3. Introduction to Respiratory Therapy
Scope of Respiratory therapy
RT Job Descriptions
History of Respiratory care
Respiratory care organizations
Respiratory care in Pakistan
RT Future Plan
3
4. Egan's Fundamentals of Respiratory Care -
14th edition
Respiratory Care: Principles and Practice, by
Dean R. Hess
4
5. Respiratory therapist also known as respiratory care
practitioners, evaluate, treat and care for patients with
breathing and other cardiopulmonary disorders.
Practicing under the direction of physician, respiratory
therapists assume primary responsibility for all
respiratory care therapeutic treatments and diagnostic
procedures, including the supervision of respiratory
therapy technicians. They consult with physician and
other health care staff to help develop and modify
patient care plans. Therapists also provide complex
therapy requiring considerable independent
judgment, such as caring for patients on life
support in intensive care units of hospital.
5
14. Respiratory Therapist Works in:
Medical ICU
Surgical ICU
Cardiac ICU
Neurosurgical ICU
Peads ICU
Neonatal ICU
HDU
Emergency
Pulmonology ward
Resus
PFTs Lab
Sleep Lab
RRT and Code Blue
Rehabilitation Centers
Consultant Clinics
Home Respiratory Care
Air Ambulance
Educational institutes and Universities
Many More
14
15. We work with adults, children, neonates to help them breath
utilizing such things as:
◦ Patient assessment, Interviewing
◦ Aerosol and Medical Gas Therapy
◦ Mechanical ventilation(Invasive & Noninvasive)
◦ Airway management
◦ ABGs
◦ Lung Expansion Therapy (Hyperinflation devices)
◦ Chest physiotherapy/bronchial hygiene (Suction)
◦ Tracheostomy Care
◦ Home Respiratory Care
◦ Transport of Critically ill patient
◦ Diagnostic procedures such as bronchoscopy, pulmonary function testing
◦ Sleep Study (Polysomnography)
◦ Disease management education, Rehab and home care
◦ CPR (Code Blue Member)
15
16. 1. Work as part of a team of physicians, nurses and other health care
professionals to manage patient care.
2. Enforce safety rules and ensure careful adherence to physicians' orders.
3. Apply scientific principles for the identification, prevention, treatment
and rehabilitation of acute and chronic cardiopulmonary disorders.
4. Set up and operate devices such as mechanical ventilators, therapeutic
gas administration apparatus, environmental control systems, and
aerosol generators, following specified parameters of treatment.
5. Provide emergency care, including artificial respiration, external cardiac
massage and assistance with cardiopulmonary resuscitation.
6. Determine requirements for treatment, such as type, method and
duration of therapy, precautions to be taken, and medication and
dosages, compatible with physicians' orders.
7. Monitor patient's physiological responses to therapy, such as vital signs,
arterial blood gases, and blood chemistry changes, and consult with
physician if adverse reactions occur.
16
17. 1. Read prescription, measure arterial blood gases, and review
patient information to assess patient condition.
2. Inspect, clean, test and maintain respiratory therapy equipment to
ensure equipment is functioning safely and efficiently, ordering
repairs when necessary.
3. Educate patients and their families about their conditions and
teach appropriate disease management techniques, such as
breathing exercises and the use of medications and respiratory
equipment.
4. Administer medical gases, humidification and aerosol
medications, postural drainage, Broncho pulmonary hygiene,
cardiopulmonary resuscitation, monitor mechanically ventilated
patients, maintain artificial airways and perform pulmonary
function testing.
5. Practice infection control procedures and personal hygiene
consistent with professionals in close contact with patients.
17
18. 1. Perform diagnostic procedures, interpret results, determine
pathophysiological state, and perform continuous quality
improvement.
2. Assist the physician and surgeons with special procedures.
3. Apply Respiratory Care Protocols appropriately in the clinical
settings.
4. Conduct research relevant to the field of respiratory therapy.
5. Endotracheal and Nasotracheal suction according to AARC
guidelines.
6. Chest Tube and Tracheostomy Care.
7. Demonstrate respiratory care procedures to trainees and other
health care personnel.
8. Apply Noninvasive ventilation such as BIPAP and CPAP etc.
9. Perform Sleep study.
10. Perform PFTs
18
19. 1. Demonstrate advance competence in critical care setting.
2. The respiratory therapist must be able to think critically,
communicate effectively, demonstrate judgment and provide
self-direction.
3. Demonstrate knowledge of the physiological bases for all
therapeutic interventions and diagnostic procedures in all areas
of respiratory therapy practice.
4. Practice as an Advanced Critical Care Practitioner.
5. Demonstrate advanced knowledge in one of three specialization
areas in respiratory therapy: (1) professional education; (2)
hospital department administrative leadership; or (3) a clinical
specialty practice area.
19
20. The U.S. Bureau of Labor Statistics estimates that employment
opportunities for respiratory therapists will grow 19 percent through
2022.
