Respiratory Therapy - University of Manitobaumanitoba.ca/rehabsciences/media/RT_binder_2016_FINAL...CLINICAL RESOURCE MANUAL Respiratory Therapy Coursework Year I Human Anatomy (ANAT

College of Rehabilitation Sciences

Respiratory TherapyCLINICAL RESOURCE MANUAL

The intended purpose of this manual is to track the number of times a student has been exposed to a clinical procedure/skill dur-ing their clinical education courses throughout the program.

Competency skills/procedures listed in the manual can be signed by the preceptor each time the student is observing, attempting with guidance, or independently completing. A signature in this book does not indicate the student has PASSED an evaluation for a listed competency. It is the intention that preceptors can utilize this tool to see how much exposure to a skill/competency the student has had, and to use this information to guide the preceptor’s level of expectation for the student. Example: a student who has been exposed to a skill 2 times may not yet be able to perform that skill independently, and may not be ready for a final evalu-ation. A student with multiple exposures to a skill, should be expected to perform with minimal guidance, and may be ready to be tested to to determine if they pass the competency.

The final competencies are passed only when the student is able to perform the procedure independently at the entry to practice level. A preceptor would then sign the CBO Manual.

The list of skills and procedures in this manual link directly to the 2011 Respiratory Therapy National Competency Profile and are deemed to be entry- to- practice by the National Alliance of Respiratory Therapy Regulatory Bodies.

All of the procedures listed herein link to the CBO manual that the student will also bring with them to the clinical fieldwork sites.

The student is not required to perform a skill or procedure a specific number of times to PASS the competency, as we acknowl-edge some procedures take less time to master than others. We also acknowledge that some skills/procedures may not occur very frequently in clinical practice, and therefore exposures would be limited. The preceptor is asked to use their judgment to determine when a student is prepared to have a final evaluation of a skill/procedure, based on the template contained in the CBO manuals.

CLINICAL RESOURCE MANUAL

Respiratory Therapy Coursework

Year IHuman Anatomy (ANAT 1030) Introduction to Professional Practice (RESP 1400) Health Systems and Respiratory Care in Canada (RESP 1410) Applied Physiology for Respiratory Therapy (RESP 1420)

Year II Research Methodology for Medical Rehabilitation (REHB 2450) Primary Care in Respiratory Therapy (RESP 2200)Pathophysiology (RESP 2210)Physical Examination and Health Assessment (RESP (2220)Respiratory Therapeutics 2 (RESP 2230)

Clinical Mechanical Ventialation (RESP 2240) Ventilator Instrumentation (RESP 2250)Cardiopulmonary Diagnostics (RESP 2260)Basic Fieldwork II (RESP 2380) Clinical Simulation & Integration (RESP 2390)

Respiratory Therapeutics 1 (RESP 1430) Pharmacology (RESP 1440) Principles of Mechanical Ventilation (RESP 1450) Basic Fieldwork 1 (RESP 1460)

Year III Clinical Education in Pediatric Respiratory Care (RESP 3320) Clinical Education in Pulmonary Diagnostics (RESP 3350) Clinical Education in Anesthesia (RESP 3360) Clinical Education in Community Care (RESP 3370) Clinical Education in Critical Care (RESP 3410) Clinical Education in Neonatal Care (RESP 3420) Clinical Education in General Therapeutics (RESP 3430)Current Topics in Respiratory Therapy (RESP 3440)

Clinical Education Courses

There are nine (9) clinical education courses in the BRT program:

Courses:

RESP 1460 Basic Fieldwork I

RESP 2380 Basic Fieldwork 2

RESP 3320 Clinical Education in Pediatric Respiratory Care

RESP 3350 Clinical Education in Pulmonary Diagnostics

RESP 3360 Clinical Education in Anesthesia

RESP 3370 Clinical Education in Community Care

RESP 3410 Clinical Education in Critical Care

RESP 3420 Clinical Education in Neonatal Care

RESP 3430 Clinical Education in General Therapeutics—General Respiratory Care

Clinical Education Courses are evaluated using a variety of methodologies, the grading of which is on a pass/fail basis.

CLINICAL EDUCATION COURSE EVALUATION

In order to successfully complete clinical courses the student must successfully complete each of the course components, which may include and are not limited to:

• competency-basedevaluationtemplatesforevaluationofclinicalskills

• writtentests

• seminars/tutorials

• formativeandsummativecoursewrittenevaluationsusedtoevaluateeffectiveintegrationoftheorywithclinicalpractice

• reflectivewritingandselfassessmentassignments

Specific clinical education course requirements are outlined in the syllabus for each course.

Common to all the BRT program clinical education courses, students must register a pass mark on the final course evaluation, based on satisfactory formative and summative preceptor evaluations.

Clinical Competency Evaluation Templates

Each clinical course utilizes clinical competency evaluation templates which relate to the competencies required to achieve a pass in the relevant course. Students must complete all clinical competency evaluation templates for each clinical education course.

For further details regarding the policies governing this please refer to the BRT Academic Progression/Supplementary Regulations (available in the Respiratory Therapy Student Handbook).

PRECEPTOR EVALUATIONS In all courses, preceptors will complete a formative daily evaluation of the student and a summative final evaluation.

In ALL CLINICAL COURSES, daily evaluation forms are used by all preceptors; a final evaluation form is completed by the clinical site coordinator once the rotation is completed. The final evaluation is shared with the student and signed by the student upon completion of the rotation. All the evaluations are sent back to the University Clinical Coordinator. Any rotation that is longer than 4 weeks will also include a mid-way evaluation form (Adult ICU and Children’s) which will be shared with the student half-way through the rotation. This gives the student time to improve their performance before the final evaluation period. All evaluations need to be signed and dated by the preceptors and the students. Students should be given the feedback necessary to improve performance and areas to work on each day so they can successfully reach their goals.

