussors

2. Kinetic or similar beds

3. Flutter valves

4. High Frequency Chest Wall Oscillation (HFCWO)

5. IPV, PEP and other multipurpose therapies

G. Discuss therapeutic procedures specific to aerosol therapy:

1. Prescribed pharmacological agents delivery via medication nebulizers, MDI and MDI with spacer.

2. Large reservoir nebulizers

3. Ultrasonic nebulizers

H. Demonstrate therapeutic procedures specific to bronchial hygiene therapy:

1. Postural drainage, including proper positioning for the areas of involvement

2. Vibration and percussion

3. Flutter valve

4. HFCWO

5. IPV, PEP and other multipurpose therapies

6. Autogenic drainage

I. Demonstrate the ability to evaluate, monitor and make recommendations, based on patient’s response to aerosol and bronchial hygiene therapies.

1. Chest X-ray

2. ABG and pulse-ox

3. Changes in sputum production and consistency

4. Patient’s subjective response

5. VS and cardiac rhythm

6. Oxygen and liter flow requirements

7. Breath sounds

8. Fluid balance

J. Demonstrate the ability to recognize indications, contraindications and possible adverse effects related to aerosol and bronchial hygiene therapy.

VII. Clinic Time Management

A. Demonstrate the ability to apply the general respiratory care implementation objectives to all assigned therapies and activities with specific applications in the critical care area.

B. Demonstrate the ability to organize, prioritize and safely administer a workload that would be at least 50% of that assigned to a staff member.

C. Demonstrate the ability to identify, organize, prioritize and complete other responsibilities of a staff member in the course of a shift to include:

1. Stat oxygen setups

2. Stat blood gas and oximetry

3. Code blue or emergency calls

4. Stat therapies

5. Physician assistance

6. Patient transport

VIII. Cardiac Patient Care

A. Apply general respiratory care implementation objectives to all assigned therapies and activities.

B. Demonstrate the ability to identify the differences in the sights, smells, pace, communication and acuity of care that occur in the cardiac critical care area.

C. Obtain appropriate equipment for changes in humidification and the mechanical ventilator breathing circuit.

D. Review the blood flow through the heart and cardiac circulation to the heart.

E. State the pathophysiology with the appropriate care plan for each of the following disease processes:

1. Hypertension

2. Myocardial infarction

3. Cardiac valve disorders

4. Congestive heart failure

5. Cardiomyopathy

F. Assess overall patient cardiopulmonary status by:

1. Inspection for venous distention, peripheral edema that may be significant for the cardiac patient.

2. Palpation for heart rate, rhythm and force.

3. Auscultation for verification of heart sounds, dysrhythmias, murmurs, bruits.

G. Discuss diagnostic testing procedures for cardiac disease, to include:

1. Cardiac catheterization

2. Exercise stress testing

3. Thallium stress testing

4. Echocardiograms

5. Holter monitoring

6. Lab data

H. Discuss therapy interventions for cardiac abnormalities, to include:

1. Pacemakers

2. Cardiac rehab

3. Thrombolitic therapy

4. Cardioversion

5. Defibrillation

6. Fluid balance

I. Demonstrate the ability to discuss indications, contraindications and possible adverse effects related to interventions and pharmacological agents used in cardiac patient care:

1. Angiotensin Converting Enzyme (ACE)  inhibitors

2. Beta blockers

3. Calcium antagonists

4. Diuretics

5. Anti-arrhythmic

6. Oxygen

7. Anti-thrombolytics

J. Demonstrate the ability to practice basic ECG interpretations with descriptions of therapeutic interventions for identified rhythms, including the application of BLS and ACLS protocols for cardiopulmonary collapse.

K. Determine cylinder length of service for patients being transported for various procedures.

IX. Pediatric Management

A. Apply general respiratory care implementation objectives to the pediatric population.

B. Demonstrate the ability to assess cardiopulmonary patient learning needs, vital signs and clinical signs and symptoms that are manifested in a child with respiratory distress.

