1. MODULE A - Airway Management
  1. KEY TOPICS
  2. Aspects of laryngeal airways.
  3. Aspects of esophageal airways.
  4. Aspects of tracheal airways.
  1. OBJECTIVES: The student will be able to…
  1. PART 1- Pharyngeal, Laryngeal & Esophageal Airways
  1. State the following in regards to laryngeal airway use.
  2. Indications
  3. Contraindications
  4. Hazards/complications
  5. Describe the following airways (include insertion, advantages & disadvantages):
  6. Laryngeal Mask Airway (LMA)
  7. Esophageal-Tracheal Combitube (ETC)
  8. King airway
  9. On an anatomical model, demonstrate proper technique for placement, maintenance and removal of the following airways:
  10. Combitube
  11. LMA
  1. PART 2- Tracheal Airways
  2. Compare the following in regards to ORAL AND NASAL endotrachealtubes:
  3. Indications
  4. Physiological & psychological alterations
  5. Contraindications
  6. Hazards/complications (early & late)
  7. Advantages
  8. Disadvantages
  9. Equipment needed
  10. Procedure for insertion
  11. Confirming placement
  12. Confirming depth
  13. Securing
  14. Repositioning & oral care
  15. Explain the following regarding endotracheal:
  16. Changing process
  17. Oral Care (ET tube)
  18. Removal (extubation)
  19. State the correct size or formula for determining the size of endotracheal tube for each of the following patient types:
  20. Pre-Term Infant
  21. Full-Term Infant
  22. Adult
  23. Describe the purpose for the following in regards to an endotracheal tube.
  24. Oral vs. nasal
  25. Curved/Macintosh vs. straight/Miller laryngoscope blade
  26. Reusable vs. disposable fiberoptic
  27. Laryngoscope handles (hand of use, batteries, bulbs)
  28. Stylet
  29. Magill forceps
  30. Tube exchangers
  31. Tube choices
  32. Cuffs (high volume-low pressure vs. high pressure-low volume)
  33. Hi/Lo Evac tubes
  34. State the correct size for determining the correct size of laryngoscope blade for each of the following patient types:
  35. Pre-Term Infant
  36. Full-Term Infant
  37. Adult
  38. Given a clinical scenario, use the algorithms for difficult intubations and airways to determine the appropriate airway.
  39. Describe the following in regards to extubation:
  40. Determining readiness to extubate
  41. Difference between extubation & weaning from ventilation
  42. Preparing the patient
  43. Extubation procedure
  44. Follow-up
  45. Handling post extubation difficulties
  46. Describe the common methods for determining proper ET & tracheostomy tube placement and for securing the different airways.
  47. List the following in regards to tracheostomy tubes:
  48. Indications
  49. Physiological & psychological alterations
  50. Contraindications
  51. Hazards/complications (early & late)
  52. Advantages
  53. Disadvantages
  54. Procedure for insertion
  55. Percutaneous vs. surgical
  56. Describe the purpose of each of the following as it relates to tracheostomy tubes.
  57. Obturator
  58. Lubricant
  59. Inner cannula
  60. Outer cannula
  61. Lyofoam
  62. Trach care kit
  63. Bivona
  64. Extra length
  65. Silver Jackson
  66. ET tube adapter
  67. Lanz
  68. Buttons
  69. Fenestrated
  70. Explain each of the following processes as it relates to endotracheal tube and tracheostomy tubes:
  71. Cuff management
  72. Changing process
  73. Wound care (trach tube)
  74. Communication devices
  75. Removal (decannulation)
  76. Describe the results of improper ET & tracheostomy care.
  77. Describe the common lesions associated with tracheal tubes.
  78. State the ideal intra-cuff pressure (in cmH2O & mmHg) and the consequences of extraordinary high pressures and demonstrate cuff pressure measurement.
  79. Differentiate between “minimal leak technique” and “minimal occlusive volume”.
  80. Describe the techniques for providing proper artificial airway humidification and the complications of inappropriate humidity.
  81. Describe the techniques for preventing nosocomial infections in patients with tracheal airways.
  82. On an anatomical model, demonstrate proper technique for placement, maintenance and removal of the following airways:
  83. Endotracheal tube
  84. Tracheostomy tube
  85. Demonstrate a proper method for securing an endotracheal tube.
  86. Demonstrate a proper method for performing oral care.
  1. PART 3 – Artificial Clearance
  1. Describe the following in regards to Suctioning according to the AARC’s Describe eachof the following as it relates to suctioning according to the AARC’s Clinical Practice Guideline: Endotracheal Suctioning of Mechanically Ventilated Adults and Children with Artificial Airways.