Clinical Site and Course Number: _______________________________________________ Student Name: ______________________ Preceptor Name: _____________________ ____ Date of Evaluation: ____________________________________________________________ Shift Start Time: __________________ Shift End Time: ________________________ ______ Rating Scale:

NA. Not Applicable or Observed 1. Poor

2. Borderline

3. Satisfactory

4. Good

5. Exceptional

Assessment Categories: Please circle response:

1. Clinical Reasoning / Diagnosis

(Interpretation of findings, judgment, efficiency) NA 1 2

3 4 5

2. Demonstrates knowledge of theory

NA

1 2

3 4 5

3.

History taking/shift change report (Accurate, efficient)

NA

1 2

3 4

5 4.

Organization/Time Management

(motivation, efficient, team approach, appropriate utilization of down time)

NA

1 2

3 4

5

5. Communications Skills -Verbal/Non-Verbal

(Empathy, voice inferences and tone, Introduction, terminology)

NA 1

2 3

4 5

6. Professionalism

(Punctual, initiative, respectful, Attends to patient’s needs, confidence)

NA 1

2 3

4 5

7. Patient Assessment/ Physical Examination (Logical sequence, appropriate, informs patient) NA

1 2

3 4

5

8.

Skill Development Toward Competencies NA

1 2

3 4

5

Daily Student Clinical Evaluation Form

University of Manitoba Department of Respiratory Therapy

Please provide additional feedback relating to any item for which a score of 1(Poor) or 2 (borderline) was provided. Course objectives/skills which were developed today are recorded in the Clinical Resource M

anual:

Yes □ No □

Competencies which were attained today are recorded in the Competency Based Objective M

anual:

Yes □ No □

What course objectives, skills, or competencies need more exposure? (This

response may be developed collaboratively by the preceptor and the student) Additional Comments (preceptor or student): Student Signature: ____________________________________________________________ Preceptor Signature: __________________________________________________________ Daily debriefings are recommended to provide the student with ongoing

feedback and strategies for improvement. Concerns should promptly be made known to both the student and on-site coordinator or University Coordinator.

Bethesda Regional Health Centre 1-204-326-6411

Brandon General Hospital 1-204-578-4051

Concordia General Hospital 204-661-7346

Deer Lodge Centre 204-831-1301 ext. 2206

Deer Lodge Pulmonary Lab 204-833-1717

Grace General Hospital 204-837-0185 or 204-837-0186

HSC Winnipeg 204-787-3043

HSC Children’s Hospital 204-787-7420

Home Care (WRHA) 204-940-2118

Interfacility Transport Team 204-787-8041

Long Term Ventilator Program 204-787-3163

Medigas 204-786-4719

Misericordia Health Centre 204-788-8575 Michelle or 204-788-8570 Main Line

Misericordia Pulmonary Rehab 204-788-8554

PFT Lab 204-787-2916

RANA Respiratory Care Group 204-928-1403 or 204-928-1400 General line

Riverview Health Centre 204-478-6240

St. Boniface General Hospital 204-235-3338 or 204-235-3367 NICU

Seven Oaks Anesthesia 204-632-3102

Seven Oaks General Hospital 204-632-3149 Seven Oaks Pulmonary Rehab 204-632-3159

Victoria General Hospital 204-477-3325

Clinical placements related to the clinical education courses occur throughout all years of the program with emphasis in year three. Most of the clinical placements are arranged within the greater Winnipeg area, however, in some cases travel outside of the city may be required. The following institutions/organizations currently provide clinical education experiences for Department of Respiratory Therapy students:

CLINICAL EDUCATION SITES

ORIENTATION TO CLINICAL EDUCATION - GENERAL

All students in the BRT program will be provided general orientation to clinical education by the University Clinical Education Coordinator. All general orientation components will precede student participation in any clinical education experiences. These include:• Attendance policy• Dress code• Clinical course objectives• Evaluation process• Contact information (relevant University and clinical education site personnel)• Provision of any required site specific orientation information (provided by clinical affiliate site)• Body Mechanics/Patient Handling• PHIA training• WHIMIS training• Infection prevention and control (including use of Personal Protective equipment)• Respiratory mask fit testing• Criminal Record Check, Child Abuse Registry Check and Adult Abuse Registry Check (with Vulnerable Sector)• Heart & Stroke BLS (Basic Life Support) Health Care Provider Level C• Obtain all necessary immunizations• Sign Practicum Agreement WRHA• Electronic patient record registration

ORIENTATION TO CLINICAL EDUCATION - CLINICAL SITES

All students new to a clinical education site will be provided a site-specific orientation by the clinical site coordinator or designatedstaffofthatsite. The orientation will at minimum consist of site specific information encompassing:• Physical layout• Policies and procedures• Documentation procedures• Emergency procedures (including infectious and environmental disease prevention and exposure)• Personal safety (including personal protective equipment and respiratory masks)• Location of supplies and equipment • Site specific policies, procedures, and clear expectations of students• Respiratory Therapist roles and responsibilities, including instruction, student evaluation, and supervision• Organization of the healthcare team at the site• Critical incident - Reporting structure, documents

Students should be made aware of who to contact on-site if they have needs or concerns regarding:• Patient safety• Personalsafety,includingbloodandbodyfluidcontact• Critical incident debriefing post-traumatic clinical experiences*

*NOTE: In addition to support services available at clinical education site, Services for Students at Bannatyne Campus also covers counselling and other services that students can access while engaged in clinical education activities (see Services for Students at Bannatyne Campus entry in this manual for further information and contact information).