C. Demonstrate the ability to describe the function, principles of operation, characteristics, advantages and disadvantages and applications to the pediatric population of:

1. Oxygen administration devices, including oxygen tents and hoods

2. Humidifiers

3. Aerosol generators, including oxygen tents

4. Hyperinflation devices

5. Secretion clearance devices

6. Resuscitation devices

7. Artificial airways

D. Explain planned therapy and goals to patient and family members in understandable terms.

E. Discuss therapeutic procedure applications for the pediatric population in:

1. Maintenance of a patent airway

2. Removal of bronchopulmonary secretions

3. Achievement of adequate ventilation

4. Achievement of adequate oxygenation

F. Describe the pathophysiology and the appropriate care plan for each of the following disease processes:

1. Croup

2. Epiglottitis

3. Cystic fibrosis

4. Asthma

5. Bronchiolitis

6. Respiratory Syncytial Virus

G. Discuss treatment of pediatric cardiopulmonary collapse according to Pediatric Advanced Life Support protocols.

X. Blood Gas Procurement, Analysis and Interpretation

A. Demonstrate the ability to appropriately contact the instructor, staff and others for assistance.

B. Demonstrate the ability to safely perform arterial puncture for blood gas analysis.

C. Demonstrate the ability to review existing data in the patient record and recommend procedures to obtain additional data assuring  a safe arterial puncture and correlated interpretations for:

1. Pulse oximetry

2. Clinical lab data

3. Previous ABGs

4. Medications

D. Demonstrate the ability to perform, measure, calculate and interpret results for:

1. ABGs acid base and oxygenation status

2. Co-oximetry

3. Alveolar-arterial gradient (P(A-a)O2)

4. Oxygen content

5. Bicarbonate (HCO3) estimation

6. HCO3 administration

7. Hydrogen (H+) ion content

8. Venous results

9. Mixed venous results

E. Demonstrate the ability to identify potential causes for a given acid/base state with recommended changes to the therapeutic plan.

F. Demonstrate the ability to perform blood gas quality control procedures on analyzing equipment and discuss implications of the results.

G. Demonstrate the ability to describe the function, principles of operation, characteristics and advantages and disadvantages of the equipment used for obtaining and analyzing the sample.

1. PO2 electrode

2. PCO2 electrode

3. pH electrode

4. Co-oximeter

5. Specialty gas mixtures

6. Arterial line equipment

7. Pulmonary artery equipment

H. Contrast the use of tonometry for quality control of analyzing equipment with other quality control measures.

I. Demonstrate the ability to handle blood samples to avoid erroneous results.

J. Describe the changes imposed on the blood sample if:

1. Iced/Not iced

2. Large air bubble is present

3. Diluted with liquid heparin

4. Patient is hyper/hypothermic

5. Patient has abnormal electrolytes

6. Patient has leukocytosis

K. Demonstrate the ability to recognize indications, contraindications and possible adverse effects related to arterial puncture or line draw.

L. Record results in patient and department records using conventional terminology as required by the healthcare institution and regulatory agencies including:

1. Specify sample site, date, time

2. Patient’s adverse or subjective response

3. Correlating oxygen and/or ventilator management

4. Verify computations and note erroneous data

M. Apply computer technology to patient management.

N. Demonstrate the ability to communicate information regarding patient’s clinical status to appropriate members of the healthcare team.

XI. Fluid and Electrolyte Balance

A. Identify the four most common and two other electrolytes measured noting the accepted normal ranges and usual units of measurement.

B. Demonstrate the ability to identify the appropriate cations and anions and determine the anion gap and its implications.

C. Describe the following:

1. Where electrolytes are stored

2. Mechanisms for fluid loss by the body

3. How imbalances in fluid status may occur

4. Possible implications of imbalances in fluid status

5. Possible implications of electrolyte imbalances

XII. Specialty Practicum

A. Ensure selected equipment cleanliness.

1. Demonstrate the ability to determine appropriate agent and techniques for disinfection and sterilization

2. Demonstrate the ability to perform procedures for disinfection and sterilization

3. Discuss effectiveness of sterilization procedures

B. Review X-ray to determine proper ET/trach tube position.

C. Measure ET/trach tube cuff pressure and volume with interpretation.

D. Obtain the equipment appropriate for achieving a patent airway and resuscitation.

1. Vacuum systems

2. Open and in-line suction catheters

3. Oral suction devices

4. Bag/valve mask

5. Demand valve

6. Mouth/valve/mask

7. Oro/naso pharyngeal airways

8. Oro/naso ET tubes

9. Intubation equipment

10. Laryngeal Mask Adaptor (LMA)

11. Exhaled CO2 detection devices

E. Conduct therapeutic procedures to maintain a patent airway and resuscitation.

1. Insertion of oro/naso pharyngeal airways

2. Intubation and extubation

3. Proper tube placement with stabilization

4. Proper cuff inflation

5. Proper patient position

F. Demonstrate the ability to recognize indications, contraindications and possible hazards relating to maintaining a patient airway and resuscitation.

