Respiratory Therapy Handbook
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Bronchopulmonary Hygiene Protocol
BRONCHOPULMONARY HYGIENE PROTOCOL MD order for Bronchopulmonary Hygiene Protocol Evaluate Indications: 9 Difficulty with secretion clearence with sputum production > 25 ml/day 9 Evidence of retained secretions 9 Mucus plug induced atelectasis 9 Foreign body in airway 9 Diagnosis of cystic fibrosis, bronchiectasis, or cavitating lung disease Yes Does contraindication or potential hazard exist? No Address any immediate need and contact MD/RN Select method based on: 9 Patient preference/comfort/pain avoidance 9 Observation of effectiveness with trial 9 History with documented effectiveness Method may include: 9 Manual chest percussion and positioning 9 External chest wall vibration 9 Intrapulmonary percussion Adminster therapy no less than QID and PRN, supplemented by suctioning for all patients with artificial airways Re-evaluate pt every 24 hours, and 24 hours after discontinued Assess Outcomes: Goals achieved? 9 Optimal hydration with sputum production < 25 ml/day 9 Breath sounds from diminished to adventitious with ronchi cleared by cough 9 Patient subjective impression of less retention and improved clearance 9 Resolution/Improvement in chest X-ray 9 Improvement in vital signs and measures of gas exchange 9 If on ventilator, reduced resistance and improved compliance Care Plan Considerations: Discontinue therapy if improvement is observed and sustained over a 24-hour period. Patients with chronic pulmonary disease who maintain secretion clearance in their home environment should remain on treatment no less than their home frequency. Hyperinflation Protocol should be considered for patients who are at high risk for pulmonary complications as listed in the indications for Hyperinflation Protocol. 5/5/03 (Jan Phillips-Clar, Rick Ford, Judy Tietsort, Jay Peters, David Vines) AARC References for Bronchopulmonary Algorithm 1. -
Respiratory Therapy Program
UNIVERSITY OF THE DISTRICT OF COLUMBIA RESPIRATORY THERAPY PROGRAM The University offers the A.A.S. Degree in Respiratory ASSOCIATE IN APPLIED SCIENCE DEGREE IN Therapy. The curriculum reflects high standards of RESPIRATORY THERAPY professional practice and incorporates guidelines from practice trends, professional organizations and accrediting Total Credit Hours of College-Level Courses Required agencies. Students develop the knowledge base and For Graduation: 70 clinical competencies required to meet the health care needs of patients with cardiopulmonary disorders. The program offers both a day and an evening option. Respiratory Therapists treat patients along the age and health-care continuums – from premature infants to the PROGRAM OF STUDY aged in critical care, acute care, rehabilitation, and home care settings. PREREQUISITES 1535-101 General College Math I 3 ACCREDITATION & CREDENTIALING 1133-111 English Composition I 3 1401-112 Anatomy and Physiology II – Lecture 3 The UDC Respiratory Therapy Program is accredited by 1401-114 Anatomy and Physiology II – Lab 1 the Commission on Accreditation of Allied Health Total 10 Credits Education Programs (CAAHEP), in collaboration with the FIRST YEAR – FALL SEMESTER Committee on Accreditation for Respiratory Care 1431-170 Introduction to Health Sciences 2 1431-171 Principles and Practice of Resp Therapy I 4 (CoARC). Graduates are eligible for both the entry-level licensure/ CRT examination (required by the District of 1401-112 Anatomy and Physiology II – Lecture 3 Columbia, Maryland and Virginia) and the advanced 1401-114 Anatomy and Physiology II – Lab 1 1133-112 or 1535-102 English Composition II or practice RRT examinations, both offered by the National Board for Respiratory Care (NBRC). -
Teaching Cases of the Month