CLINICAL SITE ORIENTATION & STUDENT SERVICES

All students new to a clinical education site will be provided an orientation by the clinical site coordinator or designated staffofthatsite.Theorientationwillensurethatstudentsareawareofpoliciesandprocedures,safetyprecautions,responsibilities and contact personnel if they encounter difficulties. They will be made aware of who to contact if they haveconcernsregardingpatientsafety,personalsafetyincludingbloodandbodyfluidcontact,isolationprocedures,N95 masks, and critical incident debriefing post-traumatic clinical experiences.

Services for Students at Bannatyne Campus alsoofferscounselingandotherservicesthatstudentscanaccessthroughout their clinical year (see Other Student Services section of the CoRS Student Handbook for additional counseling services).

ADVOCACY Student Advocacy umanitoba.ca/student/advocacy

[email protected]

Other Student Affairs and University units offer services at Bannatyne Campus upon request.

Registrar’s Office:204-474-9420

Photo IDs can be obtained at the Neil

John Maclean Health Sciences Library.

SS@BC (umanitoba.ca/student/bannatyne)A120 Chown BuildingGeneral Office Phone: [email protected]

Heather Paterson (204-272-3191)Director, Services for Students at Bannatyne [email protected]

SERVICES FOR STUDENTS AT BANNATYNE CAMPUS

HEALTH AND WELLNESS

CAREERS

COUNSELLING

FINANCIAL AID

ACCESSIBILITY

ACADEMIC SUCCESS

Health and Wellness Educator umanitoba.ca/student/health-wellness/

Career Services umanitoba.ca/student/careerservices/

Student Counselling umanitoba.ca/student/counselling

Financial Aid and Awards umanitoba.ca/student/fin_awards

Student Accessibility Services umanitoba.ca/student/saa/accessibility

Academic Learning Centre umanitoba.ca/student/academiclearning

[email protected]

Call 204-474-8592

[email protected]

[email protected]

[email protected]

[email protected]

[email protected]

204-474-8411

204-789-3511

University Health Service

International Centre for Students

Human Rights and Conflict Management

Student Support Case Manager

English Language Centre

Centre for Aboriginal Health Education

Indigenous Student Centre

Student Life [email protected]

[email protected]

[email protected]

[email protected]

[email protected]

ADVOCACY Student Advocacy umanitoba.ca/student/advocacy

[email protected]

Other Student Affairs and University units offer services at Bannatyne Campus upon request.

Registrar’s Office:204-474-9420

Photo IDs can be obtained at the Neil

John Maclean Health Sciences Library.

SS@BC (umanitoba.ca/student/bannatyne)A120 Chown BuildingGeneral Office Phone: [email protected]

Heather Paterson (204-272-3191)Director, Services for Students at Bannatyne [email protected]

SERVICES FOR STUDENTS AT BANNATYNE CAMPUS

HEALTH AND WELLNESS

CAREERS

COUNSELLING

FINANCIAL AID

ACCESSIBILITY

ACADEMIC SUCCESS

Health and Wellness Educator umanitoba.ca/student/health-wellness/

Career Services umanitoba.ca/student/careerservices/

Student Counselling umanitoba.ca/student/counselling

Financial Aid and Awards umanitoba.ca/student/fin_awards

Student Accessibility Services umanitoba.ca/student/saa/accessibility

Academic Learning Centre umanitoba.ca/student/academiclearning

[email protected]

Call 204-474-8592

[email protected]

[email protected]

[email protected]

[email protected]

[email protected]

204-474-8411

204-789-3511

University Health Service

International Centre for Students

Human Rights and Conflict Management

Student Support Case Manager

English Language Centre

Centre for Aboriginal Health Education

Indigenous Student Centre

Student Life [email protected]

[email protected]

[email protected]

[email protected]

[email protected]

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RT binder 2015 revised March.indd 183/25/2015 2:54:39 PM

GENERAL REGULATIONS Reporting Sick When reporting sick on a scheduled clinical experience in any area, the student will be required to phone the respective clinical department prior to commencement of the ‘shift.’ The student will also be expected to notify the Department of Respiratory Therapy at the University in both of the following methods:

• bycallingtheDepartmentalOfficeat204-480-1357(leaveavoicemailmessage)

• [email protected]

Dress Code

Thepurposeofthedresscodeistopromoteaneatandprofessionalappearancetopatients,visitorsandstaff,atalltimes. Requirements:

1. All clothing shall be clean, neat and of suitable style to promote a professional appearance.

2. Students are required to wear uniforms in the patient care areas.

3. All students must wear name tags in the clinical areas.

4. O.R. greens are to be worn only in the Anaesthesia rotation and the Maternal-Fetal rotation.

5. Personal hygiene and general appearance shall also comply with the requirements of the clinical site.

Specific Considerations:

Hair:

Hair must be clean and well-groomed and of suitable length according to job activity.

Long hair must be worn up when in contact with patients.

Footwear:

Shoes are to be worn at all times and must conform to safety standards.

Footwear should not produce disruptive noise and should be clean and in good repair.

Footwear with laces must be kept tied.

Jewelry:

Jewelry should be worn in moderation and good taste.

Policies of clinical areas must be adhered to strictly.

Cosmetics:

Perfume should not be worn in patient care areas.

