Respiratory Therapy - University of ManitobaThe list of skills and procedures in this manual link...

College of Rehabilitation Sciences

Respiratory TherapyCLINICAL RESOURCE MANUAL

RT binder 2015 revised March.indd 1 3/26/2015 2:33:01 PM

CLINICAL RESOURCE MANUAL FOR RESPIRATORY THERAPY

This manual is intended to be used to track the number of times a student is exposed to a procedure throughout their clinical education experiences.

All the procedures in this Clinical Resource manual are meant to be signed by the preceptor, when the student is shown how to do the skill, and as the student learns to perform the skill with assistance. Signing in this book does not indicate the student is competent; it shows the exposure the student has had prior to signing the Competency-Based Objective (CBO) manual with the final evaluations. The final competencies are signed once the student is able to perform the procedure independently at an entry-to-practice level.

All the procedures in this resource manual are taken from the 2011 Respiratory Therapy National Competency Profile and are deemed to be entry-to-practice by the National Alliance of Respiratory Therapy Regulatory Bodies.

All of the procedures listed herein link to the CBO manual that the student will also bring with them to the clinical fieldwork sites.

The student does not have to do the procedure a specific number of times to become competent, as some procedures take less time to master than others. There may also be less opportunity for exposure to certain skills due to the frequency in which they are performed clinically. The preceptor can make the decision as to when they feel the student is prepared to be evaluated based on the evaluation template contained in the CBO manuals.

The intended purpose of this manual is to track the number of times a student has been exposed to a clinical procedure/skill dur-ing their clinical education courses throughout the program.

Competency skills/procedures listed in the manual can be signed by the preceptor each time the student is observing, attempting with guidance, or independently completing. A signature in this book does not indicate the student has PASSED an evaluation for a listed competency. It is the intention that preceptors can utilize this tool to see how much exposure to a skill/competency the student has had, and to use this information to guide the preceptor’s level of expectation for the student. Example: a student who has been exposed to a skill 2 times may not yet be able to perform that skill independently, and may not be ready for a final evalu-ation. A student with multiple exposures to a skill, should be expected to perform with minimal guidance, and may be ready to be tested to to determine if they pass the competency.

The final competencies are passed only when the student is able to perform the procedure independently at the entry to practice level. A preceptor would then sign the CBO Manual.

The list of skills and procedures in this manual link directly to the 2011 Respiratory Therapy National Competency Profile and are deemed to be entry- to- practice by the National Alliance of Respiratory Therapy Regulatory Bodies.

All of the procedures listed herein link to the CBO manual that the student will also bring with them to the clinical fieldwork sites.

The student is not required to perform a skill or procedure a specific number of times to PASS the competency, as we acknowl-edge some procedures take less time to master than others. We also acknowledge that some skills/procedures may not occur very frequently in clinical practice, and therefore exposures would be limited. The preceptor is asked to use their judgment to determine when a student is prepared to have a final evaluation of a skill/procedure, based on the template contained in the CBO manuals.

CLINICAL RESOURCE MANUAL


Respiratory Therapy Coursework

Year IHuman Anatomy (ANAT 1030) Introduction to Professional Practice (RESP 1400) Health Systems and Respiratory Care in Canada (RESP 1410) Applied Physiology for Respiratory Therapy (RESP 1420)

Year II Research Methodology for Medical Rehabilitation (REHB 2450) Primary Care in Respiratory Therapy (RESP 2200)Pathophysiology (RESP 2210)Physical Examination and Health Assessment (RESP (2220)Respiratory Therapeutics 2 (RESP 2230)

Clinical Mechanical Ventialation (RESP 2240) Ventilator Instrumentation (RESP 2250)Cardiopulmonary Diagnostics (RESP 2260)Basic Fieldwork II (RESP 2380) Clinical Simulation & Integration (RESP 2390)

Respiratory Therapeutics 1 (RESP 1430) Pharmacology (RESP 1440) Principles of Mechanical Ventilation (RESP 1450) Basic Fieldwork 1 (RESP 1460)


Year IIIIntroduction to Health Care Administration and Management (REHB 3460) Clinical Education in Pediatric Respiratory Care (RESP 3320) Clinical Education in Pulmonary Diagnostics (RESP 3350) Clinical Education in Anesthesia (RESP 3360) Clinical Education in Community Care (RESP 3370) Clinical Education in Critical Care (RESP 3410) Clinical Education in Neonatal Care (RESP 3420) Clinical Education in General Therapeutics (RESP 3430)Current Topics in Respiratory Therapy (RESP 3440)


Clinical Education Courses

There are nine (9) clinical education courses in the BRT program:

Courses:

RESP 1460 Basic Fieldwork I (yellow CBO manual)