Teaching Cases of the Month A 60-Year Old Man Presenting With Yellow Nail Syndrome Ariel Modrykamien MD and Omar Minai MD Introduction Blood total protein was 5.2 g/dL, and lactate dehydroge- nase was 350 U/L. His FEV1 was 64% of predicted, forced Yellow nail syndrome is a rare disorder of unclear eti- vital capacity was 60% of predicted, the ratio of FEV1 to ology. Since its original description by Samman and White,1 forced vital capacity was 0.81, and his diffusion capacity many other reports and associations have been described. for carbon monoxide was 97% of predicted. Current evidence suggests that its pathologic mechanism Echocardiogram revealed normal cavities and valve is based on lymphatic dysfunction, which is thought to be function. Left-side thoracentesis obtained a cloudy pleural acquired rather than congenital. However, our understand- fluid with total protein 3.9 g/dL, lactate dehydrogenase ing of its pathogenesis is still speculative, as it relies on 144 U/L, glucose 100 mg/dL, and pH 7.6, with 79% lym- anecdotal observations. We report a case of a man who phocytes. Pleural fluid cultures for bacterial, fungal, and presented with dry cough, shortness of breath, bilateral acid-fast bacilli were negative. Cytology was negative for lower-extremity edema, and pleural effusion. Yellow nail malignant cells. Flow cytometry was negative for chronic syndrome was diagnosed. lymphoproliferative disorders. Tuberculosis skin test was also negative. Case Summary Radiology Findings A 60-year-old man presented with 2 months of persis- tent dry cough. He noticed dyspnea with moderate effort, Chest radiograph revealed a left-side pleural effusion such as walking 2–3 blocks, and bilateral lower-extremity (Fig. -
Touching Lives and Advancing Patient Care Through Education PASSY
PASSY-MUIR® TRACHEOSTOMY & VENTILATOR SWALLOWING AND SPEAKING VALVES INSTRUCTION BOOKLET Passy-Muir® Tracheostomy & Ventilator Passy-Muir® Tracheostomy & Ventilator Swallowing and Speaking Valve Swallowing and Speaking Valve PMV® 005 (white) PMV® 007 (Aqua Color™) 15mm l.D./23mm O.D. 15mm l.D./22mm O.D. Dual Taper Passy-Muir® Low Profile Tracheostomy & Passy-Muir® Low Profile Tracheostomy & Ventilator Swallowing and Speaking Valve Ventilator Swallowing and Speaking Valve PMV® 2000 (clear) PMV® 2001 (Purple Color™) 15mm l.D./23mm O.D. 15mm l.D./23mm O.D. For technical questions regarding utilization of the Passy-Muir Valves, please contact our respiratory and speech clinical specialists. Touching Lives and Advancing Patient Care Through Education CONTENTS OF PMV® PATIENT CARE KIT: This package contains one of the following Passy-Muir® Tracheostomy & Ventilator Swallowing and Speaking Valves (PMVs): PMV 005 (white), PMV 007 (Aqua Color™), PMV 2000 (clear), or PMV 2001 (Purple Color™) and Instruction Booklet, Patient Handbook, PMV Storage Container, Patient Parameters Chart Label, and Warning Labels for use on the trach tube pilot line, chart and at bedside. A PMV Secure-It® is also included in the PMV 2000 (clear) and PMV 2001 (Purple Color) Patient Care Kit. The PMV 005 (white), PMV 007 (Aqua Color), PMV 2000 (clear) and PMV 2001 (Purple Color) are not made with natural rubber latex. Contents of PMV Patient Care Kit are non-sterile. READ ALL WARNINGS, PRECAUTIONS AND INSTRUCTIONS CAREFULLY PRIOR TO USE: INSTRUCTIONS FOR USE The following instructions are applicable to the PMV 005 (white), PMV 007 (Aqua Color), PMV 2000 (clear) and PMV 2001 (Purple Color) unless otherwise indicated. -
Clinical and Team Management in the COVID-ICU: Successful Strategies from the First Weeks
Emory Critical Care Center Emory ECMO Center Clinical and team management in the COVID-ICU: Successful strategies from the first weeks Grand Rounds University of Rochester SMD, Dept of Pediatrics Mark Caridi-Scheible, MD Emory Critical Care Center, Atlanta, GA Emory Critical Care Center Emory ECMO Center 2009 Emory Critical Care Center Emory ECMO Center Introduction • URSMD Grad • Critical Care and Cardiothoracic Anesthesia, Emory University Hospital • Large academic hospital system with high acuity • Initial team of four physicians on-service in 3 different units (luck of the draw), now 7 units • Helped coordinate best practices efforts since • Co-credit to my starting comrades, Dr. Sara Auld, Dr. Will Bender and Dr. Lisa Daniel, and numerous others for their efforts since Emory Critical Care Center Emory ECMO Center Objectives and Caveats • Aimed for those directly providing care to critically ill patients • Extrapolate points for floor care • Adult population only • Practical, observable, common sense and within standards of care • Not going to rehash freely available reports • Observations not rigorously validated • Outcomes likely to vary based on patient mix, location and resources available • Have to go fast, more information on slides than can discuss • More than anything: there is hope and things we can do better Emory Critical Care Center Emory ECMO Center Our starting points 1. The best practice critical care with maximum delivery 2. No luxury of time, get them better FAST for: • Sake of patient’s chance of recovery • Sake of -