Allstudents,facultyandstaffoftheCollegeofRehabilitationSciencesareaskedtorefrainfromusingstrongsmelling scented products including perfumes, hairsprays, aftershaves, lotions etc. Scented products can trigger or aggravate health problems for some people, such as those with asthma, allergies or other health conditions.

Other cosmetics may be worn in moderation.

Fingernails:

Those in direct contact with patients must maintain short and clean fingernails, no artificial nails.

Violation of this dress code may result in students being required to leave the clinical education site. This decision is atthediscretionoftheYear3Coordinator,ClinicalCourseCoordinator,orClinicalPreceptor.Anyclinicaltimemissedfor this reason must be rescheduled at a time convenient to the program and the clinical site.

Cell Phone Use in the Classroom:

Use of Laptop and Tablet Computers in the Classroom:The College of Rehabilitation Sciences supports the use of technology to enhance learning. This is evidenced by investments made in the updating of classroom technology and provision of wireless Internet access throughout the Bannatyne campus. The popularity and ease of access to laptop computers, tablets, and similar electronic devices has resulted in a desire by many instructors and students to use this tool to support the educational experience.

The Department of Respiratory Therapy supports the use of these electronic devices in the classroom as a means to enhancetheeffectivenessoftheteachingandlearningenvironment,andtomeetevolvingpreferencesforaccessto course materials. Access to any of the electronic devices listed above is not mandatory in the Respiratory Therapy program, however, some classes may involve activities where the instructor encourages the use of electronic devices as an option for undertaking coursework (e.g., searching the internet for information, generating a small group report, etc.).

Use of cell phones and the cellular communications capabilities of other electronic devices in the classroom is not permittedforanyreason(i.e.makingtelephonecallsortexting).Pleaseturncellphonesofforswitchtosilentmodeand disable the cellular functions of other devices when participating in Respiratory Therapy and College of Rehabilitation Sciences classroom activities.

Students may wish to utilize electronic devices to access course notes made available on the University’s online learning platform, UM Learn (previously called Desire2Learn (D2L). This option provides an environmentally sensitive solution to printing paper copies of those notes, and can result in substantial cost saving for the student.

The Department of Respiratory Therapy encourages students to take advantage of the benefits of these devices in an appropriate and professional manner. Students should use discernment and professional judgment in determining appropriate use of laptop computers during other College-related activities outside of classroom instruction. Instructors may use their discretion and indicate to students when behaviours related to laptop use are not appropriate and should cease. We thank you in advance for using your laptop in a respectful and appropriate manner.

It is recognized that Student Accessibility Services sometimes recommends the use of a laptop computer for students for accommodation of special needs. Students are encouraged to discuss these recommendations with instructors prior to commencing class.

Cell phones and electronic devices may be permitted for professional use only as permitted by each sites’ clinical specialist or manager.

Exposure Competency Completed

ADULT COMPETENCIES Date & Initial

Date & Initial

Date & Initial

Date & Initial

Date & Initial

Date & Initial

Date & Initial

Communication

Document

Health and Safety

Humidity Therapy

Mechanical Ventilation (Standby Ventilator Preparation)

Pharmacology - Medication Delivery

Pharmacology - Provide Oxygen Therapy

Professionalism

Pulse Oximetry

Secretion Clearance and Breathing Techniques

Suctioning - Pharyngeal

Suctioning – Thoracic Drainage

Year 1 - RESP 1460 Basic Fieldwork I

Initials Signature Print Name



Date & Initial

Date & Initial

Date & Initial

Date & Initial

Date & Initial

Date & Initial

Airway Management - Maintenance

Assessment Modified

Blood Analysis

Blood Sample Procurement ( Radial)

Discontinue Therapy Complete Procedure

Document

Electrocardiography

Humidity Therapy

Manual Ventilation

Mechanical Ventilation - Initiation

Monitoring

Year 2 - RESP 2380 BASIC Fieldwork II



Date & Initial

Date & Initial

Date & Initial

Date & Initial

Date & Initial

Date & Initial

Pharmacology – Medication Delivery

Pharmacology – Provide Oxygen Therapy

Preparation

Pulse Oximetry

Suctioning – Pharyngeal

Year 2 - RESP 2380 BASIC Fieldwork II


NEONATAL COMPETENCIES Date & Initial

Date & Initial

Date & Initial

Date & Initial

Date & Initial

Date & Initial

Date & Initial

Assessment Modified

Mechanical Ventilation (Standby Ventilator Preparation)

Monitoring




Date & Initial

Date & Initial

Date & Initial

Date & Initial

Date & Initial

Date & Initial

Date & Initial

Pulmonary Function Testing

Year 3 RESP 3350 Clinical Education in Pulmonary Diagnostics



Date & Initial

Date & Initial

Date & Initial

Date & Initial

Date & Initial

Date & Initial

Date & Initial

Airway Management –Basic Non-invasive

Airway Management Intubation

Anesthesia Administration –General assist with

Anesthesia Administration- Regional assist with

Assessment Modified

End Tidal Carbon Dioxide Measurement

Intravenous Placement Infusion via syringe

Intravenous Placement (Peripheral)

Manual Ventilation

Year 3 RESP 3360 Clinical Education in Anesthesia


Year 3 RESP 3410 Clinical Education in Critical Care


Date & Initial

Date & Initial

Date & Initial

Date & Initial

Date & Initial

Date & Initial

Date & Initial

Airway Management Discontinue Airway Management Intubation AssistAnalysis and Problem SolvingArterial Line InsertionBronchoscopy (assist with)Lung Volume RecruitmentManual VentilationMechanical Ventilation – Initiation Advanced ModesMechanical Ventilation - Basic Assessment and ManagementMechanical Ventilation - Cardiovascular AssessmentMechanical Ventilation - Neurological AssessmentMechanical Ventilation - Oxygenation and Ventilation

