RESP 207 - Clinical Applications and Concepts in Critical Care II

1. Retain knowledge, skills and competencies from prerequisites courses
2. Evaluate data in the patient record:
   1. Imaging study results (chest radiographs, CT scan, Ultrasonography, echocardiography, PET scan, Ventilation/Perfusion scan)
   2. Trends and monitoring i. Pulmonary mechanics ii. Cardiac evaluation/monitoring results (ECG, hemodynamic parameters)
   3. Determination of a patient’s pathophysiological state
3. Perform clinical assessment by auscultation
   1. Breath sounds
   2. Heart sounds and rhythm
4. Perform clinical assessment by chest radiograph:
   1. Presence and position of airways, lines and drains
   2. Presence of foreign bodies
   3. Presence of or change in diaphragms, mediastinum or trachea
   4. Presence or change in cardiopulmonary abnormalities (pneumothorax, consolidation, pleural effusion, pulmonary edema, pulmonary artery size)
5. Perform procedures to gather:
   1. Blood gas analysis/hemoximetry (co-oximetry)
   2. Pulmonary compliance and airway resistance
   3. Plateau pressure
   4. Auto-PEEP determination
   5. Apnea test (brain death determination)
6. Evaluate procedure results:
   1. Evaluate 12 lead ECG
   2. Hemodynamic monitoring
   3. Pulmonary compliance and airways resistance
   4. Plateau pressure
   5. Auto-PEEP determination
   6. Cuff management tracheal and laryngeal
   7. Spirometry inside or outside a pulmonary function laboratory
   8. Lung volumes in a pulmonary function laboratory
7. Recommend diagnostic procedures:
   1. Imaging studies
   2. Blood gas and/or hemoximetry (co-oximetry)
   3. ECG
8. Troubleshoot and assembling of equipment:
   1. Mechanical ventilators
   2. Blood analyzers (hemoximetry (co-oximetry), blood gas, point of care)
   3. Patient breathing circuits
9. Perform quality control procedures
   1. Blood analyzers (hemoximetry (co-oximetry), blood gas, point of care)
   2. Mechanical ventilators (Pretest, EST)
10. Maintain a patent airway and care for artificial airways
    1. Maintaining protocols to prevent ventilator associated infections
    2. Performing extubation
11. Support oxygenation and ventilation:
    1. Initiating and adjusting mechanical ventilation settings:
       1. Continuous mechanical
       2. Noninvasive
       3. Alarms
    2. Recognizing and correcting patient ventilator dyssynchrony
    3. Utilizes ventilator graphics (waveforms, scales)
    4. Liberating patient from mechanical ventilation
12. Administers medications and specialty gases via endotracheal instillation
13. Ensure modifications are made to the respiratory care plan
    1. Terminates treatment based on life threatening 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
14. Utilizes principles of evidence based medicine principles or clinical practice guidelines
    1. Classification of disease severity
    2. Recommendation for changes in therapeutic plan as indicated
    3. Application of guidelines (ARDSnet, NAEEP, GOLD)
15. Assist a physician/provider in performing procedures
    1. Withdrawal of life support

Noninvasive monitoring of the cardiopulmonary system (ECG)

Managing patients in critical care

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. Mechanical Ventilation Initiation
2. Mechanical Ventilation Rounds
3. Mechanical Ventilation Circuit Change
4. CXR for Tubes and Lines
5. Basic Interpretation of Waveform Graphics
6. Adult Extubation *Suggested that students continue arterial line and ABG stick per semester in critical care
   TOTAL PROCEDURES: 6