Table of Contents 1
GENERAL THORACIC SURGERY DATABASE v.2.3 TRAINING MANUAL August 2017 Table of Contents 1. Demographics ................................................................................................................................................................. 2 2. Follow Up ........................................................................................................................................................................ 9 3. Admission ..................................................................................................................................................................... 10 4. Pre-Operative Evaluation ............................................................................................................................................. 14 5. Diagnosis (Category of Disease) ................................................................................................................................... 48 6. Procedure ..................................................................................................................................................................... 70 7. Post-Operative Events ................................................................................................................................................ 111 8. Discharge .................................................................................................................................................................... 135 9. Quality Measures ...................................................................................................................................................... -
Knowledge on Pulmonary Hygiene and Sociodemographic Factors Affecting It Among Health Professionals Working in Two Government Hospitals, North East Ethiopia
IOSR Journal of Nursing and Health Science (IOSR-JNHS) e-ISSN: 2320–1959.p- ISSN: 2320–1940 Volume 6, Issue 5 Ver. IV. (Sep. -Oct .2017), PP 78-81 www.iosrjournals.org Knowledge on Pulmonary Hygiene and Sociodemographic Factors affecting it among Health Professionals working in Two Government Hospitals, North East Ethiopia Prema Kumara,1 Yemiamrew Getachew,2 Wondwossen Yimam3 1Assistant Professor, Department of Comprehensive Nursing, College of Medicine and Health Sciences 2Head, Department of Comprehensive Nursing, College of Medicine and Health Sciences 3Dean, School of Nursing and Midwifery, College of Medicine and Health Sciences Wollo University, Ethiopia Introduction: Pulmonary hygiene is formerly referred to as pulmonary toilet which is a set of methods used to clear mucus and secretions from the airways and it is depends on consistent clearance of airway secretions. Objective: To determine the level of knowledge and to identify the socio-demographic factors affecting knowledge on pulmonary hygiene among Health Professionals. Methodology: Institution based cross sectional study design was employed among one hundred twelve health professionals using systematic random sampling technique. The collected data were analyzed using descriptive and inferential statistics. Results: The mean knowledge score of the total sample was 13.80 (+ 3.01 SD). Subjects who scored above the mean value were categorized as having good level of knowledge. But only 37 (33 %) study participants had good knowledge about pulmonary hygiene and rest 67 % had poor knowledge. In the multivariable logistic analysis, Married subjects were 3.7 times (AOR = 3.7, CI=1.38, 10.04) more likely to have good knowledge as compared to single individuals. -
Suction of the Patient with an Artificial Airway Effective: 11/07/94 Formulated: 03/80 Revised: 12/02/14 Reviewed: 04/17/18