RESP 2380 Basic Fieldwork 2 (blue CBO manual)

RESP 3410 Clinical Education in Critical Care (green CBO manual)

RESP 3320 Clinical Education in Pediatric Respiratory Care (pink CBO manual)

RESP 3420 Clinical Education in Neonatal Care (pink CBO manual)

RESP 3350 Clinical Education in Pulmonary Diagnostics (orange section of green CBO manual)

RESP 3360 Clinical Education in Anaesthesiology (purple CBO manual)

RESP 3370 Clinical Education in Community Care (white section of green CBO manual)

RESP 3430 Clinical Education in General Therapeutics—Non-ICU (yellow section of green CBO manual)

Clinical Education Courses are evaluated using a variety of methodologies, the grading of which is on a pass/fail basis.


CLINICAL EDUCATION COURSE EVALUATION

In order to successfully complete this course the student must successfully complete each of the course components, which may include:

• competency-basedevaluationtemplatesforevaluationofclinicalskills

• writtentests

• reflectivewritingassignments

• seminars/tutorials

• formativeandsummativecoursewrittenevaluationsusedtoevaluateeffectiveintegrationoftheorywithclinicalpractice

Specific clinical education course requirements are outlined in the syllabus for each course.

Common to all the BRT program clinical education courses, students must register a pass mark on the final course evaluation, based on satisfactory formative and summative preceptor evaluations.


Competency-Based Objective Manuals (CBO)

There are five (5) CBO manuals in the BRT program. There is one (1) manual for each of the first and second year clinical courses:

1. YELLOW Manual (year 1—RESP 1460)

2. BLUE Manual (year 2—RESP 2380)

In year three of the program, there are three (3) CBO manuals. Each manual is divided into colour-coded sections which link to specific Clinical Education Courses:

3. GREEN Adult Manual

• RESP 3410—Adult ICU (green tab)

• RESP 3430—General Therapeutics (yellow tab)

• RESP 3350—Pulmonary Diagnostics (orange tab)

• RESP 3370—Community Care (white tab)

4. PINK Manual

• RESP 3420/3320—Neonatal and Pediatric Care

5. PURPLE Manual

• RESP 3360 - Anesthesia


Clinical Competency Evaluation Templates

Each CBO contains the Clinical Competency Evaluation Templates which relate to the competencies required to achieve a pass in the relevant course. Students must complete all clinical competency evaluation templates contained in the CBO for each clinical education course.

For further details regarding the policies governing this please refer to the BRT Academic Progression/Supplementary Regulations (available in the Respiratory Therapy Student Handbook).


PRECEPTOR EVALUATIONS

In all courses, preceptors will complete a daily evaluation of the student. These documents are used to track student hours in the course and to provide students with formative feedback throughout the course.

In RESP 1460 (yellow manual) the clinical evaluations completed by preceptors are the daily evaluation. These are provided to the university RT Clinical Coordinator by the clinical site coordinator.

In RESP 2380 (blue manual) the clinical evaluations completed by preceptors are the daily evaluation. These are provided to the university RT Clinical Coordinator by the clinical site coordinator.

In ALL THIRD YEAR CLINICAL COURSES, daily evaluation forms are used by all preceptors; a final evaluation form is completed by the clinical site coordinator once the rotation is completed based on the summative daily evaluations. The final evaluation is shared with the student and signed by the student upon completion of the rotation. All the evaluations are sent back to the University Clinical Coordinator. Any rotation that is longer than 4 weeks will also include a mid-way evaluation form (Adult ICU and Children’s) which will be shared with the student half-way through the rotation. This gives the student time to improve their performance before the final evaluation period. All evaluations need to be signed and dated by the preceptors and the students. Students should be given the feedback necessary to improve performance and areas to work on each day so they can successfully reach their goals.


Clinical Site and Course Number: _______________________________________________ Student Name: ______________________ Preceptor Name: _____________________ ____ Date of Evaluation: ____________________________________________________________ Shift Start Time: __________________ Shift End Time: ________________________ ______ Rating Scale:

NA. Not Applicable or Observed 1. Poor

2. Borderline

3. Satisfactory

4. Good

5. Exceptional

Assessment Categories: Please circle response:

1. Clinical Reasoning / Diagnosis

(Interpretation of findings, judgment, efficiency) NA 1 2

3 4 5

2. Demonstrates knowledge of theory

NA

1 2

3 4 5

3.

History taking/shift change report (Accurate, efficient)

NA

1 2

3 4

5 4.

Organization/Time Management

(motivation, efficient, team approach, appropriate utilization of down time)

NA

1 2

3 4

5

5. Communications Skills -Verbal/Non-Verbal

(Empathy, voice inferences and tone, Introduction, terminology)

NA 1

2 3

4 5

6. Professionalism

(Punctual, initiative, respectful, Attends to patient’s needs, confidence)

NA 1

2 3

4 5

7. Patient Assessment/ Physical Examination (Logical sequence, appropriate, informs patient) NA

1 2

3 4

5

8.