Mechanical Ventilation - Renal Assessment

Year 3 RESP 3410 Clinical Education in Critical Care


Date & Initial

Date & Initial

Date & Initial

Date & Initial

Date & Initial

Date & Initial

Date & Initial

Mechanical Ventilation - Respiratory MechanicsMechanical Ventilation - WeanSuctioning - TracheobronchialTherapeutic Gas AdministrationTransportation (in Hospital)Transport (Inter Facility)


Year 3 RESP 3430 Clinical Education in General Therapeutics


Date & Initial

Date & Initial

Date & Initial

Date & Initial

Date & Initial

Date & Initial

Date & Initial

Arterial Line Sampling

Assessment Full

Blood Sample Procurement (Brachial)

Blood Sample Procurement (Femoral)

Discharge Planning

Preceptor Education Program Certificate

Non-Invasive Positive Airway Pressure

Sputum Induction


Year 3 RESP 3370 Clinical Education in Community Care


Date & Initial

Date & Initial

Date & Initial

Date & Initial

Date & Initial

Date & Initial

Date & Initial

Airway Management—Tracheostomy

Health Education and PromotionPulmonary Rehabilitation Program

Non-invasive Positive Airway Pressure CPAP

Pharmacology - Provide Oxygen Therapy

Perform Sleep Studies



Date & Initial

Date & Initial

Date & Initial

Date & Initial

Date & Initial

Date & Initial

Date & Initial

Airway Management—Discontinue

Airway Management—Maintenance

Airway Management—Intubation Assist/Surfacant

Blood Sample Procurement—Capillary

Endtidal CO2 Measurement

Lung Volume Recruitment

Manual Ventilation

Mechanical Ventilation—Initiation Basic

Mechanical Ventilation—Initiation Advanced Modes

Therapeutic Gas Administration

Year 3 RESP 3420 Clinical Education in Neonatal Care - St. Boniface/Children’s


Date & Initial

Date & Initial

Date & Initial

Date & Initial

Date & Initial

Date & Initial

Date & Initial

Mechanical Ventilation—Basic Assessment and Management

Mechanical Ventilation—Wean

Non-invasive Positive Airway Pressure

Pharmacology—Medication Delivery

Suctioning—Pharyngeal

Suctioning—Tracheobronchial

Thermal Regulation Devices

Transcutaneous Monitoring

Transportation

Year 3 RESP 3420 Clinical Education in Neonatal Care - St. Boniface/Children’s



Date & Initial

Date & Initial

Date & Initial

Date & Initial

Date & Initial

Date & Initial

Date & Initial

Airway Management—Discontinue

Airway Management—Intubation Assist

Airway Management—Maintenance

Assessment—Full

Blood Sample Procurement

End Tidal Carbon Dioxide Measurement

Humidity Therapy

Lung Volume Recruitment

Manual Ventilation

Mechanical Ventilation - Initiation

Year 3 RESP 3320 Clinical Education in Pediatric Care - Children’s Hospital


Date & Initial

Date & Initial

Date & Initial

Date & Initial

Date & Initial

Date & Initial

Date & Initial

Mechanical Ventilation - Initiation Advanced Modes

Mechanical Ventilation - Basic Assessment and Management

Mechanical Ventilation - Wean

Monitoring

Non-Invasive Positive Airway Pressure

Pharmacology - Medication Delivery


Secretion Clearance and Breathing Techniques

Suction - Pharyngeal

Therapeutic Gas Administration



Date & Initial

Date & Initial

Date & Initial

Date & Initial

Date & Initial

Date & Initial

Date & Initial

Suctioning—Tracheobronchial

Transportation



Blood Gases

Excerpted from the Candidate Information Manual—Canadian Board for Respiratory Care Inc. (CBRC) National Respiratory Therapy ExaminationsJanuary 2012 and July 2012—http://www.cbrc.ca/MANUAL2012E%20feb%202012-1.pdf

Arterial Mixed Venous

Accepted adult ranges for blood gas interpretation

Hypoxemia Interpretation: Note: There is no correction for age

MILD PaO2 60-79 mmHg

MODERATE PaO2 40-59 mm Hg

SEVERE PaO2 < 40 mm Hg

““Egan’’s Fundamentals of Respiratory Care, 9th Ed.”” Wilkins, Stoller, Kacmarek 2009


Blood gases

Accepted adult ranges for blood gas interpretation

Arterial Mixed Venous

pH PCO2

7.35 - 7.45 35 –– 45

mm Hg

pH PCO2

7.30 - 7.40 40 –– 50

mm Hg

PO2

HCO - 3

80 –– 100 22 –– 26

mm Hg mmol/L plasm

PO2

a HCO - 3

35 –– 40 22 –– 26

mm Hg mmol/L plasma

Base Excess -2 to + 2 Base Excess -2 to + 2 SO2 93-97 % SO2 70-75 %


Hypoxemia Interpretation: Note: There is no correction for age

MILD PaO2 60-79 mm Hg MODERATE PaO2 40-59 mm Hg SEVERE PaO2 < 40 mm Hg


Excerpted from the Candidate Information Manual—Canadian Board for Respiratory Care Inc. (CBRC) National Respiratory Therapy Examinations January 2012 and July 2012—http://www.cbrc.ca/MANUAL2012E%20feb%202012-1.pdf