G. Interpret results of ECG.

H. Discuss treatment of cardiopulmonary collapse according to BLS and ACLS protocols.

I. Obtain equipment appropriate to changing the breathing circuit and humidification setup on ventilators with external exhalation valves, external PEEP valves and closed system suction setups.

J. Select equipment appropriate for delivering aerosolized pharmacological agents in-line with the ventilator.

K. Demonstrate proper placement of equipment in-line with the ventilator to deliver aerosolized pharmacological agents.

XIII. Physician Rounds

A. Review data in the patient record determining the need for additional data.

B. Assess overall patient cardiopulmonary status by inspection and auscultation.

C. Assess overall patient cardiopulmonary status by percussion and palpation.

D. Observe taking a patient history.

E. Review findings of X-ray.

F. Demonstrate the ability to review planned therapy, ,establish therapeutic goals and recommend modifications to the therapeutic plan.

G. Discuss how the respiratory care practitioner may assist the physician in performing special procedures including:

1. Cardioversion

2. Intubation

3. Bronchoscopy

4. Thoracentesis

5. Insertion of chest tubes

6. Conscious sedation

H. Demonstrate the ability to communicate with the physician regarding patient assessment, benefits and responses to therapy, continuing clinical indications for therapy and recommendations for modification in therapy or diagnostic testing.

XIV. Polysomnography

A. Differentiate between active and quiet sleep stages.

B. Differentiate between obstructive, central and mixed apneas.

C. Review the technical aspects of performing a sleep study:

1. Equipment used

2. Patient preparation

3. Patient history and physical

4. Study procedures

5. Cleaning and calibration

D. Discuss the methods of treating sleep disorders with the appropriate method for specific patients conditions including:

1. Surgical interventions

2. Weight loss

3. Drug therapy

4. Nocturnal oxygen therapy (NOT)

5. CPAP or BiPAP

6. Diaphragmatic pacing

E. Discuss the scoring of polysomnography.

F. Discuss how the respiratory care practitioner may assist the physician in sleep studies.

XV. Diagnostic Bronchoscopy

A. Discuss the indications for a diagnostic bronchoscopy.

B. Discuss the potential complications for a bronchoscopy and strategies for minimizing complications.

C. Demonstrate the ability to observe, participate and identify the role of the respiratory care practitioner in assisting the physician with diagnostic bronchoscopy, to include:

1. Procedure setup

2. Patient preparation

3. Biopsy and specimen sample procurement and preparation

a. Needle biopsy

b. Retrieval baskets

c. Forceps

d. Blind and fluoroscopy assisted techniques

e. Brushings, washings

f. Specimen preparation for lab

4. Cleaning and disinfection of a bronchoscope

5. Physician technique for the procedure

Content Outline and Competencies:

I. General Respiratory Care Implementation Objectives

A. Demonstrate the ability to gather appropriate data from existing patient record in a timely fashion.

B. Gather additional needed data from other appropriate resources.

C. Demonstrate the ability to perform and measure, interpret and analyze results for:

1. Vital signs

2. Pulse oximetry

3. Arterial blood gases (ABGs), co-oximetry and other oxygenation and ventilation assessments

4. Electrocardiogram (ECG)

5. Artificial airway pressures

6. Respiratory mechanics and critical care indices

7. Other diagnostic tests (nutrition, sleep, stress, metabolic)

D. Demonstrate the ability to determine the appropriateness of the respiratory care plan and apply modifications.

E. Determine the disease or pathophysiological state through evaluating data and clinical evidence.

F. Administer assigned therapeutic procedures according to established procedures or protocols with appropriate safety, dexterity and timing.

1. Obtain equipment appropriate to the respiratory care plan

2. Assemble equipment prior to patient use with appropriate attention to safety, dexterity and timing

3. Correct malfunctions of equipment identified, demonstrating appropriate dexterity, timing and attention to patient safety

4. Maintain equipment cleanliness through the use of standard precautions and institutional policies and procedures

5. Demonstrate infection control procedures, proper body kinetics and patient safety at the bedside

6. Demonstrate the ability to explain planned therapy and goals to the patient and family members and confirm understanding of the information delivered

7. Assess patient responses to respiratory care throughout therapy

8. Modify therapeutic procedures based on patient responses and established protocols

9. Demonstrate the ability to record complete and accurate entries for therapies, procedures and diagnostic test results in patient and departmental records as required in the healthcare setting and by regulating agencies

G. Recognize indications, contraindications and adverse effects related to administered therapies and pharmacological agents.

