This slideshow gives an outlook of what a Respiratory Therapist's duties and functions at the VA hospital in Palo Alto, California and how RT's collaborate with the nursing department to ensure proper treatment to our veterans.

1. RT Competency Review
By: Anrey bartoszynski-RRT-accs
@ Veterans Affairs, palo alto, CA

2. 4 Life Functions
Ventilation - RT
Oxygenation - RT
Circulation - RN
Perfusion - RN

3. Ventilation
PCO2
•TV (Set TV, set pc)
•RR
*Note: we deliver breath- not take away

4. Oxygenation
PaO2
•Fio2
•PEEP
Fio2 up to 60% then Optimum PEEP
Then Fio2 up to 100%

5. ABG
• pH
• PCo2
• Pao2
• HCo3
• SaO2
*SPO2
Metabolic VS Alkalotic
H2o + Co2 <> H2CO3 <> H+ + CO2
Saturation goals:
•Normal
•COPD
•ILD/ARDS

6. Circulation: Hemodynamics
DAM Idea!!
•CVP
•PAP
•PCWP
•MAP/ CO
Watch those pressors that affects PVR

7. Perfusion
• Urine Output
• BP
• CRT
• Pulse
You Know this!!

8. EMERGENCY!!
RN intervention if RT is unavailable
PATIENT NOT VENTILATING
•Resp. arrest
•Ventilator malfunction
•Obstruction in artificial
airway
INTERVENTION(s)
1.Disconnect from vent
2.Ambu Bag ventilation
•Mask
•Artificial airway (ETT vs Trach)-
don’t forget the CUFF
3. Suction with Lavage
•Mucus plugs

9. REMEMBER YOUR ACLS
Rescue Breaths
Do not wait
for that BRAIN
to starve from
OXYGEN!

10. Why RT’s Intervene?
 Recruit (Alveoli Recruitment) – Lung Expansion Therapy
 Clear airway – airway clearance
 Protect airway
 Medicate- Bronchodilator/anti-inflammatory
 Oxygenate
 Ventilate
 Establish airway

11. Recruit Alveoli
(Lung Expansion
Therapy)
• IS
• Long I.Time
• PEP – EZPAP
• Aerobika –
combo

12. Airway
Clearance
• IPV
• Suction lines
1. Open
2. Close
• Cough Assist

13. Protect Airway
(Cuffed)
•ETT (Endotracheal
Tube)
•Trach
DEFLATE CUFF
DURING PMV TRIAL!!

14. Medicate
• Bronchodilator
• Corticosteroid
(Pulmonary)
• Antibiotic
(Pulmonary)
• Mucolytic

16. Oxygenate
• Low Flow
• High Flow
• Ambu Bag

18. Cool or Heated Aerosol • Mask
• Trach Mask
• Face tent
• Blow-by
Flow will depend on
Fio2 Delivered

19. Ventilate
• Hospital Grade
Ventilators
• Home Ventilators
• V60/VPAP/CPAP

20. Establish
(Cuffed and
uncuffed)
• OPA (oropharyngeal
airway)
• NP (Naso- pharyngeal
airway
• ETT
• Trach

21. Paralytics
 Propofol- SBT’s
 Presedex - Does not decrease WOB
 Ketamine – also sedates and increases BP
 Anectin (Succinylcholine) – Not for TBI or Burn
*Watch for Respiratory decline

22. Sedatives
 Morphine – decreases RR/TV
 Versed – common
*Watch for Respiratory decline

23. Pressors
 Increases PVR ( pulmonary vascular resistance)
1. Neo-synephrine
 Common
1. Levophed
Increase PVR = Decrease C.O.

24. Prevent VAP (ventilator acquired PNA)
 HOB> 30 degrees
 Prevent breaking vent tubing circuit, use Heated wire
circuit versus HME
 Keep Tube cuff inflated Using MLT or MOV technique
 Continue oral care.
 ETT with Subglottic suction port
 Daily sedation interruption during SBT.
Don’t Forget!!
•Hand Hygiene
•PPE

25. Modes of Ventilator
 AC
Versus
 SIMV/PS
Note: Every Vent calls their modes differently so don’t sweat remembering the
modes, but understand how it works.
Other:
•APRV/Bi-Level
•CPAP/PS
VC (Volume Control)
Versus
PC (Pressure Control)

26. Wean/SBT
 Neuro
 Cardio
 Pulmonary
 Airway
”You Pray”
If Ok: Turn off Sedation

27. Weaning
SBT Qualification/Screen Test
3. Pulmonary
•FIo2< 40
•PEEP < 8
• TV
• RR
•RSBI <106
•SPo2
•Abg
•BS
•WOB
4. Airway
•Secure
•Leak
•Block1. Neuro
•Mental Status
•Sedation
•Pain
2. Cardio
•No pressors
•Stable Hemodynamics
STOP SBT if not tolerating
Resume again in 24 hours

28. MISC.
 Neuro-respiratory-
1. Hypoxic Drive?
 Renal System’s affect to ABG
 POP Quiz
 Questions?

29. THE END