This is an open-source of the course overview for the Respiratory Care Board Exam, preparation, and review with a focus on the Clinical Simulation Exam (CSE) testing.

1. Skyline College
Respiratory Care Board Examination, Preparation, and Review
Clinical Simulation Exam Overview 2020
Instructor: Anrey Bartoszynski- BSRC, RRT-ACCS, RCP
"Clinical Simulation Exam Overview"" by A. Bartoszynski-BSRT, RRT-ACCS,, Skyline College is licensed under CC BY-NC-ND 4.0

2. What’s the
Difference?
TMC
vs
CSE
1. Format
a. Scenarios vs Choices
b. IG and DM
2. Time (How long)
3. How do you answer?
4. How do you get
graded?
5. How many
questions?

3. RT
Case
Investigate
Solve the
problem

4. Content and How
the Exam Works
Testing tips
1. Scenario (Recognizing
the Problem)
2. Information Gathering
(Primary and
Secondary)
3. Decision Making
(Critical Thinking)
CSE outline 2015.pdf
CSE outline After 1:15:2020.pdf
CSE Information.pdf

5. Pick the course of Action!
+3 ● BEST
+2 ● GOOD
+1 ● FAIR
0 ● NEUTRAL (Neither good or bad)
-1 ● SLIGHTLY BAD
-2 ● BAD
-3 ● DANGEROUS/HARMFUL

6. 3 parts of CSE
1. Scenario
■ Recognizing the problem
● Sets the stage
2. Information Gathering (IG)
3. Decision Making (DM)

7. Sample Scenario
You are the staff therapist in charge or a 400 bed
hospital You have been paged to see a patient in
the emergency room complaining of chest pain
and shortness of breath.
Recognize
the Problem
Set the Stage

8. What to look for?
PART 1
INFORMATION GATHERING
Stage #1 Visual Assessment
Stage #2 Bedside Assessment
Stage #3 Labs, Imaging, or Special Procedures
FOLLOW THESE STEPS. TRY NOT TO GET AHEAD OF YOURSELF>

9. STEP #1 Pick your VISUAL ASSESSMENT
It’s always safe to
pick these ones
first:
● General = Gen.
Appearance
● Chest = Chest Appearance
● R = Resp. Rate & Pattern
● C = Color
● P = Posture
● S = Sensorium

10. A= Appearance
● Color
● Facial Expression (Grimace)
● Body Language
○ Diaphoretic
○ Stance ( Body position)
○ WOB (Work of
Breathing)
Credit to: Natural Remedies, YouTube Videos Open resource, https://youtu.be/6i3jpmvLhGM
Examples: VISUAL ASSESSMENT
Airway
● Can patient protect
their airway?
● Tracheal Position?
● Is there an airway
established?
● Facial Trauma?

11. NEURO
LOC (Level of
Consciousness) or
MS (Mental Status)
● Awake
● Alert
● Confused
● Lethargic
● Agitated
● Conscious
● Unconscious
WHY IS THIS IMPORTANT?
Con’t of Examples: VISUAL ASSESSMENT

12. STOP!! IS THERE AN EMERGENCY?!
If NOT, then move
to the next stage Stage #2

13. Step #2 Pick the Basic BEDSIDE ASSESSMENT
It’s safe to pick
these ones Next:
● P = Pulse
● B = Blood Pressure
● T = Temperature
● P = Percussion (Chest)
● B = Breath Sounds
● T = Tracheal Position
● H = Heart Sounds
● C = Capnography

14. OTHER:
Stage #2
(Special Bedside
Assessments)
1. T = Transcutaneous Monitoring
2. H = Hemodynamic Monitoring
3. E = ECG Monitor
4. B = Bowel Sounds
5. R = ROM (Range of Motion)
6. O = Oximetry
7. R =Reflexes
i. Pupil
ii. Gag
iii. Babinski, ETC
8. C = CRT (Capillary Refill Time)
Choose the Assessment BEST fit
your scenario.
Do Not Select
Unnecessary Bedside
Information
Gathering!

15. Pulmonary/
Respiratory
● RR (Resp. Rate)
● BS (Breath Sounds)
● Resp. Pattern
● Chest Rise
● Sats? O2?
● Capnography?
Examples: Bedside Results
Is the Patient
Ventilating and
Oxygenating okay?