H. Demonstrate the ability to assist physicians in performing special procedures.

I. Participate in physician’s rounds in the critical care units.

J. Demonstrate the ability to work well with peers in sharing opportunities, offering assistance and appropriately participating in discussions in a positive and timely manner.

K. Demonstrate the ability to collaborate professionally with clinical instructors for needed assistance with patients and to clarify questions about patient care.

L. Practice professional, concise and timely communication with all members of the healthcare team with regards to:

1. Patient assessment

2. Benefits/response of therapy

3. Continuing clinical indications for therapy

4. Recommendations for modification or diagnostic testing

5. Clarification of orders

M. Demonstrate the use of computer technology in patient management.

N. Project program and professional standards for appearance and promptness in performance of assigned responsibilities.

O. Execute patient care following clinical directions with appropriate clarifications and action.

P. Demonstrate the ability to perform care in a safe manner to avoid any risk to patient, self or other healthcare team members.

Q. Demonstrate acquired clinical skills in all patient care areas showing competency, autonomy and professionalism.

R. Integrate logistical approaches to improve timing, efficiency and decision making without compromising patient care.

S. Demonstrate flexibility through handling interruptions or abrupt changes in assignments with composure and professionalism.

II. Open Heart Surgical Management and Critical Care Monitoring

A. Apply general respiratory care implementation objectives to all assigned therapies and activities.

B. Demonstrate the ability to conduct therapeutic procedures to achieve adequate ventilation and oxygenation, including:

1. Selecting the appropriate ventilator and equipment

2. Initiating the various ventilator modes with modifications

3. Initiating weaning procedures with modifications

4. Implement Continuous Positive Airway Pressure (CPAP) and Positive End Expiratory Pressure (PEEP) with modifications

5. Position patients appropriately to minimize hypoxemia

6. Prevent procedure associated hypoxemia

C. Demonstrate the ability to evaluate and monitor patient’s responses to respiratory care, to include:

1. Lung compliance and airway resistance

2. Ventilator waveforms

3. Ventilator mean airway pressure

4. Ventilator alarms

5. Ventilator parameters

6. Hemodynamic calculations

7. Critical care indices

8. Clinical indicators of oxygenation and ventilation

9. Other patient monitoring measures including chest X-ray, clinical lab and electrocardiogram (ECG)

D. Demonstrate the ability to review existing data in the patient record and recommend procedures to obtain additional data for open heart surgical management and critical care monitoring.

1. Vital signs

2. Fluid balance

3. Respiratory monitoring

4. Hemodynamic monitoring

5. Other diagnostic studies as ordered

E. Assess overall patient cardiopulmonary status by:

1. Auscultation of heart sounds, dysrhythmias, murmurs, bruits

2. Bedside cardiopulmonary monitoring and weaning procedures

3. Review of X-ray

a. Endotracheal (ET) and tracheal tube positions

b. Position of chest tubes and hemodynamic catheters

4. Recognition of clinical signs of hypoxia and hypercapnia

F. Demonstrate the ability to perform, monitor and interpret results, as indicated:

1. Hemodynamic monitoring

a. Central venous pressure (CVP)

b. Cardiac output/cardiac index

c. Pulmonary artery wedge pressure (PAWP)

d. Pulmonary artery pressure (PAP)

e. Mixed venous sampling

f. Arterial-mixed venous oxygen content difference C(a-v) O2

g. Pulmonary vascular resistance (PVR)

h. Stroke volume resistance (SVR)

i. Stroke volume (SV)

2. Critical care indices

a. ABG profile

b. Arterial oxygen content (CaO2)

c. Saturation of oxygen in mixed venous blood (SvO2)

d. Weaning parameters

e. Partial pressure of arterial oxygen/ fraction of inspired oxygen (PaO2/FIO2)

f. Alveolar-arterial oxygen partial pressure difference (P(A-a)O2)

g. Rapid shallow breathing index (RSBI)

G. Establish therapeutic goals with modifications to prescribed therapy.

1. Pre-op evaluation and clinical indications for surgery

2. Surgical management or alternatives

3. Post-op clinical lab, ECG, ABG

H. Demonstrate the ability to discuss the function, principle(s) of operation, characteristics, advantages/disadvantages of the equipment and methods used to manage and monitor the open heart surgical or other critical patient.

1. Blood pressure monitoring via sphygmomanometer, Doppler and arterial catheter

2. Pulmonary artery catheter equipment

3. Chest tubes

4. Intra-aortic balloon pump

5. Left ventricular assist device

6. Ventilator and respiratory adjuncts

I. Demonstrate the ability to recommend therapeutic procedures and make necessary modifications to therapy based on patient responses.