Blood Gases


ELBW VLBW Term Infant to Child

Toddler to Adult

Age < 28 weeks GA 28 ʹ 40 weeks GA

40 weeks GA to 2 years

>2 years

pH ш ϳϮϱ ш ϳϮϱ 7.30 - 7.40 7.35 - 7.45 PCO2 mm Hg 45 - 55 45 - 55 30 - 40 35 –– 45 PO2 mm Hg 45 - 65 50 - 70 80 - 100 80 –– 100 HCO - mmol/L

3 15 - 18 18 - 20 20 - 22 22 –– 24

““Perinatal and Pediatric Respiratory Care”” Walsh, Czervinske, Diblasi 2010

GA –gestational age ELBW –– extremely low birth weight VLBW –– very low birth weigh

Accepted neonatal ranges for blood gas interpretation

Blood Chemistry


K+ 3.5 - 4.8 mmol/LNa+ 137 - 147 mmol/LCl- 98 - 105 mmol/LCreat 50 - 110 µmol/LAnion Gap 9 - 14 mmol/LPlease note: K+ is not considered in the formula for this anion gap normal range

Hematology

WBC 4.5 - 11.5 X 109 U/LHb 135 - 165 g/L (MALE) 120 - 150 g/L (FEMALE)




BP

PAP

systolic diastolic mean systolic diastolic mean

100 –– 140 60 –– 95

70 –– 105 20 –– 30

6 –– 15 10 –– 20

mm Hg mm Hg mm Hg mm Hg mm Hg mm Hg

CVP ч 6 mm Hg PCWP 4 –– 12 mm Hg CO CI

4 –– 8 2.5 –– 4

L/minute L/minute/m2

SV SVI SVR* PVR*

60 –– 130 30 –– 50

1200 –– 1600 120 –– 240

mL/beat mL//beat/m2

dynes.sec/cm5

dynes.sec/cm5


* ““Pilbeam’’s Mechanical Ventilation, Physiology and Clinical Applications 5th Ed.”” Cairo 2012

Hemodynamics

20

Cardiopulmonary Formulae

ALVEOLAR AIR EQUATION

PAO2 = [(PB - 47 mm Hg) x FIO2] - (PaCO2/RQ) P(A-a)O2 = PAO2 - PaO2

ANION GAP (daily use formula that does not use K+ in the formula)

AG = (Na+) - (Cl- + TCO2)

CARDIAC INDEX (L/MIN/M2)

CI = Qt BSA

CARDIAC OUTPUT (FICK EQUATION) (L/minute)

Qt = ( VO2 ) ( CaO2 - CvO2 ) X 10

CO2 PRODUCTION

VCO2 = PECO2 x VE (PB - 47 mm Hg) MEAN ARTERIAL PRESSURE

MAP = Systolic Pressure + (Diastolic Pressure x 2) 3

O2 CONSUMPTION (MODIFIED FICK EQUATION) (mL/MIN)

VO2 = [(CaO2 - CvO2) Qt] x 10

STROKE VOLUME (mL)

SV = Qt HR

SYSTEMIC VASCULAR RESISTANCE (dynes.sec/cm5) SVR = ( MAP - CVP ) x 80

Qt



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ALVEOLAR AIR EQUATION

PAO2 = [(PB - 47 mm Hg) x FIO2] - (PaCO2/RQ) P(A-a)O2 = PAO2 - PaO2

ANION GAP (daily use formula that does not use K+ in the formula)

AG = (Na+) - (Cl- + TCO2)

CARDIAC INDEX (L/MIN/M2)

CI = Qt BSA

CARDIAC OUTPUT (FICK EQUATION) (L/minute)

Qt = ( VO2 ) ( CaO2 - CvO2 ) X 10

CO2 PRODUCTION

VCO2 = PECO2 x VE (PB - 47 mm Hg) MEAN ARTERIAL PRESSURE

MAP = Systolic Pressure + (Diastolic Pressure x 2) 3

O2 CONSUMPTION (MODIFIED FICK EQUATION) (mL/MIN)

VO2 = [(CaO2 - CvO2) Qt] x 10

STROKE VOLUME (mL)

SV = Qt HR

SYSTEMIC VASCULAR RESISTANCE (dynes.sec/cm5) SVR = ( MAP - CVP ) x 80

Qt



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PULMONARY VASCULAR RESISTANCE (dynes.sec/cm5) PVR = ( PAP - PCWP ) x 80

Qt OXYGEN DELIVERY (mL/min)

DO2 = CaO2 x Qt x 10 OXYGEN EXTRACTION (mL/min)

O2ER = .25 (CaO2 x Qt x 10)

OXYGEN INDEX OI = (FIO2 x Pãw) x 100 PaO2

ARTERIAL OXYGEN CONTENT (CaO2) (mL/dL)

= (Hb x 1.34 x SaO2) + (PaO2 x .003) MIXED VENOUS OXYGEN CONTENT (CvO2) (mL/dL)

= (Hb x 1.34 x SvO2) + (PvO2 x .003) PULMONARY END-CAPILLARY OXYGEN CONTENT (CcO2) (mL/dL)

= (Hb x 1.34 x 1.0) + (PAO2 x .003) CLASSIC SHUNT EQUATION (Qs/Qt)

= CcO2 - CaO2 CcO2 - CvO2

NOTE: Hb units must be in gm% for use in the above calculations.