Skill Development Toward Competencies NA

1 2

3 4

5

Daily Student Clinical Evaluation Form

University of Manitoba Department of Respiratory Therapy


Please provide additional feedback relating to any item for which a score of 1(Poor) or 2 (borderline) was provided. Course objectives/skills which were developed today are recorded in the Clinical Resource M

anual:

Yes □ No □

Competencies which were attained today are recorded in the Competency Based Objective M

anual:

Yes □ No □

What course objectives, skills, or competencies need more exposure? (This

response may be developed collaboratively by the preceptor and the student) Additional Comments (preceptor or student): Student Signature: ____________________________________________________________ Preceptor Signature: __________________________________________________________ Daily debriefings are recommended to provide the student with ongoing

feedback and strategies for improvement. Concerns should promptly be made known to both the student and on-site coordinator or University Coordinator.


CLINICAL EDUCATION SITES

Clinical placements related to the clinical education courses occur throughout all years of the program with emphasis in year three. Most of the clinical placements are arranged within the greater Winnipeg area, however, in some cases travel outside of the city may be required. The following institutions/organizations currently provide clinical education experiences for Department of Respiratory Therapy students:

Brandon General Hospital 1-204-578-4051

Concordia General Hospital 204-661-7346

Deer Lodge Centre 204-831-1301 ext. 2206

Deer Lodge Pulmonary Lab 204-833-1717

Grace General Hospital 204-837-0185 or 204-837-0186

HSC Winnipeg 204-787-3043

HSC Children’s Hospital 204-787-7420

Home Care (WRHA) 204-940-2118

Interfacility Transport Team 204-787-8041

Long Term Ventilator Program 204-787-3163

Medigas 204-786-4719

Misericordia Health Centre 204-788-8575 Michelle or 204-788-8570 Main Line

Misericordia Pulmonary Rehab 204-788-8554

PFT Lab 204-787-2916

RANA Respiratory Care Group 204-928-1403 or 204-928-1400 General line

Riverview Health Centre 204-478-6240

St. Boniface General Hospital 204-235-3338 or 204-235-3367 NICU

Seven Oaks Anesthesia 204-632-3102

Seven Oaks General Hospital 204-632-3149 Seven Oaks Pulmonary Rehab 204-632-3159

Victoria General Hospital 204-477-3325


ORIENTATION TO CLINICAL EDUCATION - GENERAL

All students in the BRT program will be provided general orientation to clinical education by the University Clinical Education Coordinator. All general orientation components will precede student participation in any clinical education experiences. These include:• Attendance policy• Dress code• Clinical course objectives, evaluation process• Contact information (relevant University and clinical education site personnel)• Provision of any required site specific orientation information (provided by clinical affiliate site)• Body Mechanics/Patient Handling• PHIA training• WHIMIS training• Infection prevention and control (including use of Personal Protective equipment)• Respiratory mask fit testing• Checks (list): Criminal Record (Vulnerable Sector Check); Child and Abuse Registry• Heart & Stroke BLS (Basic Life Support) Health Care Provider Level C• Obtain all necessary immunizations• Sign Practicum Agreement WRHA


ORIENTATION TO CLINICAL EDUCATION - CLINICAL SITES

All students new to a clinical education site will be provided a site-specific orientation by the clinical site coordinator or designatedstaffofthatsite. The orientation will at minimum consist of site specific information encompassing:• Physical layout• Policies and procedures• Documentation procedures• Emergency procedures (including infectious and environmental disease prevention and exposure)• Personal safety (including personal protective equipment and respiratory masks)• Location of supplies and equipment • Site specific policies, procedures, and clear expectations of students• Respiratory Therapist roles and responsibilities, including instruction, student evaluation, and supervision• Organization of the healthcare team at the site• Critical incident - Reporting structure, documents

Students should be made aware of who to contact on-site if they have needs or concerns regarding:• Patient safety• Personalsafety,includingbloodandbodyfluidcontact• Critical incident debriefing post-traumatic clinical experiences*

*NOTE: In addition to support services available at clinical education site, Services for Students at Bannatyne Campus also covers counselling and other services that students can access while engaged in clinical education activities (see Services for Students at Bannatyne Campus entry in this manual for further information and contact information).


CLINICAL SITE ORIENTATION & STUDENT SERVICES

All students new to a clinical education site will be provided an orientation by the clinical site coordinator or designated staffofthatsite.Theorientationwillensurethatstudentsareawareofpoliciesandprocedures,safetyprecautions,responsibilities and contact personnel if they encounter difficulties. They will be made aware of who to contact if they haveconcernsregardingpatientsafety,personalsafetyincludingbloodandbodyfluidcontact,isolationprocedures,N95 masks, and critical incident debriefing post-traumatic clinical experiences.