J. Apply computer technology to patient management.

1. Charting

2. Ventilator waveform analysis

3. Patient care protocols/algorithms

III. Ventilator Management and Weaning

A. Apply general respiratory care implementation objectives to all assigned therapies and activities.

B. Demonstrate the ability to conduct therapeutic procedures to achieve adequate ventilation and oxygenation, to include:

1. Select the appropriate ventilator and equipment

2. Initiate ventilator modes with modifications

3. Weaning procedures

4. Initiate Continuous Positive Airway Pressure (CPAP) and Positive End Expiratory Pressure (PEEP) with modifications

5. Position the patient to minimize procedure induced hypoxemia

C. Demonstrate the ability to evaluate and monitor patient’s responses to respiratory care, to include:

1. Lung compliance and airway resistance

2. Ventilator waveforms

3. Ventilator mean airway pressure

4. Ventilator alarms

5. Ventilator parameters

6. Hemodynamic calculations

7. Critical care indices

8. Clinical indicators of oxygenation and ventilation

9. Other patient monitoring measures including chest X-ray, clinical lab and ECG.

D. Demonstrate the ability to review planned therapy to establish therapeutic goals and appropriateness of prescribed therapy and recommend changes in therapeutic plan, as indicated.

1. Contrast the following weaning methods:

a. T-tube trials

b. Synchronized intermittent mechanical ventilation (SIMV)

c. CPAP

d. Pressure support

e. Flow-by

2. Perform the following parameters for weaning:

a. Ventilation and FIO2 requirements

b. ABGs and pulse oximetry

c. Weaning parameters

d. Vital signs

e. Capnography

f. Sensorium and mentation

g. Deadspace volume/ tidal volume ratio (VD/VT)

E. Demonstrate the ability to discuss the function, principles of operation, characteristics, advantages and disadvantages, and indications of the equipment used to manage and monitor the weaning process.

1. Oxygen administration devices

2. Aerosol generators

3. Monitoring devices

F. Demonstrate the ability to appropriately measure parameters of the weaning process:

1. Respiratory monitoring

a. Frequency

b. VT

c. Minute ventilation (VE)

d. Inspiratory: Expiratory ratio (I:E ratio)

e. Inspiratory/Expiratory (I/E) pressures

f. Vital Capacity(VC)

g. Flow/volume/pressure waveforms

h. Lung compliance

i. Airway resistance

j. Work of breathing indices (RSBI)

k. Maximum inspiratory pressure (MIP)

G. Evaluate and monitor patient’s response to the weaning process.

IV. Airway Management

A. Apply general respiratory care implementation objectives to all assigned therapies and activities.

B. Demonstrate the ability to conduct therapeutic procedures to achieve adequate ventilation and oxygenation, to include:

1. Selecting the appropriate ventilator and adjunct equipment

2. Initiating and adjusting assist/control (A/C), SIMV, pressure support ventilation (PSV), pressure control ventilation (PCV) and flow-by

3. Initiating and modifying weaning procedures

4. Initiating and adjusting CPAP and PEEP

5. Positioning the patient to minimize hypoxemia

6. Preventing procedure associated hypoxemia

C. Demonstrate the ability to evaluate and monitor patient’s response to respiratory care, to include:

1. Lung compliance and airway resistance

2. Ventilator waveforms

3. Ventilator mean airway pressure

4. Ventilator alarms

5. Ventilator parameters

6. Hemodynamic measurements/calculation

7. Critical care indices

8. Clinical indicators of oxygenation and ventilation

9. Other patient evaluation/monitoring measures (chest X-ray, clinical lab, ECG, etc.)

D. Demonstrate the ability to perform the correct procedures to insert, secure and remove the following airways:

1. Oro /nasopharyngeal

2. Oro/nasotracheal

3. Tracheostomy

4. Trach button

E. Demonstrate the correct procedure for:

1. Minimum leak technique

2. Cuff pressure monitoring

3. Trach dressing changes

4. Trach inner cannula replacement

F. Demonstrate appropriate suctioning technique of the patient airway, including the use of demand valves, self-inflating resuscitation bags and flow inflating resuscitation bag.

