RCP 100: Ch 1

AARC Definition of Respiratory Care

• It involves the scientific principles of cardiopulmonary physiology and pathophysiology.
• It involves the biomedical engineering and application of technology.
• Therapists use critical thinking and patient assessment skills.
• Evidence-based clinical practice guidelines enable respiratory therapists to develop care plans.
• It includes patient-driven protocols, disease pathways, and disease management.

History of Respiratory Medicine - Ancient Times

• Early cultures used herbal remedies for diseases.
• Hippocrates, known as the "father of medicine,” lived in the 5th-4th centuries BC.
• Hippocrates was the first to describe digital clubbing.
• Hippocratic medicine was based on essential fluids: phlegm, blood, yellow bile, and black bile.
• Hippocrates believed air contained a substance distributed to the body by the heart.
• The Hippocratic oath, which calls for physicians to follow ethical principles, is given to graduates.

History of Respiratory Medicine - Middle Ages

• The fall of the Roman empire in 476 AD caused slow scientific progress.
• An intellectual rebirth occurred in Europe in the 12th century.
• Leonardo da Vinci (1453-1519) found that sub-atmospheric pressures inflated the lungs.
• Andreas Vesalius (1514-1564) did human dissections and experimented with resuscitation.
• The 17th Century saw advances in science from Galileo, Pascal, Hooke, and Newton.
• In 1628, Harvey fully described the circulatory system.
• Boyle published "Boyle's Law" in 1662 defining the relationship between gas volume and pressure.
• In 1650, Torricelli invented the barometer and Pascal demonstrated air pressure decreases with altitude

Development of the Respiratory Care Profession

• Technicians hauled oxygen cylinders and applied oxygen delivery devices in the1940s.
• Positive-pressure breathing devices were applied to patients for treatment in the 1950s
• Formal education programs for inhalation therapists began in the 1960s.
• Sophisticated ventilators expanded the role of respiratory therapists (RT) in the 1960s.
• Respiratory Therapists (RTs) were soon responsible for arterial blood gas & PFT laboratories.
• The designation “respiratory therapist" designation became standard in 1974.

Oxygen Therapy Development

• 1907: Large-scale production of O₂ was developed by Karl von Linde.
• 1910: Oxygen tents were first used.
• 1918: Oxygen masks were first used.
• 1940s: O₂ therapy was commonly prescribed due to ease of use, but it wasn't measurable.
• 1960s: The Clark electrode development allowed measurement of arterial PO2.
• 1974: The ear oximeter was invented.
• 1980s: Pulse oximetry began being used.

Aerosol Medication Development

• 1910: Aerosolized epinephrine was introduced to treat asthma.
• Later: Isoproterenol (1940), isoetharine (1951), Albuterol (1980), and Xopenex (2000) were introduced as bronchodilators.

Mechanical Ventilation Development

• 1928: Philip Drinker introduced the iron lung.
• 1950s: A negative-pressure "wrap" ventilator was introduced.
• Originally, positive-pressure ventilation was used during anesthesia.
• 1911: The Drager Pulmotor was invented.
• 1970s: More advanced volume ventilators were available: Servo 900, Bourns Bear I and II, and MA II.

Airway Management

• Tracheostomies performed as early as the 1500s relieved airway obstructions.
• 1880: William MacEwen successfully applied the first endotracheal tube to a patient.
• 1913: The laryngoscope was introduced.

Respiratory Care Education

• 1950: The first formal RT program was offered in Chicago.
• 1960s: RT schools grew; many programs hospital-based,
• Today, most RT programs are offered at colleges and universities.
• All accredited RT programs today are monitored by the Committee on Accreditation for Respiratory Care (CoARC).

Organizations Within the Respiratory Care Profession

• 1946: Inhalational Therapy Association (ITA)
• 1954: American Association of Inhalation Therapists (AAIT)
• 1960: First hospital-based training programs
• 1960: American Registry of Inhalation Therapists (ARIT)
• 1972: American Association for Respiratory Therapy (AART)
• 1975: National Board for Respiratory Therapy (NBRT)
• 1983: National Board for Respiratory Care (NBRC)
• Scientific Journal Respiratory Care is a major international publication focused on respiratory care.
• The NBRC is the nationally recognized, voluntary credentialing body in respiratory care.
• A profession is described by advancing science, technology, and practice.
• A profession involves continuing education, active participation from members, credentials, & leadership.
• A profession is described by its pursuit of research and innovation.
• NBRC is the national credentialing organization for respiratory therapists.
• The NBRC exams are used as the standard for licensure or certification that regulates the profession.
• The CRT examination is the entry-level credential for respiratory care practice.
• The RRT examination was developed to measure the advanced respiratory therapists.
• CoARC is the national accreditation body for respiratory care education programs.
• The NBRC requires graduation from an accredited program for eligibility for credentialing exams.
• CoARC program standards include sponsorship, outcome orientation, resources, student disclosure, planning, and program evaluation.