  2. Process
  3. Goals
  4. Indications
  5. Contraindications
  6. Hazards
  7. Complications
  8. List three parameters that should be monitored on a patient prior to, during and after suctioning.
  9. State the proper level of vacuum to be used for each of the following patient types:
  10. Infant
  11. Child
  12. Adult
  13. Describe and state the purpose of each of the following:
  14. Coudé top catheter (Left Bronchitrac)
  15. Closed system suction catheter
  16. Red Rubber Rusch
  17. Yankaeur device
  18. Lukens trap
  19. Given a clinical scenario, determine the correct size of suction catheter for each of the following patient types:
  20. Pre-Term Infant
  21. Full-Term Infant
  22. Adult
  23. List the main differences between suctioning technique for an adult, child and infant.
  24. Describe each of the following as it relates to Bronchoscopy according to the AARC’s Clinical Practice Guideline: Fiberoptic Bronchoscopy.
  25. Process
  26. Goals
  27. Indications
  28. Contraindications
  29. Hazards
  30. Complications
  31. Describe Transtracheal aspiration and explain its purpose.
  32. Explain the diagnostic & therapeutic indications for a bronchoscopy.
  33. Describe the therapist’s role in bronchoscopy.
  34. Explain what a Bal-CATH is and why it is used.
  35. Explain why a Bal-Cath might be better that tracheal aspiration or bronchoscopy for obtaining a sputum specimen.
  36. Explain the purpose for transtracheal aspiration.
  1. PART 4- Airway Emergencies
  1. Describe the proper procedures to follow for each of the following airway emergencies:
  2. Accidental extubation
  3. Difficulty with reintubation
  4. Airway obstruction
  5. Pilot line cut
  6. Pilot balloon valve malfunction
  7. Cuff leak
  8. Severe hemoptysis
  1. PART 5 – Advanced Airways
  1. Describe the following surgical emergency airways:
  2. Percutaneous transtracheal airway
  3. Cricothyrotomy
  4. Given a situation where tracheostomy is not an option, describe the best procedure for relieving an inspiratory & expiratory upper airway obstruction.
  5. Given a situation where tracheostomy is not an option, describe the best procedure for relieving an inspiratory upper airway obstruction.