G. Describe indications and possible complications associated with the use of airway equipment.

H. Discuss the concerns for maintaining a stable airway and ventilation during patient transport.

I. Compare the role of respiratory care in a subacute healthcare environment with that of the acute care environment.

V. Adult Critical Care Management and Capnography

A. Apply general respiratory care implementation objectives to all assigned therapies and activities.

B. Demonstrate the ability to conduct therapeutic procedures to achieve adequate ventilation and oxygenation, to include:

1. Selecting the appropriate ventilator and adjunct equipment

2. Initiating and adjusting A/C, SIMV, PSV, PCV and flow-by

3. Initiating and modifying weaning procedures

4. Initiating and adjusting CPAP and PEEP

5. Positioning the patient to minimize hypoxemia

6. Preventing procedure associated hypoxemia

C. Demonstrate the ability to evaluate and monitor patient’s response to respiratory care, to include:

1. Lung compliance and airway resistance

2. Ventilator waveforms

3. Ventilator mean airway pressure

4. Ventilator alarms

5. Ventilator parameters

6. Hemodynamic measurements/calculation

7. Critical care indices

8. Clinical indicators of oxygenation and ventilation

9. Other patient evaluation/monitoring measures (chest X-ray, clinical lab, ECG, etc.)

D. Demonstrate the ability to perform, measure and interpret results of capnography.

E. Discuss the function, principles of operation, characteristics and advantages and disadvantages of the capnography.

F. Demonstrate the ability to determine the amount of auto-PEEP present and discuss the significance and alternatives for relieving it.

VI. Neonatal/Pediatric Critical Care

A. Apply general respiratory care implementation objectives to all assigned therapies and activities of the neonatal and pediatric patient.

B. Demonstrate the ability to review existing data in the patient record and recommend procedures to obtain additional data, as indicated.

1. Physical exam/ Vital signs (VS)

2. Pulse oximetry and/or transcutaneous monitoring of carbon dioxide (TcCO2), transcutaneous monitoring of oxygen (TcO2) and ABGs

3. Lab data

4. Chest/upper airway X-ray

5. ECG and echocardiography

6. Fluid balance

7. Respiratory monitoring

8. Hemodynamic monitoring

9. Medications

10. Maternal and perinatal/neonatal history and data

C. Demonstrate the ability to review the differences between the child and an adult anatomy and physiology and describe how the following may influence therapy administration:

1. Size/position/characteristics of the tongue, larynx, epiglottis and trachea

2. Tidal volume and respiratory rate

3. Alveolar size and number

4. Rib cage shape and structure

D. Assess overall patient cardiopulmonary status by:

1. Inspection, including transillumination of infant chest, Apgar scoring and gestational age assessment

2. Auscultation

3. Assessment of family and patient learning needs with age appropriate interactions

4. Review of X-ray

E. Demonstrate the ability to perform, measure and interpret results:

1. Basic vital signs

2. Pulse oximetry

3. Transcutaneous monitoring for oxygen (O2)and carbon dioxide (CO2)

4. Apnea monitoring

F. Demonstrate the ability to analyze available data and discuss factors that determine pathophysiological state of neonatal and pediatric disorders.

1. Neonatal

a. Hyaline membrane disease (HMD)

b. Transient tachypnea of newborn (TTN)

c. Bronchopulmonary Dysplasia/Chronic Lung Disease (BPD/CLD)

d. Meconium aspiration syndrome (MAS)

e. Pulmonary interstitial emphysema (PIE)

f. Congenital heart anomalies

2. Pediatric

a. Respiratory syncytial virus (RSV)

b. Respiratory distress syndrome (RDS)

c. Sepsis

d. Neuromuscular disorders

e. Head injury

f. Asthma

g. Bronchiolitis

h. Croup

i. Epiglottitis

G. Demonstrate the ability to select and obtain equipment appropriate to the respiratory care plan and discuss specific applications and considerations for the neonatal and pediatric population.

1. O2 therapy (isolette, cannula, mask, oxyhood, croup tent, CPAP)

2. Aerosol and humidity therapy

3. Bronchial hygiene procedures

4. Suction and airway care

5. Ventilation, including high frequency oscillator

6. Monitoring TcO2, pre/post ductal oxygenation studies, umbilical arterial catheter/ umbilical venous catheter (UAC/UVC), temperature probes, oxygen analyzers, oxygen saturation monitors, ECG)

H. Demonstrate the ability to recognize indications, contraindications and possible adverse effects relating to respiratory therapy and management of the neonatal and pediatric patient.