UTMB RESPIRATORY CARE SERVICES Policy 7.3.50 PROCEDURE - Suction of the Patient with an Artificial Page 5 of 5 Airway Suction of the Patient with an Artificial Airway Effective: 11/07/94 Formulated: 03/80 Revised: 12/02/14 Reviewed: 04/17/18 Suction of the Patient with an Artificial Airway Purpose To outline the procedure for suction of the patient with an artificial airway. Audience All respiratory care practitioners Scope Suction of the patient with an artificial airway is a procedure for the mobilization and removal of secretions. It is used to assist the patient with pulmonary hygiene when the airway severely limits the patient’s own ability to remove lung secretions and to evaluate the patient's cough reflex mechanic in the lung clearing process. Suction to a patient’s airway will be done using sterile techniques according to physician’s orders. A closed catheter suction system will be used on all ventilated patients. Accountability This procedure may be administered by a Licensed Respiratory Care Practitioner with understanding of age specific requirements of patient population. Physician's The physician's order must specify type of therapy and frequency. This Order procedure will automatically be performed as needed unless a physician order specifies a particular frequency. Indications This procedure is indicated for any patient who is intubated or has a tracheostomy, whether or not they are receiving continuous mechanical ventilation. Contra- Suction shall be postponed if the patient's well being is threatened by the indications procedure due to: Acute cardiac arrhythmia, which could be exacerbated by hypoxia or vagal stimulation. -
Respiratory Therapy (RTH) 1
Respiratory Therapy (RTH) 1 RTH-205. Cardiopulmonary Pathophysiology. 2 Credits. Respiratory Therapy LECT 2 hrs An overview of the pathophysiology of diseases of the (RTH) cardiopulmonary system with an emphasis on pathophysiologic processes such as hypoxemia, hypoventilation, diffusion defects and ventilation perfusion mismatch; a survey of diseases encountered Courses by the respiratory therapist, including pathophysiology, diagnostic RTH-199. Respiratory Therapeutics. 5 Credits. methods and findings, clinical manifestations, treatment and LECT 4 hrs, LAB 3 hrs prognosis. An introduction to respiratory care, including history of the Prerequisites: RTH-203 and permission of program director. profession, ethical and legal responsibilities of the respiratory RTH-206. Mechanical Ventilation. 4 Credits. therapist; medical terminology, basic respiratory care procedures LECT 3 hrs, LAB 3 hrs including the physics, physiology and administration of medical Techniques of airway management and the provision of mechanical gas therapy, basic patient communication and assessment skills. ventilation; includes types of airways and appropriate uses; the Basic respiratory care procedures, humidity and aerosol therapy, physics and physiology of mechanical ventilation; classification hyperinflation therapy, chest physiotherapy and bronchial hygiene; of mechanical ventilators; indications for clinical application an overview of microbiology as applied to respiratory care; infection and complications of mechanical ventilation; management control; and equipment sterilization procedures. Course requires and monitoring of the patient requiring ventilatory support; and that students have completed the pre-professional phase of the appropriate methods of withdrawing ventilatory support. Respiratory Therapy program and have permission of the program Prerequisites: RTH-199, RTH-202, RTH-203, RTH-210 and director to enroll. permission of program director Prerequisites: Permission of Program Director Corequisites: RTH-204, RTH-205 and RTH-211 Additional Fees: Course fee applies. -
Efficacy of Active Cycle of Breathing Technique and Postural Drainage in Patients with Bronchiectesis - a Comparative Study
Innovative Journal of Medical and Health Science 2: 6 Nov – Dec (2012) 129 – 132. Contents lists available at www.innovativejournal.in INNOVATIVE JOURNAL OF MEDICAL AND HEALTH SCIENCE Journal homepage: http://www.innovativejournal.in/index.php/ijmhs EFFICACY OF ACTIVE CYCLE OF BREATHING TECHNIQUE AND POSTURAL DRAINAGE IN PATIENTS WITH BRONCHIECTESIS - A COMPARATIVE STUDY Bipin Puneeth1, Mohamed Faisal,C.K2, Renuka Devi.M3, Ajith S4 1Assistant Professor, 3Assistant Professor, JSS college Of Physiotherapy, Mysore 2Professor & Vice Principal, Nitte Institute of Physiotherapy, Nitte University, Mangalore, India-575018 4Assistant Professor, Nitte Institute of Physiotherapy, Nitte University, Mangalore, India-575018 ARTICLE INFO ABSTRACT Corresponding Author: Back Ground and Objective: Bronchiectasis is one of the most common Mohamed Faisal, C. K diseases in the rural and industrial areas of India. The most accepted treatment Professor & Vice Principal, Nitte protocol preferred for Bronchiectasis now days includes oral, aerosolized or Institute of Physiotherapy, intravenous antibiotic therapy according to the severity of the exacerbation and Nitte University, Mangalore, mucus clearance by