Services for Students at Bannatyne Campus alsoofferscounselingandotherservicesthatstudentscanaccessthroughout their clinical year (see Other Student Services section of the CoRS Student Handbook for additional counseling services).




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RT binder 2015 revised March.indd 183/25/2015 2:54:39 PMRT binder 2015 revised March.indd 18 3/26/2015 2:33:03 PM

GENERAL REGULATIONS

Reporting Sick

When reporting sick on a scheduled clinical experience in any area, the student will be required to phone the respective clinical department prior to commencement of the ‘shift.’ The student will also be expected to notify the Department of Respiratory Therapy at the University in both of the following methods:

• bycallingtheDepartmentalOfficeat204-787-2900(leaveavoicemailmessage)

• [email protected]

Dress Code

Thepurposeofthedresscodeistopromoteaneatandprofessionalappearancetopatients,visitorsandstaff,atalltimes.

Requirements:

1. All clothing shall be clean, neat and of suitable style to promote a professional appearance.

2. Students required to wear uniforms in the intensive care units should ensure they are suitably covered if leaving the area.

3. Students required to wear uniforms/lab coats in patient care areas, are not to wear such uniforms to and from the hospital premises.


4. Students may wear shorts to the classroom during the summer months. Shorts must be well maintained and in good taste.

5. All students must wear name tags in the clinical areas.

6. O.R. greens are to be worn only in the Anaesthesia rotation and the Maternal-Fetal rotation.

7. Personal hygiene and general appearance shall also comply with the requirements of the clinical site.

8. Some sites require business casual dress.

Specific Considerations:

Hair:

Hair must be clean and well-groomed and of suitable length according to job activity.

Long hair must be worn up when in contact with patients.

Footwear:

Shoes are to be worn at all times and must conform to safety standards.

Footwear should not produce disruptive noise and should be clean and in good repair.

Footwear with laces must be kept tied.


Jewelry:

Jewelry should be worn in moderation and good taste.

Policies of clinical areas must be adhered to strictly.

Cosmetics:

Perfume should not be worn in patient care areas.

Allstudents,facultyandstaffoftheCollegeofRehabilitationSciencesareaskedtorefrainfromusingstrongsmelling scented products including perfumes, hairsprays, aftershaves, lotions etc. Scented products can trigger or aggravate health problems for some people, such as those with asthma, allergies or other health conditions.

Other cosmetics may be worn in moderation.

Fingernails:

Those in direct contact with patients must maintain short and clean fingernails, no artificial nails.

Clinical Education Site specific dress code information and uniform requirements will be provided to students by the relevant year coordinator/course coordinator prior to the first day of clinical courses.

Violation of this dress code may result in students being required to leave the clinical education site. This decision is at the discretion of the Year 3 Coordinator, Clinical Course Coordinator, or Clinical Preceptor. Any clinical time missed for this reason must be rescheduled at a time convenient to the program and the clinical site.


No electronic devices (including cell phones) allowed in clinical areas.



Book One Adult Competencies 1 of 2

Exposure Competency Completed

Adult ICU (RESP 2380 and RESP 3410)

Date & Initial

Date & Initial

Date & Initial

Date & Initial

Date & Initial

Date & Initial

Date & Initial

Airway Management—Discontinue

Airway Management—Maintenance

Analysis and Problem-Solving

Art Line Insertion

Assist with Vascular Access (central line, pulmonary artery catheter)Blood Analysis

Bronchoscopy (Assist) (St. Boniface)

Discontinue Therapy/Complete Procedure

Esophageal Gastric Tube Insertion

Humidity Therapy

Lung Volume Recruitment

All Hospitals


Initials Signature Print Name


Book One (Continued) Adult Competencies 2 of 2


Adult ICU (RESP 2380 and RESP 3410)

Date & Initial

Date & Initial

Date & Initial

Date & Initial

Date & Initial

Date & Initial

Date & Initial

Mechanical Ventilation—Initiation Basic

Mechanical Ventilation—Initiation Advanced Modes

Mechanical Ventilation—Management

Mechanical Ventilation—Standby Ventilatory Preparation

Mechanical Ventilation—Weaning

Monitoring

Suctioning—Pharyngeal

Suctioning—Tracheobronchial

Suctioning Thoracic Drainage

Therapeutic Gas Administration

Transport (Inter Facility)

Transportation In Hospital

All Hospitals




Book One Adult Competencies


General Therapeutics (RESP 1460, RESP 2380, RESP 3430)