16. Cardio/Cardiac
💜
Is the patient
hemodynamically
stable?
1. Pulse
a. Week/Strong
2. HR
a. Fast or slow
3. ECG monitor reading
4. Any other Hemodynamic
Readings
a. CVP
b. MAP
Con’t of Examples: Bedside Results

17. SYSTEM
(Perfusion)
● Temperature
○ Fever
○ Hypothermia
● BP (Blood Pressure)
● CRT (Capillary Refill)
● Wound?
● Post Sx (Surgery)
● Bruise?
● Infection?
● Disability?
● Edema
Any system issues?
Con’t of Examples: Bedside Results

18. If NOT, then move
to the next stage Stage #3
STOP!! IS THERE AN EMERGENCY?!

19. Step #3 Pick the Basic Lab Test
It’s safe to pick
these ones Next:
● A= ABG
● C = CXR (Chest x-ray)
● E = Electrolytes
● C= CBC
● 12 = 12 Lead EKG

20. OTHER: Stage #3 (Special Labs or Tests)
Choose the Assessment BEST fit your scenario.Do Not Select Unnecessary Bedside
Information Gathering!
Basic Case-by-
Case
PFT Imaging
Cardio-
Pulmonary
Hemo-
dynamics
Other
C/S (Sputum
Culture &
Sensitivity
Volumes (FVC, or
SVC)
CT or MRI Bronchoscopy A-Lines ● Sweat
Chloride
● V/Q Scan
● Cardiac
Enzyme
● Polysomnog
raphy
● ELISA Test
● APGAR
Score
Urinalysis
Flow Rates (FEV1,
FEF 25-75)
Lateral Neck Stress Testing
PA-Lines
(Swan-Ganz)
Blood Culture
Pre-Post
Bronchodilator
Angiograms
Echo-
Cardiogram
ICP
DLCO, ETC. PET Scan Angiography

21. DECISION MAKING! (DM)
Part 2
● Choose ONLY
ONE
● Make Another
Selection
OR
● Select AS
MANY

22. A.CROSS.SYSTEM
Neuro
💜
Pulmonary
(R)
Pulmonary
(L)
👄
System
A = Appearance
Clinical Simulation Exam Overview" by A. Bartoszynski-BSRT, RRT-ACCS, Skyline College is licensed under CC BY-SA 4.0

23. PART 2
Decision Making (DM)
G = General Care
E = Emergency Care
D = Discharge Care
C = Critical Care
V = Ventilator Care
What kind of care
does the patient
needs?

24. RECAP
You are the staff therapist in charge or a 400 bed
hospital You have been paged to see a patient in
the emergency room complaining of chest pain
and shortness of breath.
Now, what are you going to do?

25. Examples of DECISION MAKING

26. GENERAL CARE- non emergency
Neuro Cardiac Pulmonary/Airway System
Meds (Non critical)
“Doors”
Pain Meds
Fio2/O2 (Low flow,
High flows)
Antibiotics
Lung Expansion Tx
● IS
● IPPB
Nicotine Patch..ETC
Airway Clearance Tx
Equipment...ETC

27. EMERGENCY CARE!
Neuro Cardiac Pulmonary/Airway System
Sedation
(Induced for
Intubation)
Meds
Cardiac drugs
Airway
● ETT
● OP
Diuretics
● (CHF
Exacerbation)
Analgesics/
Anesthetic
Compression
(30:2)
Ventilation
● BVM (30:2)
● ETT (12 bpm)
Fluids
● Shock
Paralytic Defibrillate Oxygenation
What is considered an EMERGENCY? (Respiratory
Arrest, and/or Cardiac Arrest)

28. DISCHARGE CARE
Neuro Cardiac Pulmonary/Airway System
Cardiac Drugs TGH
(to go home)- Long
Term
● HTN
● CHF
Airway
● Trach Care
Meds
● Cholesterol
Maintenance
Clot Preventive
Drugs
● Coumadin
● Plavix
Ventilation
● Home vent-
long term
Diet/Nutrition
Equipments
● Transport
● Mobility at
home

29. CRITICAL CARE
Neuro Cardiac Pulmonary/Airway System
Sedation Meds
Cardiac drugs
Meds (Critical)
● iNO
● Surfactant
Diuretics
● Ace Inhibitors
● Lasix
Paralytic Ventilation (PCO2)
● Invasive
● NIV
Fluids
● Shock
Analgesics Oxygenation (PaO2)
Ventilator Management
● Modes
● Modification
Resp. Center Stimulant
Ventilator
Troubleshooting

30. Now let’s practice some cases!
Thank you
Clinical Simulation Exam Overview" by A. Bartoszynski-BSRT, RRT-ACCS, Skyline College is licensed under CC BY-SA 4.0

31. References/Web sources:
1. CSE 2015 Outline Open Source:
a. https://drive.google.com/file/d/12YinUV6MyUdeKZE03WqQq6dmMlGZ8rWg/view?usp=shari
ng (Links to an external site.)Links to an external site.
2. CSE Outline After 2020 Open Source:
a. https://drive.google.com/file/d/1LwZ_Kss3_UJTh4PwvtI-sVAgHopHl9p-/view?usp=sharing
(Links to an external site.)Links to an external site.
3. How to pass the Clinical Simulation Exam:
a. https://www.respiratorytherapyzone.com/pass-the-clinical-simulations-exam/
4. Pathophysiology of Cardiopulmonary Related Diseases:
a. https://www.respiratorytherapyzone.com/