RESP 104 - Concepts in Adult Critical Care

1. Retain knowledge, skill and competency from pre-requisite courses.
2. Evaluate data in the patient record:
   1. Lines, drains and airways (chest tube, vascular lines, artificial airways-laryngeal mask airway, esophageal-tracheal tubes/supraglottic, combitube, king tube, and endotracheal tube)
   2. Blood gas analysis and/or hemoximetry (co-oximetry) results
   3. Imaging study results (chest radiograph)
   4. Trends in monitoring results (pulmonary mechanics, WOB, resistance, compliance)
3. Perform procedures to gather clinical information:
   1. Mechanics of spontaneous ventilation linked to tidal volume, minute volume, maximal inspiratory pressure and vital capacity)
   2. Blood gas sample collection
   3. Cardiopulmonary calculations (PA-aO2, Vd/Vt, P/F, OI)
   4. Pulmonary compliance and airways resistance
   5. Plateau pressure
   6. Auto-PEEP determination
   7. Spontaneous breathing trail (SBT)
   8. Apnea test (brain death determination)
   9. Cuff management (tracheal, laryngeal)
   10. Capnography (mechanical ventilation)
4. Evaluate procedure results:
   1. Mechanics of spontaneous ventilation linked to tidal volume, minute volume, maximal inspiratory pressure and vital capacity
   2. Cardiopulmonary calculations (PA-aO2, Vd/Vt, P/F, OI)
   3. Pulmonary compliance and airways resistance
   4. Plateau pressure
   5. Auto-PEEP determination
   6. Spontaneous breathing trial (SBT)
   7. Apnea test (brain death determination)
   8. Cuff management (tracheal, laryngeal)
   9. Chest x-ray
   10. Capnography (mechanical ventilation)
5. Assemble/troubleshoot equipment:
   1. Resuscitation devices (self-inflating resuscitator, flow-inflating resuscitator, AED)
   2. Mechanical ventilators
   3. Intubation equipment
   4. Artificial airways
   5. Patient breathing circuits
6. Perform quality control procedures (mechanical ventilators)
7. Maintain a patent airway including the care of artificial airways:
   1. Recognizes a difficult airway
   2. Esophageal-tracheal tubes/supraglottic airways
   3. Endotracheal tube
   4. Laryngectomy tube
   5. Speaking valves
   6. Devices that assist with intubation (endotracheal tube changer, video laryngoscopy)
   7. Exchanging artificial airways
   8. Maintaining adequate humidification
   9. Initiating protocols to prevent ventilator associated infections
   10. Performing extubation
8. Support oxygenation and ventilation:
   1. Minimizing hypoxemia (patient positioning, secretion removal)
   2. Continuous mechanical ventilation
   3. Alarms
   4. Recognizing and correcting patient-ventilator dyssynchrony
   5. Utilizing ventilator graphics
   6. Performing lung recruitment maneuvers
   7. Liberating patient from mechanical ventilation
9. Ensure modifications are made to the respiratory care plan modalities (BVM, artificial airways, mechanical ventilation, weaning parameters)
   1. Treatment termination (life threatening adverse event)
   2. Liberating from mechanical ventilation (e.g. t-piece, weaning modes)
   3. Discontinuing treatment based on patient response
10. Make recommendations for changes based on patient assessment:
    1. Patient position
    2. Mechanical ventilation
       1. Modes of ventilations (SIMV, A/C, and Spontaneous in both VCV and PCV)
       2. Ventilator settings (rate, tidal volume, inspiratory pressure, PEEP, FiO2, I-Time, peak flow, alarms, class of ventilator, terminology associated with mechanical ventilation)
    3. Chest x-ray
11. Utilize evidence based medicine principles:
    1. Application of guidelines (ARDS Net, NAEPP, GOLD)
12. Provide respiratory care in high risk situations for cardiopulmonary emergencies (e.g. rapid response team, transport inside hospital and obstructed/lost airway, etc.)
13. Assist a physician/provider in performing procedures:
    1. Intubation
    2. Withdrawal of life support

Establishing, maintaining a patent airway

Airway emergencies

Arterial line blood gases

Adult Invasive Ventilation to include QC

Monitoring and management of the critically ill patient

Pulmonary Compliance, Airway Resistance, Work of Breathing

Supporting oxygenation and ventilation

Liberating/terminating mechanical ventilation

Assisting physician with intubation and withdrawal of life support

Evaluations

Procedures:

1. Arterial Line ABGs
2. Assisting with Intubation
3. Adult Mechanical Ventilation Initiation and Rounds
4. Adult Mechanical Ventilation Circuit change
5. Weaning Parameters
6. Adult inline suctioning
7. Adult Endotracheal Tube Care (Securing airway and Cuff management)
8. Adult Extubation
9. CXR for Tubes and Lines
10. Basic Waveform Graphic Interpretation
11. Capnography (mechanical ventilator)
    TOTAL PROCEDURES: 11