Date & Initial

Date & Initial

Date & Initial

Date & Initial

Date & Initial

Date & Initial

Date & Initial

Assessment FullBlood Sample Procurement—Arterial BrachialBlood Sample Procurement—Arterial FemoralBlood Sample Procurement—Arterial RadialConscious SedationDocumentNon-invasive Positive Airway PressurePerform Electrocardiography (Community Hospital)Pharmacology—Medication DeliveryPharmacology—Provide Oxygen TherapyPreparationPulse OximetrySecretion Clearance and Breathing TechniquesSputum Induction

All Hospitals






Pulmonary Diagnostics (RESP 3350)

Date & Initial

Date & Initial

Date & Initial

Date & Initial

Date & Initial

Date & Initial

Date & Initial

Pulmonary Function Testing

All Hospitals






Community Care (RESP 3370) Date & Initial

Date & Initial

Date & Initial

Date & Initial

Date & Initial

Date & Initial

Date & Initial

Airway Management—Tracheostomy

Health Education and Promotion

Non-invasive Positive Airway Pressure

Oxygen Therapy

Perform Sleep Studies

All Hospitals




Book Two Child Competencies


Neonatal ICU (RESP 3420, RESP 1460) Date & Initial

Date & Initial

Date & Initial

Date & Initial

Date & Initial

Date & Initial

Date & Initial

Administer Medical Gases(Therapeutic Gas Administration)Airway Management—Discontinued

Airway Management Maintenance

Assessment—Modified

Blood Sample Procurement—Capillary only

Endtidal CO2 Monitoring

Intubation Assist

Lung Volume Recruitment Maneuvers

Manual Ventilation



St. Boniface/HSC




Book Two Child Competencies


Neonatal ICU (RESP 3420, RESP1460) Date & Initial

Date & Initial

Date & Initial

Date & Initial

Date & Initial

Date & Initial

Date & Initial

Mechanical Ventilation—ManagementMechanical Ventilation—Standby Ventilatory PreparationMechanical Ventilation—WeaningMonitoringNon-invasive Positive Airway PressurePharmacology Medication DeliveryPharmacology Oxygen TherapySecretion ClearanceSuctioning—PharyngealSuctioning—TracheobronchialThermal Regulation DevicesTranscutaneous MonitoringTransportation

St. Boniface/HSC




Book TwoChild Competencies


Pediatric ICU (RESP 3320, RESP 1460) Date & Initial

Date & Initial

Date & Initial

Date & Initial

Date & Initial

Date & Initial

Date & Initial

Administer Medical Gases (Therapeutic Gas Administration)Airway Management—Discontinue

Airway Management—Intubation Assist

Airway Management—Maintenance

Assessment—Full

Blood Sample Procurement—Capillary

Endtidal CO2 Monitoring

Humidity Therapy

Manual Ventilation


St. Boniface/HSC




Book TwoChild Competencies


Pediatric ICU (RESP 3320) Date & Initial

Date & Initial

Date & Initial

Date & Initial

Date & Initial

Date & Initial

Date & Initial


Mechanical Ventilation—Management

Mechanical Ventilation—Weaning

Monitoring

Non-invasive Positive Airway Pressure

Pharmacology—Medication Delivery

Pharmacology Oxygen Therapy

Suctioning—Pharyngeal

Suctioning—Tracheobronchial

Transportation

St. Boniface/HSC




Book ThreeAnesthesia Competencies


Anesthesia (RESP 3360) 1 of 2 Date &Initial

Date &Initial

Date &Initial

Date &Initial

Date &Initial

Date &Initial

Date &Initial

Airway Management—Basic Non Invasive

Airway Management—Intubation (Nasal)

Airway Management—Intubation (Oral)

Airway Management—Invasive (LMA)

Airway Management—Invasive (Nasal Pharyngeal)

Airway Management—Invasive (Oral Pharyngeal)

Seven Oaks Hospital

Book Three Anesthesia Competencies


Anesthesia (RESP 3360) 1 of 2 Date & Initial

Date & Initial

Date & Initial

Date & Initial

Date & Initial

Date & Initial

Date & Initial

Airway Management—Basic Non Invasive

Airway Management—Intubation (Nasal)

Airway Management—Intubation (Oral)

Airway Management—Invasive (LMA)

Airway Management—Invasive (Nasal Pharyngeal)

Airway Management—Invasive (Oral Pharyngeal)

Seven Oaks Hospital




Book Three Anesthesia Competencies


Anesthesia (RESP 3360) 2 of 2 Date & Initial

Date & Initial

Date & Initial

Date & Initial

Date & Initial

Date & Initial

Date & Initial

Anesthesia Administration—General (Assist with)

Anesthesia Administration—Regional Anesthesia (Assist with)