Govt and Private Hospitals,
Clinics and physicians’ offices
Critical care units
Transportation of critically ill patients (Air ambulance)
Diagnostic Laboratories
Sleep Centers
Pulmonary function test labs
Awareness projects
TB, COPD, Asthma etc. Centers
Home care and extended-care facilities
Colleges, Universities and
Research facilities
20
21. Respiratory Therapy Assistant / Associate /Professor
Manager Respiratory Therapy
Chief Respiratory Therapist
Respiratory Therapist
Manager ICU
Pulmonary Function Technologist
Sleep Study technologist (Polysomnography Technologist)
Lecturer in Respiratory Therapy
Project Manager in (Tb, COPD, Asthma, Pneumonia)
Manager Pulmonary Lab
Sleep study educator
Manager/ In charge sleep study center
Research or project manager
21
22. We listen to Patient's lungs, check vital signs,
oxygen levels using pulse oximetry
We draw and assess arterial blood
From this assessment we determine level of
respiratory distress or failure
22
25. Medications such as Albuterol and Others are
used to open constricted lungs caused by
Asthma and COPD
These drugs are administered through either a
nebulizer or as MDI or DPI
25
34. We teach breathing techniques such as pursed
lip breathing, diaphragmatic breathing
We teach smoking cessation, CPR, COPD,
asthma and other lung disease management
techniques to our patients
34
36. 1943: Edwin R. Levine, MD, establishes a primitive
inhalation therapy program using on-the-job
trained technicians to manage post-surgical
patients at Michael Reese Hospital in Chicago
July 13, 1946: Dr. Levine’s students and other
interested doctors, nurses, and oxygen orderlies
meet at the University of Chicago Hospital to form
the Inhalation Therapy Association (ITA).
36
37. April 15, 1947: The ITA is formally chartered as a
not-for-profit entity in the state of Illinois. The new
Association boasts 59 members, 17 of whom are
from various religious orders.
1947: Albert Andrews, MD, outlines the structure and
purpose of a hospital-based inhalation therapy
department in his book, Manual of Oxygen Therapy
Techniques.
1950: The New York Academy of Medicine publishes
a report, “Standard of Effective Administration of
Inhalation Therapy,” setting the stage for formal
education for people in the field
37
38. March 16, 1954: The ITA is renamed the American
Association of Inhalation Therapists (AAIT). In
February 1966, it was again renamed the American
Association for Inhalation Therapy (still, AAIT).
May 11, 1954: The New York State Society of
Anesthesiologists and the Medical Society of the
State of New York form a Special Joint Committee in
Inhalation Therapy to establish “the essentials of
acceptable schools of inhalation therapy.”
November 7-11, 1955: The AAIT holds its first
annual meeting (now the AARC International
Respiratory Congress) at the Hotel St. Clair in
Chicago.
38
39. June 1956:
The American Medical Association (AMA) House of
Delegates adopts a resolution calling for the use of
the New York Essentials in the creation of schools of
inhalation therapy.
1956:
The AAIT begins publishing a science journal,
Inhalation Therapy (now RESPIRATORY CARE).
October 1957:
The AAIT, AMA, American College of Chest
Physicians, and American Society of
Anesthesiologists jointly adopt the Essentials for an
Approved School of Inhalation Therapy Technicians;
the Essentials begin a three-year trial period. 39
40. 1960:
The American Registry of Inhalation Therapists
(ARIT) is formed to oversee a new examination
leading to a formal credential for people in the field.
November 18, 1960:
The ARIT administers the first Registry exams in
Minneapolis.
December 1962:
The AMA House of Delegates grants formal approval
for the “Essentials for an Approved School of
Inhalation Therapy Technicians.”
October 8, 1963: The Board of Schools of Inhalation
Therapy Technicians is formed in Chicago.
40
41. 1969:
The AAIT launches the Technician Certification Program to
offer a credential to people working in the field who do
not qualify to take the Registry exams.
January 9, 1970:
The Board of Schools of Inhalation Therapy Technicians
becomes the Joint Review Committee for Respiratory
Therapy Education (JRCRTE).
1973:
The AAIT becomes the American Association for
Respiratory Therapy (AART).
1974: The profession’s two credentialing programs merge
into the National Board for Respiratory Therapy (NBRT);
the AAIT forms the American Respiratory Therapy
Foundation (ARTF) to support research, education, and
charitable activities in the profession. 41
42. 1982:
California passes the first modern licensure law governing the
profession of respiratory care; President Ronald Reagan
proclaims the first National Respiratory Care Week.
1986:
The AART becomes the American Association for Respiratory
Care (AARC); the ARTF becomes the American Respiratory Care
Foundation (ARCF); the NBRT becomes the National Board for
Respiratory Care (NBRC).
1990:
The AARC begins developing Clinical Practice Guidelines (CPGs)
for treatments and modalities common in the field; the ARCF
launches an International Fellowship Program to bring health
care professionals from around the world to the U.S. every year
to tour health care facilities in two cites and then attend the
AARC International Respiratory Congress.
42
43. 43
An oxygen mask was developed in 1938
by 3 physicians from the Mayo Clinic for
use by Army pilots flying at high altitude.
In the 1940s, technicians were used to
haul O2 cylinders and apply O2 delivery
devices.