I. Demonstrate the ability to recognize indications, contraindications, possible adverse effects and discuss delivery methods for respiratory related pharmacological agents as they apply to the neonatal and pediatric patient:

1. Sympathomimetics

2. Anti-asthmatics

3. Mucolytics

4. Aerosolized anti-viral agents

5. Aerosolized corticosteroids

6. Aerosolized antibiotics

7. Methylxanthines

8. Benzodiazepines

9. Neuromuscular blocking agents

10. Morphine

11. Corticosteroids

12. Indomethacin

13. Resuscitation drugs

14. Magnesium Sulfate

15. Surfactant replacement

J. Discuss Pediatric Advanced Life Support (PALS) and Neonatal Resuscitation Program (NRP) protocols for treatment of cardiopulmonary collapse including necessary equipment and techniques.

K. Observe a high-risk delivery as available.

L. Discuss neonatal/pediatric transport needs to include necessary equipment considerations.

M. Discuss modification of neonatal respiratory care procedures for use in the home while ensuring safety and infection control.

VII. Physician Rounds

A. Determine if data is missing from the patient record for a complete patient assessment.

B. Assess overall patient cardiopulmonary status by inspection and auscultation.

C. Assess overall patient cardiopulmonary status by percussion and palpation.

D. Participate in taking a patient history.

E. Review findings of X-ray and other diagnostic tests.

F. Demonstrate the ability to review therapy to establish therapeutic goals and need for modification.

G. Discuss how the respiratory care practitioner may assist the physician in performing special procedures:

1. Cardioversion

2. Intubation

3. Bronchoscopy

4. Thoracentesis

5. Insertion of chest tubes

6. Conscious sedation

7. Transtracheal aspiration

8. Percutaneous needle biopsy

9. Insertion of monitoring lines

10. Cardiopulmonary Stress Testing

11. Sleep studies

12. Tracheostomy

H. Practice communication occurring between the respiratory care practitioner and healthcare team for:

1. Patient assessment

2. Response of therapy

3. Clinical indications for therapy

4. Recommendations for modification in therapy

5. Diagnostic testing

VIII. Alternative Care Site

A. Differentiate between the levels of care in the acute care setting versus alternative care settings.

B. Discuss the implications of the various healthcare reimbursement plans for services in the alternative care setting.

1. Medicare

2. Medicaid

3. Preferred Provider System (PPS)

4. Health Maintenance Organization (HMO)

C. Demonstrate the ability to recommend changes for care after performing a general patient assessment.

D. Review interdisciplinary care plans for possible modification.

E. Demonstrate the ability to communicate the respiratory care plan and goals to the patient and family.

F. Demonstrate the ability to communicate patient information on clinical status and coordination of care to healthcare team members.

G. Demonstrate the ability to record the patient assessment, respiratory care plan and evaluation of results in the alternative care setting.

IX. Pulmonary Rehab

A. Recommend procedures for obtaining additional data following review of the patient record.

B. Assess overall patient cardiopulmonary status, including:

1. Exercise tolerance

2. Activities of daily living (ADL)

3. Physical environment

4. Social support systems

5. Nutrition status

6. Patient learning needs.

C. Review the interdisciplinary patient care plan.

D. Identify the goals of a rehab program for a pulmonary patient.

E. Demonstrate the ability to discuss the guidelines, basic components and implementation of a pulmonary rehab program including:

1. Resources

2. Staffing

3. Medical direction

4. Patient selection and evaluation

5. Patient instruction

6. Equipment selection

7. Follow-up

8. Reimbursement

F. Explain planned therapy and goals to patients and family regarding:

1. General patient education and the aids used for patient understanding and participation.

2. Specific patient instruction for:

a. Graded exercise breathing pattern

b. Home respiratory equipment cleaning procedures

Breathing patterns to accommodate activities of daily living

3. The role of exercise and breathing exercises in pulmonary rehab.

G. Discuss the elements of a smoking cessation program needed to counsel patient and family members about smoking cessation.

H. Demonstrate the ability to discuss the elements of a disease management education program and counsel patient and family members concerning disease management education.

I. Communicate information relevant to coordinating patient care and discharge planning and scheduling.

J. Participate in the development of a respiratory care plan.

K. Discuss implementation of a graded exercise program and cardiopulmonary stress testing.

X. Pulmonary Home Care

A. Recommend procedures for additional data following review of the patient record.

B. Discuss the selection of equipment appropriate to the home respiratory care plan:

1. Oxygen administration devices including transtracheal oxygen therapy and oxygen conserving devices.

2. Humidifiers.

3. Gas delivery devices with selection considerations for:

a. Cylinders

b. Concentrators;

c. Compressors

d. Liquid systems

e. Pulse dosed oxygen delivery systems

C. Explain planned therapy and goals to patient and family members in understandable terms to achieve optimal therapeutic outcomes.