Assessment—Modified (Anesthesia)

End Tidal Carbon Dioxide Measurement

Intravenous Placement (Infusion via syringe/pump)

Intravenous Placement (Peripheral)

Manual Ventilation

Seven Oaks Hospital




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Cardiopulmonary Formulae

ALVEOLAR AIR EQUATION

PAO2 = [(PB - 47 mm Hg) x FIO2] - (PaCO2/RQ) P(A-a)O2 = PAO2 - PaO2

ANION GAP (daily use formula that does not use K+ in the formula)

AG = (Na+) - (Cl- + TCO2)

CARDIAC INDEX (L/MIN/M2)

CI = Qt BSA

CARDIAC OUTPUT (FICK EQUATION) (L/minute)

Qt = ( VO2 ) ( CaO2 - CvO2 ) X 10

CO2 PRODUCTION

VCO2 = PECO2 x VE (PB - 47 mm Hg) MEAN ARTERIAL PRESSURE

MAP = Systolic Pressure + (Diastolic Pressure x 2) 3

O2 CONSUMPTION (MODIFIED FICK EQUATION) (mL/MIN)

VO2 = [(CaO2 - CvO2) Qt] x 10

STROKE VOLUME (mL)

SV = Qt HR

SYSTEMIC VASCULAR RESISTANCE (dynes.sec/cm5) SVR = ( MAP - CVP ) x 80

Qt


Excerpted from the Candidate Information Manual—Canadian Board for Respiratory Care Inc. (CBRC) National Respiratory Therapy ExaminationsJanuary 2012 and July 2012—http://www.cbrc.ca/MANUAL2012E%20feb%202012-1.pdf


20


ALVEOLAR AIR EQUATION

PAO2 = [(PB - 47 mm Hg) x FIO2] - (PaCO2/RQ) P(A-a)O2 = PAO2 - PaO2

ANION GAP (daily use formula that does not use K+ in the formula)

AG = (Na+) - (Cl- + TCO2)

CARDIAC INDEX (L/MIN/M2)

CI = Qt BSA

CARDIAC OUTPUT (FICK EQUATION) (L/minute)

Qt = ( VO2 ) ( CaO2 - CvO2 ) X 10

CO2 PRODUCTION

VCO2 = PECO2 x VE (PB - 47 mm Hg) MEAN ARTERIAL PRESSURE

MAP = Systolic Pressure + (Diastolic Pressure x 2) 3

O2 CONSUMPTION (MODIFIED FICK EQUATION) (mL/MIN)

VO2 = [(CaO2 - CvO2) Qt] x 10

STROKE VOLUME (mL)

SV = Qt HR

SYSTEMIC VASCULAR RESISTANCE (dynes.sec/cm5) SVR = ( MAP - CVP ) x 80

Qt




21

PULMONARY VASCULAR RESISTANCE (dynes.sec/cm5) PVR = ( PAP - PCWP ) x 80

Qt OXYGEN DELIVERY (mL/min)

DO2 = CaO2 x Qt x 10 OXYGEN EXTRACTION (mL/min)

O2ER = .25 (CaO2 x Qt x 10)

OXYGEN INDEX OI = (FIO2 x Pãw) x 100 PaO2

ARTERIAL OXYGEN CONTENT (CaO2) (mL/dL)

= (Hb x 1.34 x SaO2) + (PaO2 x .003) MIXED VENOUS OXYGEN CONTENT (CvO2) (mL/dL)

= (Hb x 1.34 x SvO2) + (PvO2 x .003) PULMONARY END-CAPILLARY OXYGEN CONTENT (CcO2) (mL/dL)

= (Hb x 1.34 x 1.0) + (PAO2 x .003) CLASSIC SHUNT EQUATION (Qs/Qt)

= CcO2 - CaO2 CcO2 - CvO2

NOTE: Hb units must be in gm% for use in the above calculations.




21

PULMONARY VASCULAR RESISTANCE (dynes.sec/cm5) PVR = ( PAP - PCWP ) x 80

Qt OXYGEN DELIVERY (mL/min)

DO2 = CaO2 x Qt x 10 OXYGEN EXTRACTION (mL/min)

O2ER = .25 (CaO2 x Qt x 10)

OXYGEN INDEX OI = (FIO2 x Pãw) x 100 PaO2

ARTERIAL OXYGEN CONTENT (CaO2) (mL/dL)

= (Hb x 1.34 x SaO2) + (PaO2 x .003) MIXED VENOUS OXYGEN CONTENT (CvO2) (mL/dL)

= (Hb x 1.34 x SvO2) + (PvO2 x .003) PULMONARY END-CAPILLARY OXYGEN CONTENT (CcO2) (mL/dL)

= (Hb x 1.34 x 1.0) + (PAO2 x .003) CLASSIC SHUNT EQUATION (Qs/Qt)

= CcO2 - CaO2 CcO2 - CvO2

NOTE: Hb units must be in gm% for use in the above calculations.