means of bronchial hygiene assistive devices, surgical India resection, chest physiotherapy like breathing exercises, postural drainage, high- 575018. frequency chest compression, forced expiratory techniques etc. Active cycle of breathing techniques (ACBT) is also the standard airway clearance technique Keywords: ACBT, Postural used in patients with bronchiectasis. So this study is intended to know and Drainage, PEFR, Forced Vital compare the effectiveness of ACBT and Postural drainage techniques as a means Capacity, FEV1, SPO2 of treatments in patients with bronchiectasis. Methodogy: It was a Randomized experimental study with 30 subjects who satisfied the inclusion criteria with a mean age group of 44 were selected for the study. -
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Prema K et al / Int. J. of Allied Med. Sci. and Clin. Research Vol-5(4) 2017 [823-828] International Journal of Allied Medical Sciences and Clinical Research (IJAMSCR) ISSN:2347-6567 IJAMSCR |Volume 5 | Issue 4 | Oct - Dec - 2017 www.ijamscr.com Research article Medical research Attitude towards pulmonary hygiene and socio-demographic factors affecting it among health workers in two government hospitals East Amhara, Ethiopia Prema Kumara,1 Yemiamrew Getachew,2 Wondwossen Yimam3 1Assistant Professor, Department of Comprehensive Nursing, College of Medicine and Health Sciences, Wollo University Dessie, Ethiopia 2MSc in Clinical and Community Mental Health, Department of Comprehensive Nursing, College of Medicine and Health Science, Wollo University Dessie, Ethiopia 3MSc in Medical Surgical Nursing, School of Nursing and Midwifery, College of Medicine and Health Science, Wollo University Dessie, Ethiopia *Corresponding author: Prema Kumara Email: [email protected] ABSTRACT Introduction Pulmonary hygiene is formerly referred to as pulmonary toilet which is a set of methods used to clear mucus and secretions from the airways and it is depends on consistent clearance of airway secretions. Pulmonary hygiene is a technique designed to help clear mucus and secretions from your lungs. It can be used for people who have chronic obstructive pulmonary disease (COPD), pneumonia, cystic fibrosis, or bronchiectasis and others. Objective To determine level of attitude towards pulmonary hygiene and socio-demographic factors affecting it among health workers in two government hospitals East Amhara, Ethiopia Methodology Institution based cross sectional study design was employed among one hundred twelve health professionals using systematic random sampling technique. The collected data were analyzed using descriptive and inferential statistics. -
ICD-9-CM Procedures (FY10)
2 PREFACE This sixth edition of the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) is being published by the United States Government in recognition of its responsibility to promulgate this classification throughout the United States for morbidity coding. The International Classification of Diseases, 9th Revision, published by the World Health Organization (WHO) is the foundation of the ICD-9-CM and continues to be the classification employed in cause-of-death coding in the United States. The ICD-9-CM is completely comparable with the ICD-9. The WHO Collaborating Center for Classification of Diseases in North America serves as liaison between the international obligations for comparable classifications and the national health data needs of the United States. The ICD-9-CM is recommended for use in all clinical settings but is required for reporting diagnoses and diseases to all U.S. Public Health Service and the Centers for Medicare & Medicaid Services (formerly the Health Care Financing Administration) programs. Guidance in the use of this classification can be found in the section "Guidance in the Use of ICD-9-CM." ICD-9-CM extensions, interpretations, modifications, addenda, or errata other than those approved by the U.S. Public Health Service and the Centers for Medicare & Medicaid Services are not to be considered official and should not be utilized. Continuous maintenance of the ICD-9- CM is the responsibility of the Federal Government. However, because the ICD-9-CM represents the best in contemporary thinking of clinicians, nosologists, epidemiologists, and statisticians from both public and private sectors, no future modifications will be considered without extensive advice from the appropriate representatives of all major users.