In the 1950s, positive-pressure breathing
devices were applied to patients.
Formal education programs for inhalation
therapists began in the 1960s.
44. 44
The development of sophisticated mechanical
ventilators in the 1960s expanded the role of the
respiratory therapist (RT).
RTs were soon responsible for arterial blood gas and
pulmonary function laboratories.
In 1974, the designation “respiratory therapist”
became standard.
In 1983 the state of California passed the first
licensure bill for Respiratory Care Practitioners
(RCP’s). Minimum entry level was set at completion
of a one year technician level training program.
45. 45
Oxygen Therapy
Large-scale production of O2 was
developed in 1907 by Karl von Linde.
Oxygen tents were first used in
1910, and O2 masks, in 1918.
O2 therapy was widely prescribed in
the 1940s.
46. 46
The Clark electrode was first developed in
the 1960s and allow measurement of arterial
PO2.
The ear oximeter was invented in 1974, and
pulse oximeter, in the 1980s.
The Venturi mask to deliver a specific FIO2
was introduced in 1960.
Portable liquid O2 systems were introduced
in the1970s.
47. 47
Aerosol Medications
In 1910, aerosolized epinephrine was
introduced as a treatment for asthma.
Later, isoproterenol (1940) and
isoetharine (1951) were introduced as
bronchodilators.
Aerosolized steroids first used in the
1970s to treat acute asthma.
48. 48
Mechanical Ventilation
The iron lung was introduced in 1928 by Philip Drinker.
Jack Emerson developed an improved version of the iron
lung that was used for polio victims in the 1940s and
1950s.
A negative-pressure “wrap” ventilator was introduced in
the 1950s.
49. 49
Originally, positive pressure ventilation
was used during anesthesia.
The Drager Pulmotor (1911), the Spiro
pulsator (1934), the Bennett TV-2P
(1948) and Bird Mark 7 (1958) were
positive-pressure ventilators.
The Bennett MA-1, Ohio 560, and
Engstrom 300 were introduced in the
1960s as volume-cycled ventilators.
50. 50
More advanced volume ventilators
became available in the 1970s: Servo
900, Bourns Bear I and II, and MA II.
The first microprocessor-controlled
ventilators were developed in the
1980s (Bennett 7200).
Ventilators with the capability of
applying advanced modes of
ventilation became available in the
21st century.
51. 51
William MacEwen in 1880 applied the
first endotracheal tube to a patient
successfully.
In 1913, the laryngoscope was
introduced.
The first suction catheter was
described in 1941.
Low-pressure cuffs for endotracheal
tubes were introduced in the 1970s.
52. 52
Measurement of the lung’s residual
volume was first done in 1800.
In 1846, the first water-sealed
spirometer was developed by John
Hutchinson.
In 1967, rapid arterial blood gas
analysis became available.
Polysomnography became routine
In the 1980s.
53. 53
The Inhalation Therapy Association was founded
in 1947.
The ITA became the American Association for
Inhalation Therapists in 1954.
The AAIT became the American Association for
Respiratory Therapy in 1973.
The AART became the American Association for
Respiratory Care in 1982.
http://www.aarc.org/
54. ◦ Publishes Respiratory Care Journal
Monthly
◦ Issues Clinical Practice Guidelines as
Guide to Patient Procedures
◦ Serves as Advocate For The Profession
to Legislative Bodies, Regulatory
Agencies, Insurance Companies, And
The General Public
55. 55
During the 1980s, state licensure for RTs
started.
State licensure is based on RTs passing the
entry level exam offered by the National
Board for Respiratory Care.
The NBRC offers a certification and registry
examination for RTs.
http://www.nbrc.org/
56. State Professional Organization
Sponsors Educational Activities Including
Annual State Meeting
Provides Courses on Ethics for License Renewal
www.csrc.org
57. Licensure Agency For State of California
Currently Uses Results of CRT Exam as Basis
for Licensure
May Deny License For Legal And/or Ethical
Infractions
58. Reviews Instances of Malpractice, Abuse, or
Ethical Issues; May Revoke, Suspend, or Place
on Probation
Requires Fifteen Hours of Continuing
Education Every Two Years For License Renewal
59. Maintain respiratory therapy program
standardization and quality
Every program graduating RT students is
regulated by COARC
59
60. AARC: national organization, sets national standards for
the profession, primary advocacy group
CSRC: state society for Ca, each state has one, deals
with local advocacy issues
RCB of CA: each state also has a licensing board in the
state capital. They issue you your license to practice
respiratory.
NBRC: Credentialing body, must pass this national test
to become licensed. They are responsible for all
credentialing (CRT, RRT, NPS…)
COARC: agency responsible for maintaining RT
educational programs
60
61. List of The Functions Performed by
Respiratory Therapists
◦ Recognized by The AARC
◦ CLINICAL PRACTICE GUIDELINES
◦ Listed by The RCB
62. 62
The first formal RT program was offered in Chicago in 1950.
RT schools grew in the 1960s; many programs were hospital
based.
Today, RT programs are offered mostly at colleges and
universities.
In 2006, about 350 formal RT education programs exist in the
United States.