22

Ventilatory formulae

DYNAMIC COMPLIANCE

= VT(DEL) (PIP - PEEP)

STATIC COMPLIANCE

= VT(DEL) (PPlateau - PEEP)

AIRWAY RESISTANCE (Raw)

= PIP - PPlateau Flow

DEADSPACE TO TIDAL VOLUME RATIO (VD/VT)

= PaCO2 - PECO2 PaCO2

TCO2 = HCO3

- + (PaCO2 x .03)

Ventilatory Formulae



24

Abbreviations and Symbols

"A" a arterial A alveolar ABG arterial blood gas AC assist-control ventilation ACLS advanced cardiac life support ADH antidiuretic hormone A/E air entry with auscultation AFB acid-fast bacilli AG anion gap AIDS acquired immunodeficiency syndrome ALS amyotrophic lateral sclerosis AP anterior posterior APGAR Appearance, Pulse, Grimace, Activity, Respiration APRV airway pressure release ventilation ARDS adult respiratory distress syndrome ASD atrial septal defect ATP adenosine triphosphate ATPD ambient temperature and pressure dry ATPS ambient temperature and pressure saturated AV artrioventricular

"B" BCLS basic cardiac life support

BE base excess BMI body mass index BMR basal metabolic rate BP blood pressure BSA body surface area BPD bronchopulmonary dysplasia BTPS body temperature and pressure saturated BUN blood urea nitrogen

"C" c capillary

C compliance Ca++ calcium CABG coronary arterial bypass graft CaO2 oxygen content of arterial blood C(a-v)O2 arterial to venous oxygen content difference C(a-v)O2I arterial to venous oxygen content difference indexed to BSA CcO2 oxygen content of capillary blood CBC complete blood count

Cdyn dynamic compliance CF cystic fibrosis CHF congestive heart failure CI cardiac index




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"C" c capillary






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"C" c capillary






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Cl- chloride cm H2O centimetres of water pressure CNS central nervous system CO carbon monoxide (in context) CO cardiac output CO2 carbon dioxide COHb carboxyhemoglobin COPD chronic obstructive pulmonary disease CPAP continuous positive airway pressure CPP cerebral perfusion pressure CPR cardiopulmonary resuscitation C & S culture and sensitivity CSA Canadian Standards Association CSF cerebrospinal fluid Cstat static compliance CT computerized tomography CVA cerebrovascular accident CvO2 oxygen content of mixed venous blood CVP central venous pressure CXR chest x-ray

"D" DL diffusing capacity

DLCO diffusing capacity of carbon monoxide DO2 oxygen delivery

"E" ECG electrocardiogram

ECMO extra corporeal membrane oxygenation EEG electroencephalogram EF ejection fraction

ELBW extremely low birth weight infant EOG electrooculogram EMG electromyogram EMT emergency medical technician ER emergency room/department ERV expiratory reserve volume

ETCO2 end-tidal carbon dioxide ETT endotracheal tube

"F" f frequency

FEF25-75 forced expiratory flow between 25% and 75% of vital capacity (MEFR) FEV1 forced expiratory volume at one second FEV1/FVC ratio of exhaled volume at one second to forced vital capacity FIO2 fraction of inspired oxygen FRC functional residual capacity FVC forced vital capacity FETCO2 fractional exhaled end tidal CO2




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"F" f frequency





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"F" f frequency





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FECO2 fractional mixed exhaled CO2 FVL flow volume loop f/VT rapid shallow breathing index

"G" g gram GCS Glasgow coma scale GI gastrointestinal

GxPxAx gravida, partum, abortion : gynecological terms used to represent number of pregnancies (G), number of live births (P) and number of abortion (A); x = number of

"H" Hb hemoglobin

HbCO carboxyhemoglobin HbF fetal hemoglobin Hbmet methemoglobin HBO hyperbaric oxygen HbO2/O2Hb oxyhemoglobin HCO3

- bicarbonate Hct hematocrit HFJV high frequency jet ventilation HFO high frequency oscillation HIV Human Immunodeficiency Virus HMD hyaline membrane disease HME heat and moisture exchanger

"I" IBW ideal body weight IC inspiratory capacity

ICP intracranial pressure ICU intensive care unit I:E inspiratory to expiratory time ratio

INR international normalized ratio of prothrombin time IPPA inspection, palpation, percussion, auscultation IRV inspiratory reserve volume

