RESP 206 - Clinical Applications and Concepts in Critical Care I

1. Retain knowledge, skill and competencies from pre-requisite courses.
2. Evaluate data in the patient record:
   1. Blood gas analysis and/or hemoximetry (co-oximetry) results
   2. Imaging study results (chest radiographs, CT scan, Ultrasonography and/or echocardiography, PET scan, Ventilation/Perfusion scan)
   3. Trends and monitoring of ventilator liberation parameters
   4. Determination of a patient’s pathophysiological state
3. Perform clinical assessment by auscultation of heart sounds and rhythm
4. Perform clinical assessment by chest radiograph:
   1. Quality of imaging (patient position, penetration, lung inflation)
   2. Presence and position of airways, lines and drains
   3. Heart size and position
5. Perform procedures to gather:
   1. Mechanics of spontaneous ventilation (tidal volume, minute volume, MIP, MEP, and vital capacity)
   2. Blood gas sample collection
   3. Cardiopulmonary calculations (PA-aO2, VD/VT, P/F, OI)
   4. Spontaneous breathing trial (SBT)
   5. Apnea test (brain death determination)
   6. Cuff management (tracheal tube and laryngeal)
6. Evaluate procedure results:
   1. Mechanics of spontaneous ventilation (tidal volume, minute volume, MIP, MEP, and vital capacity)
   2. Blood gas analysis/hemoximetry (co-oximetry)
   3. Cardiopulmonary calculations ((PA-aO2, VD/VT, P/F, OI)
   4. Cuff management (tracheal tube and laryngeal)
7. Troubleshooting and assembling of equipment:
   1. CPAP/NPPV with patient interfaces
   2. Intubation equipment
   3. Artificial airways
   4. Patient breathing circuits
8. Maintain a patent airway and care for artificial airways
   1. Proper patient positioning
   2. Recognition of a difficult airway
   3. Establish and manage a patient’s airway:
      1. Nasopharyngeal
      2. Oropharyngeal,
      3. Esophageal Tracheal tubes/supraglottic airways
      4. Endotracheal tubes
      5. Tracheostomy tube
      6. Laryngectomy tube
      7. Devices to assist with intubation (endotracheal tube changer, video laryngoscopy)
   4. Exchanging artificial airway
9. Support oxygenation and ventilation:
   1. Minimizing hypoxemia via patient positioning and suctioning
   2. Initiating and adjusting mask or nasal CPAP
   3. Initiating and adjusting mechanical ventilation settings
      1. Continuous mechanical ventilation
      2. Noninvasive ventilation
      3. Alarms
10. Administers medications and specialty gases via endotracheal (instillation)
11. Ensures modifications are made to the respiratory care plan
    1. Terminates treatment based on life threatening adverse events
    2. Recommendation for changes:
       1. Starting treatment based on patient response
       2. Adjusting of electrolyte therapy
       3. Insertion or change of artificial airway
       4. Liberating from mechanical ventilation
       5. Extubation
       6. Discontinuing treatment based on patient response
       7. Consultation for a physician specialist
       8. Changing patient position
       9. Changing mechanical ventilation parameters and settings
12. Utilizes principles of evidence based medicine principles or clinical practice guidelines:
    1. Classification of disease severity
    2. Recommendation for changes in therapeutic plan when indicated
    3. Application of guidelines (ARDSnet, NAEEP, GOLD)
13. Assist a physician/provider in performing procedures a. Intubation b. Withdrawal of life support

Arterial blood gas sampling and analysis

Noninvasive monitoring of the cardiopulmonary system (ECG)

Managing patients in critical care

Establishment, maintenance of artificial airways

Applications and manipulations of invasive mechanical ventilation

Therapeutic modalities in critical care settings

Quality control procedures (ABG, POC, Mechanical Ventilators)

Advanced patient assessment, including interpretation of laboratory and clinical data and recommendations of appropriate therapeutic interventions

PROCEDURES:

1. Arterial Line ABGs
   1. Suggested that students continue ABG stick competency per semester in critical care
2. Assisting with Intubation
3. Mechanical Ventilation Initiation
4. Mechanical Ventilation Rounds
5. Ventilation Liberation Parameters
6. Adult Inline Suctioning
7. Endotracheal Tube Care (Securing airway, Cuff management)
8. Non-Invasive Positive Pressure Ventilation (NPPV)
   TOTAL PROCEDURES: 8