1. Patient education and aids used for patient comprehension and compliance

2. Patient instruction for home respiratory equipment cleaning procedures

D. Describe the role of the respiratory care practitioner in home care, to include:

1. Patient selection and referral

2. Record keeping

3. Follow-up

4. Scheduling and routing

5. Supply and equipment selection and set-up

6. Assisting the patient and company in the billing/reimbursement process

E. Discuss the implications of the various healthcare reimbursement plans for the level of care and reimbursement for services in the home care setting.

1. Medicare

2. Medicaid

3. Preferred Provider Systems (PPS)

4. Health Maintenance Organization (HMO)

F. Discuss disease management programs.

1. Patient selection/referral

2. Program educational components and length

3. Goals and outcome measures

4. Follow-up

5. Scheduling

XI. Pulmonary Function Rotation

A. Demonstrate the ability to appropriately contact the instructor, staff and others for assistance.

B. Recommend procedures for additional data following review of the patient record.

C. Demonstrate the ability to perform, measure and interpret results:

1. Pulmonary function testing

a. Spirometry before/ after bronchodilator

b. Maximum voluntary ventilation (MVV)

c.Maximal expiratory pressure (MEP)

d. Functional Residual Capacity (FRC)

e. Flow-volume loops

f. Body box

g. Nitrogen washout

h. CO2 response curve

i. Total lung capacity (TLC)

j. Closing volume

k. Airway resistance

l. Bronchoprovocation

m. Maximum Inspiratory Pressure (MIP)

D. Demonstrate the ability to analyze available data to aid in determining a pathophysiological state.

1. Spirometry

2. Flow-volume loop

3. Volume of iso flow

4. Functional Residual Capacity (FRC), residual volume (RV) and total lung capacity (TLC) determinations

5. Body plethysmography

6. Single breath nitrogen test

7. Closing volume

8. Diffusing capacity

9. Diffusion capacity (DLCO)

E. Demonstrate the ability to select the following equipment for performing PFTs:

1. Spirometers

2. Plethysmography

3. Pneumotachometers

4. Carbon Monoxide (CO), helium (He), Nitrogen (N2) and other specialty gas analyzers

5. Respirometer

6. Manometers

F. Describe the function, principle(s) of operation, characteristics, advantages and disadvantages of the selected equipment and procedures, to include:

1. Applicable gas laws

2. Available measurements

G. Demonstrate the ability to assemble, check for proper function, identify and correct malfunctions for equipment.

H. Perform quality control (QC) procedures for pulmonary function equipment.

I. Demonstrate the ability to coach and explain procedures to patients.

J. Interpret pulmonary function test reports.

1. Differentiate and obstructive versus restrictive process using forced expiratory volume ratio and flow volume tracing

2. Bronchial provocation tests

3. Pre- and post-bronchodilator studies

4. Lung volume and capacities

5. Specialty evaluations:

a. Volume of iso flow

b. Closing volume

c. Single breath nitrogen test

d. Bedside pulmonary function test (PFT) assessments

K. Demonstrate the ability to perform appropriate communication between the respiratory care practitioner and physician for assessment, benefits and responses to therapy, continuing clinical indications for therapy and recommendations for modification in therapy or diagnostic testing.

XII. Specialty Lab with ACLS Emphasis

A. Demonstrate the ability to review data and recommend procedures to obtain additional information, as it applies to Basic Life Support (BLS) and Advanced Cardiovascular Life Support (ACLS.)

B. Interpret results of patient assessment in relation to BLS and ACLS.

C. Demonstrate the ability to analyze available data and determine the pathophysiological state.

D. Demonstrate the ability to select and obtain equipment appropriate to the respiratory care plan, for BLS and ACLS.

1. Oxygen administration

2. Gas delivery systems

3. Secretion clearance

4. Resuscitation devices

5. Artificial airways

6. Monitoring devices

E. Demonstrate the ability to assemble, check for proper function and correct malfunctions for equipment identified.

F. Demonstrate the ability to perform therapeutic procedures to maintain a patent airway and remove secretions.

1. Oro/nasal pharyngeal airways

2. Intubation/extubation procedures

3. Proper tube placement

4. Proper cuff inflation

5. Proper patient position

6. Suction

G. Demonstrate the ability to perform therapeutic procedures to achieve adequate ventilation and oxygenation.

1. Oxygen administration

2. Prevention of procedure associated hypoxemia

3. Resuscitation efforts

H. Demonstrate the ability to evaluate and monitor patient’s responses to care and modifications in procedures.

I. Treat cardiopulmonary collapse according to BLS/ACLS protocols.