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PULMONARY VASCULAR RESISTANCE (dynes.sec/cm5) PVR = ( PAP - PCWP ) x 80

Qt OXYGEN DELIVERY (mL/min)

DO2 = CaO2 x Qt x 10 OXYGEN EXTRACTION (mL/min)

O2ER = .25 (CaO2 x Qt x 10)

OXYGEN INDEX OI = (FIO2 x Pãw) x 100 PaO2

ARTERIAL OXYGEN CONTENT (CaO2) (mL/dL)

= (Hb x 1.34 x SaO2) + (PaO2 x .003) MIXED VENOUS OXYGEN CONTENT (CvO2) (mL/dL)

= (Hb x 1.34 x SvO2) + (PvO2 x .003) PULMONARY END-CAPILLARY OXYGEN CONTENT (CcO2) (mL/dL)

= (Hb x 1.34 x 1.0) + (PAO2 x .003) CLASSIC SHUNT EQUATION (Qs/Qt)

= CcO2 - CaO2 CcO2 - CvO2

NOTE: Hb units must be in gm% for use in the above calculations.



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Ventilatory formulae

DYNAMIC COMPLIANCE

= VT(DEL) (PIP - PEEP)

STATIC COMPLIANCE

= VT(DEL) (PPlateau - PEEP)

AIRWAY RESISTANCE (Raw)

= PIP - PPlateau Flow

DEADSPACE TO TIDAL VOLUME RATIO (VD/VT)

= PaCO2 - PECO2 PaCO2

TCO2 = HCO3

- + (PaCO2 x .03)

Ventilatory Formulae


Ventilatory Recommendations


• Regional use of makes and models of ventilators vary significantly. Therefore the emphasis should be on the operating principles of ventilators in general. Ventilators will not be examined by trade name. Ventilators examined will be described by classification and function only.

• All modes and adjuncts currently available across all patient populations may be examined.

• Unless a height is specified in a question, assume the patient weight that is provided is the ideal body weight (IBW).

• Unless specified, assume the patient is an adult.

Weaning Parameters


• The following guidelines are suggested adult values to determine the initiation of weaning from mechanical ventilation. As in the clinical situation, certain pathologies may alter the accepted ranges for these parameters.

Spontaneous

RR < 35 /minuteVC > 10 mL/KgVT 4-6 mL/KgPNIP (MIP) > 20 cm H2Of/VT (RSBI) < 105

Pharmacology


• In questions pertaining to pharmacology, there will be situations where only the generic drug name will be used. Otherwise both the generic and trade names will be provided.

Example: Ventolin®, Airomir™™, and Apo®-Salvent may appear as salbutamol

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Abbreviations and Symbols

"A" a arterial A alveolar ABG arterial blood gas AC assist-control ventilation ACLS advanced cardiac life support ADH antidiuretic hormone A/E air entry with auscultation AFB acid-fast bacilli AG anion gap AIDS acquired immunodeficiency syndrome ALS amyotrophic lateral sclerosis AP anterior posterior APGAR Appearance, Pulse, Grimace, Activity, Respiration APRV airway pressure release ventilation ARDS adult respiratory distress syndrome ASD atrial septal defect ATP adenosine triphosphate ATPD ambient temperature and pressure dry ATPS ambient temperature and pressure saturated AV artrioventricular

"B" BCLS basic cardiac life support

BE base excess BMI body mass index BMR basal metabolic rate BP blood pressure BSA body surface area BPD bronchopulmonary dysplasia BTPS body temperature and pressure saturated BUN blood urea nitrogen

"C" c capillary

C compliance Ca++ calcium CABG coronary arterial bypass graft CaO2 oxygen content of arterial blood C(a-v)O2 arterial to venous oxygen content difference C(a-v)O2I arterial to venous oxygen content difference indexed to BSA CcO2 oxygen content of capillary blood CBC complete blood count

Cdyn dynamic compliance CF cystic fibrosis CHF congestive heart failure CI cardiac index



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"C" c capillary





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"C" c capillary





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Cl- chloride cm H2O centimetres of water pressure CNS central nervous system CO carbon monoxide (in context) CO cardiac output CO2 carbon dioxide COHb carboxyhemoglobin COPD chronic obstructive pulmonary disease CPAP continuous positive airway pressure CPP cerebral perfusion pressure CPR cardiopulmonary resuscitation C & S culture and sensitivity CSA Canadian Standards Association CSF cerebrospinal fluid Cstat static compliance CT computerized tomography CVA cerebrovascular accident CvO2 oxygen content of mixed venous blood CVP central venous pressure CXR chest x-ray

"D" DL diffusing capacity

DLCO diffusing capacity of carbon monoxide DO2 oxygen delivery

"E" ECG electrocardiogram

ECMO extra corporeal membrane oxygenation EEG electroencephalogram EF ejection fraction

ELBW extremely low birth weight infant EOG electrooculogram EMG electromyogram EMT emergency medical technician ER emergency room/department ERV expiratory reserve volume

ETCO2 end-tidal carbon dioxide ETT endotracheal tube

"F" f frequency

FEF25-75 forced expiratory flow between 25% and 75% of vital capacity (MEFR) FEV1 forced expiratory volume at one second FEV1/FVC ratio of exhaled volume at one second to forced vital capacity FIO2 fraction of inspired oxygen FRC functional residual capacity FVC forced vital capacity FETCO2 fractional exhaled end tidal CO2



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"F" f frequency




25








"F" f frequency




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FECO2 fractional mixed exhaled CO2 FVL flow volume loop f/VT rapid shallow breathing index

"G" g gram GCS Glasgow coma scale GI gastrointestinal

GxPxAx gravida, partum, abortion : gynecological terms used to represent number of pregnancies (G), number of live births (P) and number of abortion (A); x = number of

