Egan's Chapter 1: History of Respiratory Care PDF

Egan’s Chapter 1 History of Respiratory Care  Objectives Define “respiratory care.” Summarize some of the major events in the history of science and medicine. Explain how the respiratory care profession got started. Describe the historical development of the major...

Egan’s Chapter 1 History of Respiratory Care  Objectives Define “respiratory care.” Summarize some of the major events in the history of science and medicine. Explain how the respiratory care profession got started. Describe the historical development of the major clinical areas of respiratory care. 2  AARC Position statement Definition of Respiratory Care (Revised 7/15) “Knowledge and understanding of the scientific principles underlying cardiopulmonary physiology and pathophysiology, as well as biomedical engineering and application of technology, enable respiratory therapists to provide care services efficiently. As a health care profession, Respiratory Care is practiced under medical direction across the health care continuum. Critical thinking, patient/environment assessment skills, and evidence-based clinical practice guidelines enable respiratory therapists to develop and implement effective care plans, patient-driven protocols, disease-based clinical pathways, and disease management programs” History of Respiratory Medicine and Science Ancient Times Hippocrates Early cultures developed herbal remedies for many diseases. The foundation of modern medicine is attributed to the “father of medicine,” Hippocrates, a Greek physician who lived during the 5th and 4th centuries BC. Hippocrates was also the first to describe “digital clubbing” 4 History of Respiratory Medicine and Science (cont.) Ancient Times (cont.) Hippocratic medicine was based on four essential fluids: phlegm, blood, yellow bile, and black bile. Hippocrates believed that the air contained an essential substance that was distributed to the body by the heart. The Hippocratic oath, which calls for physicians to follow certain ethical principles, is given to most medical students at graduation. 5 History of Respiratory Medicine and Science (cont.) Middle Ages The fall of the Roman empire in 476 AD resulted in a period of slow scientific progress. An intellectual rebirth in Europe began in the 12th century. Leonardo da Vinci (14531519) determined that subatmospheric pressures inflated the lungs. Andreas Vesalius (15141564) performed human dissections and experimented with resuscitation. 6 History of Respiratory Medicine and Science (cont.) Middle Ages 17th Century included more great advances for scientists such as Galileo, Pascal, Hooke, Newton In 1628 Harvey fully described the circulatory system 1662 Boyle published what is known as “Boyles Law”, which governs the relationship between gas volume and pressure 1650 Torricelli invented the barometer and Pascal showed that atmospheric pressures decrease with altitude 7  Knowledge Check Who is known as the “Father of Medicine”? – Hippocrates In the middle ages who published a paper on the relationship between pressure and volumes? – Boyle 8 Development of the Respiratory Care Profession In the 1940s, technicians were used to haul O2 cylinders and apply O2 delivery devices. In the 1950s, positive-pressure breathing devices were applied to patients. Formal education programs for inhalation therapists began in the 1960s. The development of sophisticated mechanical ventilators in the 1960s expanded the role of the respiratory therapist (RT). 9 Development of the Respiratory Care Profession (cont.) RTs were soon responsible for arterial blood gas and pulmonary function laboratories. In 1974, the designation “respiratory therapist” became standard. 10  Development of the Respiratory Care Profession (cont.) Oxygen Therapy Large-scale production of O2 was developed in 1907 by Karl von Linde. Oxygen tents were first used in 1910, and O2 masks, in 1918. O2 therapy was widely prescribed in the 1940s, however there was still not a good way to measure blood oxygen concentrations 11 Development of the Respiratory Care Profession (cont.) The Clark electrode was first developed in the 1960s and allowed measurement of arterial PO2. The ear oximeter was invented in 1974, and pulse oximeter, in the 1980s. 12 Development of the Respiratory Care Profession (cont.) Aerosol Medications In 1910, aerosolized epinephrine was introduced as a treatment for asthma. Later, isoproterenol (1940) and isoetharine (1951), Albuterol (1980), Xopenex (2000) were introduced as bronchodilators. 13  Development of the Respiratory Care Profession (cont.) Mechanical Ventilation The iron lung was introduced in 1928 by Philip Drinker. A negative-pressure “wrap” ventilator was introduced in the 1950s. 14 Mechanical Ventilation Originally, positive-pressure ventilation was used during anesthesia. The Drager Pulmotor (1911) 15  Mechanical Ventilation (cont.) More advanced volume ventilators became available in the 1970s: Servo 900, Bourns Bear I and II, and MA II. 16  Airway Management Tracheostomies may have been performed as early as the 1500s to relieve airway obstructions William MacEwen in 1880 applied the first endotracheal tube to a patient successfully. In 1913, the laryngoscope was introduced.. 17  Respiratory Care Education The first formal RT program was offered in Chicago in 1950. RT schools grew in the 1960s; many programs were hospital based. Today, RT programs are offered mostly at colleges and universities. Today all accredited RT programs are monitored by Committee on Accreditation for Respiratory Care (CoARC). 18 What is Our Future? The knowledge and skills needed by respiratory therapists will continue to expand, and it will become increasingly difficult to prepare therapists for advanced practice within the credit hour limitations of many existing programs. Associate degree programs may develop articulation agreements with 4-year colleges and universities to allow their graduates to complete the bachelor's degree in respiratory care without leaving their home campus. Distance education technology may allow this to occur at minimal cost. 19  Milestones in the Organizations Within the Respiratory Care Profession: Beginning Years 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)  Milestones in the Organizations Within the Respiratory Care Profession: Beginning Years Scientific Journal Respiratory Care is a major international publication that is focused on respiratory care. Credentialing is a generic term that refers to recognition of individuals who have attained a specified level of competency in an occupation. The NBRC is the nationally recognized, voluntary credentialing body in respiratory care. See Table 55–4 (next slide): National Board for Respiratory Care Examinations. Not listed is the Adult Critical Care Specialty Exam (ACCS) American Association for Respiratory Care The AARC is the national association that represents the respiratory care profession. A profession is described by: o Its advancing science, technology, and practice o Continuing education o Active participation of its members o Credentials o Leadership o Research o Innovation National Board for Respiratory Care National Board for Respiratory Care (NBRC) is the national credentialing organization for respiratory therapists. The NBRC has established standards for the credentialing of practitioners who work under medical direction. Its respiratory therapy examinations are used as the standard for licensure or certification that regulate the profession. See Table 56–2: National Board for Respiratory Care (NBRC) Respiratory Care Credentials. National Board for Respiratory Care The certified respiratory therapist (CRT) examination is the entry-level credential for practice in respiratory care. Registered respiratory therapist (RRT) examination was developed to objectively measure essential knowledge, skills, and abilities required of advanced respiratory therapists.  Commission on Accreditation for Respiratory Care Commission on Accreditation for Respiratory Care (CoARC) is the national accreditation body for respiratory care education programs. The NBRC requires graduation from an accredited educational program for eligibility for its credentialing examinations. The standards by which CoARC measures programs include sponsorship, outcome orientation, resources, student disclosure, instructional planning, and program evaluation. Questions??? Always Review your chapter objectives and terminology at the beginning of each chapter to be successful. Don’t forget, material may be added into the slides that may not be in the book, you must know this material as well. 27