"K" kg kilogram K+ potassium

"L" L litre LAP left atrial pressure

LLL left lower lobe L:S (ratio) lecithin : sphingomyelin LUL left upper lobe LVEDP left ventricular end-diastolic pressure LVH left ventricular hypertrophy LVSV left ventricular stroke volume LVSW left ventricular stroke work




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"H" Hb hemoglobin












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"H" Hb hemoglobin












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"M" m meter MAC minimum alveolar concentration

MAP mean arterial pressure MDI metered dose inhaler MEP maximum expiratory pressure Mg++ magnesium MI myocardial infraction MIP maximum inspiratory pressure mm Hg millimetres of mercury pressure (torr) MOV minimal occluding volume MVA motor vehicle accident MVV maximum voluntary ventilation MMV mandatory minute ventilation

mmol millimole mL milliliter mg milligram "N" Na+ sodium

NIBP noninvasive blood pressure NIPPV noninvasive positive pressure ventilation NO nitric oxide NO2 nitrogen dioxide N2O nitrous oxide NPPV noninvasive positive pressure ventilation NPV negative pressure ventilation NREM non-rem sleep

NTT nasotracheal tube "O" O/A on auscultation

O/E on examination O2 oxygen O2ER oxygen extraction OI oxygen index OR operating room

"P" P pressure

P50 partial pressure of oxygen at 50% HbO2 PA pulmonary artery PA alveolar pressure PPlateau plateau pressure P(A-a)O2 alveolar to arterial oxygen gradient PAC premature atrial pressure PAP pulmonary artery pressure PAP mean pulmonary artery pressure PAT paroxysmal atrial tachycardia PAV proportional assist ventilation




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"P" P pressure





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"P" P pressure




contraction


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Paw airway pressure (proximal) AWP or PAW mean airway pressure

PCWP(PAOP) pulmonary capillary wedge pressure / pulmonary artery occlusion pressure PB barometric pressure PCV pressure control ventilation PDA patent ductus arteriosus PECO2 pressure of mixed exhaled carbon dioxide PEEP positive end-expiratory pressure PEFR peak expiratory flowrate PEP peak expiratory pressure PETCO2 pressure of end-tidal carbon dioxide PFT pulmonary function testing pH standardized hydrogen ion activity Phigh pressure high PIF peak inspiratory flow PIP peak inspiratory pressure Plow pressure low PNIP peak negative inspiratory pressure PPHN persistent pulmonary hypertension of the newborn

ppm parts per million PPV positive pressure ventilation

PRVC pressure regulated volume control PSV pressure support ventilation PT prothrombin time PTT partial thromboplastin time PVC premature ventricular contraction PvCO2 pressure of carbon dioxide in mixed venous blood

PvO2 pressure of oxygen in mixed venous blood PVR pulmonary vascular resistance PVRI pulmonary vascular resistance index

"Q" Qs / Qt shunted cardiac output ratio Qt cardiac output

"R" RAW airway resistance

RBC red blood cell RDS respiratory distress syndrome REM rapid eye movement RLL right lower lobe RML right middle lobe RQ respiratory quotient RR respiratory rate RSBI rapid shallow breathing index RSV Respiratory Syncytial Virus RUL right upper lobe RV residual volume




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RVH right ventricular hypertrophy

"S" SaO2 arterial oxygen saturation SIDS sudden infant death syndrome SIMV synchronized intermittent mandatory ventilation SLE systemic lupus erythematosus SOB shortness of breath SOBOE shortness of breath on exertion SpO2 oxygen saturation by pulse oximetry STPD temperature 00C, pressure 760 mm Hg and dry SvO2 mixed venous oxygen saturation SVC slow vital capacity SVR systemic vascular resistance

SVRI systemic vascular resistance index

"T" T temperature TB tuberculosis

TC time constant TCO2 total CO2 TcPO2 transcutaneous pressure of oxygen TE expiratory time Thigh time high

TI inspiratory time TID dynamic inspiratory time

TIS static inspiratory time TLC total lung capacity

Tlow time low TTN transient tachypnea of the newborn

"U" URTI upper respiratory tract infection

UAC umbilical artery catheter UVC umbilical venous catheter

"V" VE minute volume of expired volume per minute (BTPS)

VA minute alveolar ventilation VC vital capacity VCO2 carbon dioxide production (STPD) per minute VD deadspace VD/VT deadspace to tidal volume ratio

VLBW very low birth weight infant Vmax(x) maximum flow where (x) = % of volume VO2 oxygen consumption per minute vol% concentration (percent per volume) V/Q ventilation/perfusion ratio VS volume support VSD ventricular septal defect




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Revised: February 2015



VT tidal volume VT(del) delivered tidal volume VTG thoracic gas volume

"W" WBC white blood cell WHMIS Workplace Hazardous Materials Information System


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Respiratory Therapy - University of ManitobaThe list of skills and procedures in this manual link...

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