"H" Hb hemoglobin

HbCO carboxyhemoglobin HbF fetal hemoglobin Hbmet methemoglobin HBO hyperbaric oxygen HbO2/O2Hb oxyhemoglobin HCO3

- bicarbonate Hct hematocrit HFJV high frequency jet ventilation HFO high frequency oscillation HIV Human Immunodeficiency Virus HMD hyaline membrane disease HME heat and moisture exchanger

"I" IBW ideal body weight IC inspiratory capacity

ICP intracranial pressure ICU intensive care unit I:E inspiratory to expiratory time ratio

INR international normalized ratio of prothrombin time IPPA inspection, palpation, percussion, auscultation IRV inspiratory reserve volume

"K" kg kilogram K+ potassium

"L" L litre LAP left atrial pressure

LLL left lower lobe L:S (ratio) lecithin : sphingomyelin LUL left upper lobe LVEDP left ventricular end-diastolic pressure LVH left ventricular hypertrophy LVSV left ventricular stroke volume LVSW left ventricular stroke work



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"H" Hb hemoglobin











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"H" Hb hemoglobin











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"M" m meter MAC minimum alveolar concentration

MAP mean arterial pressure MDI metered dose inhaler MEP maximum expiratory pressure Mg++ magnesium MI myocardial infraction MIP maximum inspiratory pressure mm Hg millimetres of mercury pressure (torr) MOV minimal occluding volume MVA motor vehicle accident MVV maximum voluntary ventilation MMV mandatory minute ventilation

mmol millimole mL milliliter mg milligram "N" Na+ sodium

NIBP noninvasive blood pressure NIPPV noninvasive positive pressure ventilation NO nitric oxide NO2 nitrogen dioxide N2O nitrous oxide NPPV noninvasive positive pressure ventilation NPV negative pressure ventilation NREM non-rem sleep

NTT nasotracheal tube "O" O/A on auscultation

O/E on examination O2 oxygen O2ER oxygen extraction OI oxygen index OR operating room

"P" P pressure

P50 partial pressure of oxygen at 50% HbO2 PA pulmonary artery PA alveolar pressure PPlateau plateau pressure P(A-a)O2 alveolar to arterial oxygen gradient PAC premature atrial pressure PAP pulmonary artery pressure PAP mean pulmonary artery pressure PAT paroxysmal atrial tachycardia PAV proportional assist ventilation



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"P" P pressure




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"P" P pressure




contraction

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Paw airway pressure (proximal) AWP or PAW mean airway pressure

PCWP(PAOP) pulmonary capillary wedge pressure / pulmonary artery occlusion pressure PB barometric pressure PCV pressure control ventilation PDA patent ductus arteriosus PECO2 pressure of mixed exhaled carbon dioxide PEEP positive end-expiratory pressure PEFR peak expiratory flowrate PEP peak expiratory pressure PETCO2 pressure of end-tidal carbon dioxide PFT pulmonary function testing pH standardized hydrogen ion activity Phigh pressure high PIF peak inspiratory flow PIP peak inspiratory pressure Plow pressure low PNIP peak negative inspiratory pressure PPHN persistent pulmonary hypertension of the newborn

ppm parts per million PPV positive pressure ventilation

PRVC pressure regulated volume control PSV pressure support ventilation PT prothrombin time PTT partial thromboplastin time PVC premature ventricular contraction PvCO2 pressure of carbon dioxide in mixed venous blood

PvO2 pressure of oxygen in mixed venous blood PVR pulmonary vascular resistance PVRI pulmonary vascular resistance index

"Q" Qs / Qt shunted cardiac output ratio Qt cardiac output

"R" RAW airway resistance

RBC red blood cell RDS respiratory distress syndrome REM rapid eye movement RLL right lower lobe RML right middle lobe RQ respiratory quotient RR respiratory rate RSBI rapid shallow breathing index RSV Respiratory Syncytial Virus RUL right upper lobe RV residual volume



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RVH right ventricular hypertrophy

"S" SaO2 arterial oxygen saturation SIDS sudden infant death syndrome SIMV synchronized intermittent mandatory ventilation SLE systemic lupus erythematosus SOB shortness of breath SOBOE shortness of breath on exertion SpO2 oxygen saturation by pulse oximetry STPD temperature 00C, pressure 760 mm Hg and dry SvO2 mixed venous oxygen saturation SVC slow vital capacity SVR systemic vascular resistance

SVRI systemic vascular resistance index

"T" T temperature TB tuberculosis

TC time constant TCO2 total CO2 TcPO2 transcutaneous pressure of oxygen TE expiratory time Thigh time high

TI inspiratory time TID dynamic inspiratory time

TIS static inspiratory time TLC total lung capacity

Tlow time low TTN transient tachypnea of the newborn

"U" URTI upper respiratory tract infection

UAC umbilical artery catheter UVC umbilical venous catheter

"V" VE minute volume of expired volume per minute (BTPS)

VA minute alveolar ventilation VC vital capacity VCO2 carbon dioxide production (STPD) per minute VD deadspace VD/VT deadspace to tidal volume ratio

VLBW very low birth weight infant Vmax(x) maximum flow where (x) = % of volume VO2 oxygen consumption per minute vol% concentration (percent per volume) V/Q ventilation/perfusion ratio VS volume support VSD ventricular septal defect



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Revised: July 2016



VT tidal volume VT(del) delivered tidal volume VTG thoracic gas volume

"W" WBC white blood cell WHMIS Workplace Hazardous Materials Information System

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