  6. Describe the different types of endobronchial tubes (EBT).
  7. Describe the following in regards to a double lumen airway:
  8. Indication
  9. Sizing
  10. Insertion
  11. Positioning
  12. Transport
  13. Maintenance
  14. Describe the different unilateral lung procedures that might be necessary.
  15. Explain the considerations when ventilating a patient with independent lung ventilation.
  1. ASSIGNMENTS:
  1. Class attendance & participation
  2. Take lecture notes and/or tape lecture.
  3. Reading:
  4. Pilbeam: Read & do workbooks
  5. Chapter 8 - pgs. 133-134 (leaks) and pgs. 136-140 (management)
  6. Chapter 12 – pgs. 230-235 (airway clearance) and pgs. 241 – 244 (flexible fiberoptic bronchoscopy)
  7. Chapter 14 (VAP)
  8. Chapter 17 - pgs. 345-349 (ventilator mechanical and operational hazards)
  9. Chapter 18 - pgs. 355-358 (identifying the patient in sudden distress)
  10. Chapter 21 - pgs. 447-453 (tracheostomy tubes, speaking valves and tracheal buttons)
  11. Egan’s Fundamentals of RC: Read & do workbooks
  12. Chapter 33 – (Airway Management)
  13. Chapter 34 pages, 758 – 759 (pharyngeal airways)
  14. Instructor Handout on Double Lumen ET Tubes and Independent Lung Ventilation
  15. Complete lab exercise:
  16. Chapter 20 – Pharyngeal Airways
  17. Chapter 21 – Suctioning
  18. Chapter 22 – Endotracheal Intubation
  19. Chapter 23 – Tracheostomy Care
  20. Chapter 24 - Artificial Airway Care and Maintenance
  21. Write the answers to the objectives in the ”First Day Handout” to reinforce learning material (optional).
  1. EVALUATION:
  2. Instructor constructed exams/quizzes
  3. Successful completion of lab exercises
  4. Performance Evaluation- Intubation with Combitube in Place
  5. Performance Evaluation- Extubation
  6. Performance Evaluation- Decannulation
  1. MODULE B -Monitoring During Mechanical Ventilation
  1. KEY TOPICS
  2. Review of ventilator waveforms
  3. Flow-Time curves
  4. Pressure-Time curves
  5. Volume Time curves
  6. Volume-Pressure loop
  7. Flow-Volume loop
  8. Review of documentation
  9. Review of respiratory mechanics, time constants and auto-PEEP
  1. OBJECTIVES: The student should be able to…
  2. Set-up and adjust each curve and loop available for graphics monitoring.
  3. Given a clinical scenario, draw each of the scalar waveforms.
  4. Document a basic check of the ventilator.
  5. Perform a plateau, compliance, resistance and auto-PEEP maneuver properly.
  1. CLASSROOM ASSESSMENT:
  2. Class attendance & participation
  3. Take notes and/or tape lecture
  4. Readings:
  5. Pilbeam: Read & do workbooks
  6. Chapter 1pgs. 5-11 (lung characteristics) and pgs. 11-15 (definitions of pressures in positive pressure ventilation)
  7. Chapter 3 (how a breath is delivered)
  8. Chapter 5pgs. 65-76 (mode of ventilation and breath delivery - up to Bilevel)
  9. Chapter 8pgs. 125-134 (up to vitalsigns) and pgs. 140-144 (monitoring compliance and resistance)
  10. Chapter 9 (ventilator graphics)
  11. Chapter 10pgs. 190-196 (measurements)
  12. Appendix C (graphics exercises)
  13. Egan’s Fundamentals of RC: OPTIONAL
  14. Chapter 41 – Respiratory Failure and the Need for Ventilatory Support
  15. Chapter 42– Mechanical Ventilators
  16. Chapter 43 – Physiology of Ventilatory Support
  17. Chapter 44 – Initiating and Adjusting Invasive Ventilatory Support
  18. Chapter 46 - Monitoring & Management of Patient in ICU
  19. Complete lab exercises
  20. Instructor Graphing assignments
  21. Instructor ATC, Rise Time, E Sens% labs
  22. Butler Laboratory Exercises (as assigned by instructor)
  23. Chapter 39 – Continuous Mechanical Ventilation
  24. Chapter 40 – Ventilator Modes
  25. Chapter 41 – Ventilator initiation
  26. Chapter 42 – Patient Ventilator System Care and Maintenance
  27. Go to web site and download the following clinical practice guidelines:
  28. Patient-Ventilator System Checks
  29. Capnography/Capnometry during Mechanical Ventilation
  1. EVALUATION
  2. Instructor constructed exams/quizzes
  3. Successful completion of lab exercises
  4. PERFORMANCE EVALUATION - ATC, Rise Time & E Sens%
  5. PERFORMANCE EVALUATION - Aerosol Therapy
  1. MODULE C – Management Of The Ventilator Patient

LESSON #1 – COPD

LESSON #2 – ASTHMA

LESSON #3 – ARDS

  1. KEY TOPICS
  2. Alternatives to invasive ventilation
  3. Conventional invasive ventilation
  4. Solving Ventilation problems
  5. Solving Oxygenation Problems
  6. Infection Control & VAP
  7. Transport
  8. Non-conventional invasive ventilation
  9. Problem-solving
  1. OBJECTIVES: The student should be able to…
  2. List an alternative to invasive ventilation.
  3. Given a clinical situation with a patient suffering from each of the following conditions, establish appropriate ventilator settings.
  4. Normal lungs with some other disorder (i.e. drug overdose, post-op…)
  5. COPD
  6. Asthma
  7. ARDS
  8. Head Injury
  9. CHF and pulmonary edema
  10. Describe the indications, contraindications, hazards and apply of the following methods to treat oxygenation and ventilation problems
  11. Waveform analysis
  12. PSV & ATC
  13. Dual mode ventilation
  14. Bi-Level
  15. APRV
  16. Lung recruitment maneuver
  17. PEEP
  18. Sighs
  19. Therapeutics
  20. Mechanical deadspace
  21. Airway clearance
  22. Permissive hypercapnia
  23. Hyperventilation
  24. Prone and lateral positioning
  25. Transport
  26. Describe the methods to prevent and treat ventilator associated pneumonia (VAP)
  27. Describe the process for preparing the patient and equipment for transport in each of the following situations:
  28. VQ Scans
  29. MRI ventilators
  30. High altitude transport
  31. Describe the indications, contraindications and application of the following special techniques:
  32. HFOV
  33. Heli-ox
  34. ILV
  35. IPV
  36. ECLS
  37. Tracheal gas insufflation
  38. Prevent, recognize and manage each of the following clinical situations:
  39. Auto-PEEP
  40. Atelectasis
  41. Oxygen Toxicity
  42. Increased work of breathing, respiratory drive, and patient-ventilator asynchrony
  43. Disturbances in arterial blood-gas values
  44. Flail chest
  45. Bronchospasm
  46. Unilateral lung disease
  47. Ventilator Induced Lung Injury
  48. Pneumothorax
  49. Excessive secretions
  50. Abdominal distention
  51. Restrictive chest wall disorder
  52. Pulmonary Embolism
  53. Troubleshoot the patient-ventilator system for each of the following:
  54. Alarms
  55. Leaks
  56. Mechanical deadspace
  57. Ventilator Inoperative
  1. CLASSROOM ASSESSMENT:
  1. Class attendance & participation
  2. Take notes and/or tape lecture
  3. Readings:
  4. Pilbeam: Read & do workbooks
  5. Chapter 4pgs. 56-60 (alternatives)
  6. Chapter 5pgs. 76-83 (Bilevel and additional modes)
  7. Chapter 6 (initial settings)
  8. Chapter 12 pgs. 223–230 (ventilation) and pgs. 235-241 (aerosols)
  9. Chapter 15 (pharmacology)
  10. Chapter 18 (troubleshooting) (except 355-358 from module A)
  11. Chapter 23 pgs. 515-531 (heliox & NAVA)
  12. Appendix B (abnormal physiological processes)
  13. