RESP 208 - Clinical Applications and Concepts in Critical Care III

1. Retain knowledge, skill and competency 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
      1. Ventilator liberation parameters
      2. Pulmonary mechanics
      3. Cardiac evaluation / monitoring results (ECG, hemodynamic parameters)
   4. 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. Quality of imaging (patient position, penetration, lung inflation)
   2. Presence and position of airways, lines and drains
   3. Presence of foreign bodies
   4. Heart size and position
   5. Presence or change in cardiopulmonary abnormalities (pneumothorax, pleural effusion, consolidation, pulmonary edema, pulmonary artery size)
   6. Presence or change in diaphragm, mediastinum or trachea
5. Perform procedures to gather
   1. Mechanics of spontaneous ventilation (tidal volume, minute volume, MIP, MEP, vital capacity)
   2. Blood gas sample collection
   3. Blood gas analysis and/or hemoximetry (co-oximetry)
   4. Cardiopulmonary calculations (PA-aO2, VD/VT, P/F, OI)
   5. Pulmonary compliance and airway resistance
   6. Plateau pressure
   7. Auto-PEEP determination
   8. Spontaneous breathing trial (SBT)
   9. Apnea test (brain death determination)
   10. Cuff management tracheal and laryngeal
6. Evaluate procedure results:
   1. Evaluate 12 lead ECG
   2. Mechanics of spontaneous ventilation (tidal volume, minute volume, MIP, MEP, vital capacity)
   3. Blood gas analysis / hemoximetry (co-oximetry)
   4. Cardiopulmonary calculations (PA-aO2, VD/VT, P/F, OI)
   5. Hemodynamic monitoring
   6. Pulmonary compliance and airways resistance
   7. Plateau pressure
   8. Auto-PEEP determination
   9. Cuff management tracheal and laryngeal
   10. Spirometry inside or outside a pulmonary function laboratory
   11. 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. Troubleshooting and assembling of equipment
   1. CPAP/NPPV with patient interfaces
   2. Mechanical ventilators
   3. Intubation equipment
   4. Artificial airways
   5. Blood analyzers (hemoximetry (co-oximetry), blood gas, point of care)
   6. 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. 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
    5. Maintaining protocols to prevent ventilator associated infections
    6. Performing extubation
11. 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
       1. Continuous mechanical
       2. Noninvasive ventilation
       3. Alarms
    4. Recognizing and correcting patient ventilator dyssynchrony
    5. Utilizes ventilator graphics (waveforms, scales)
    6. Liberating patient from mechanical ventilation
12. Administers medications and specialty gases via endotracheal instillation
13. Ensures modifications are made to the respiratory care plan
    1. Terminates treatment based for life threatening adverse event
    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
14. Utilizes principles of evidence based medicine principles or clinical practice guidelines
    1. Classification of disease severity
    2. Recommendation for changes in a therapeutic plan when indicated
    3. Application of guidelines (ARDSNet, NAEEP, GOLD)
15. Assist a physician/provider in performing procedures
    1. Intubation
    2. 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. Mechanical Ventilation Circuit change
6. Non-Invasive Positive Pressure Ventilation (NPPV)
7. Ventilation Liberation Parameters
8. Adult Inline Suctioning
9. Adult Endotracheal Tube Care (Securing airway, Cuff management)
10. Adult Extubation
11. CXR for Tubes and Lines
12. Basic Interpretation of Waveform Graphics
    TOTAL PROCEDURES: 12