RCP 500 - Advanced Respiratory Therapy

1. Discuss the principles of mechanical ventilation.
   1. Define and explain the clinical significance of airways resistance, static compliance and dynamic compliance.
   2. Explain how to measure pulmonary compliance and airway resistance, plateau pressure and auto PEEP.
   3. Describe the clinical application of pressure-volume slope.
   4. Describe the clinic application of the PIP-plat pressure gradient.
   5. Define the causes leading to ventilator failure
   6. Define the causes leading to oxygenation failure.
   7. Explain how mechanical ventilators are classified.
   8. List risks associated with intubation and mechanical ventilation.
2. Summarize modes of mechanical ventilation.
   1. Classify modes of mechanical ventilation.
   2. Differentiate between spontaneous modes of ventilation.
   3. Differentiate between invasive modes of ventilation.
   4. Describe characteristics of volume ventilation.
   5. Describe characteristics of pressure ventilation.
3. Facilitate noninvasive and invasive airway management.
   1. Explain proper positioning of a patient for airway patency.
   2. List the criteria for intubation.
   3. Determine factors that may lead to a difficult intubation.
   4. List the essential equipment needed for intubation.
   5. Explain initiation and modification of video laryngoscopy.
   6. Describe the methods of assessment for confirmation of endotracheal tube placement.
   7. Explain the management of cuff pressure on an endotracheal tube.
   8. Describe the assessment for extubation readiness and explain the extubation procedure.
   9. Troubleshoot artificial airways and intubation equipment.
   10. Demonstrate intubation and extubation.
   11. Initiate NIPPV.
   12. Assemble and troubleshoot CPAP/NiPPV with patient interfaces.
4. Analyze the initiation of mechanical ventilation.
   1. Initiate and adjust invasive mechanical ventilation.
   2. Differentiate between hypoxemic respiratory failure and hypercapnic respiratory failure.
   3. Identify the goals of mechanical ventilation.
   4. Select initial settings for volume and pressure-targeted mechanical ventilation.
   5. Differentiate abnormal values from those that indicate the need for ventilatory support for relevant physiologic measurements.
   6. Discuss modifications to ventilator settings for special conditions.
5. Critique monitoring in mechanical ventilation.
   1. Assess ventilation and oxygenation of a patient receiving mechanical ventilation.
   2. Differentiate the effects of mechanical ventilation on organ systems and how these effects are monitored.
   3. List indications for capnography.
   4. Interpret capnography waveforms or gradients and explain their significance.
   5. Discuss the principles of hemodynamic monitoring of the respiratory system and cardiovascular system of patients in intensive care.
   6. Explain how to perform hemodynamic monitoring.
   7. Assemble and troubleshoot hemodynamic monitoring such as pressure transducers, arterial catheters, and pulmonary artery catheter.
   8. State normal ranges for hemodynamic monitoring values.
   9. Evaluate critical care monitoring such as GCS, ICP, brain death determination, fluid balance. 
   10. Communicate how to perform apnea monitoring and apnea testing.  
6. Describe waveform analysis and application.
   1. Identify variables in graphics and waveforms.
   2. Identify leaks, obstruction and air trapping.
   3. Identify variables in graphics and waveforms.
   4. Identify and describe different types of patient-ventilator asynchronies.
7. Outline the management of mechanical ventilation.
   1. Describe strategies to improve ventilation and oxygenation such as prone positioning and lung recruitment.
   2. Initiate and adjust ventilator alarms.
8. Discuss weaning from mechanical ventilation.
   1. Define success and failure for discontinuing mechanical ventilation.
   2. Communicate how to perform a SBT, MIP and MEP.
   3. Explain criteria for weaning used to evaluate patient readiness to start the weaning process such as MIP, VC, RSBI.
9. Justify equipment used with mechanical ventilation.
   1. Perform ventilator competencies.
   2. Troubleshoot mechanical ventilators, patient breathing circuits and capnography.
   3. Describe how to perform quality control on mechanical ventilators.
10. Evaluate pharmacotherapy in critical care.
    1. List medications used for pain management in the intensive care unit.
    2. List appropriate medications for light sedation and deep sedation.
    3. Choose agents used as first line for the treatment of hypertension.
    4. Identify commonly used diuretics.
    5. Describe antiarrhythmic agents.
    6. Identify various anticoagulants and antiplatelet drugs.
    7. Compare the uses of barbiturates and benzodiazepines.
    8. List commonly used opioid and non-opioid analgesics.
    9. Recommend drug therapy for the treatment of respiratory therapy depression.
11. Incorporate Advanced Cardiac Care
    1. List indications for ECG.
    2. Perform 12 lead ECG.
    3. Evaluate ECG results.
    4. Indicate which ACLS medications can be administered via ET tube.
    5. Compare the management of pulseless ventricular fibrillation/ventricular tachycardia with pulseless electrical activity/asystole cardia arrest.
    6. Suggest the most appropriate ACLS therapy given a patient case study.
12. Obtain Advanced Cardiovascular Life Support Certification.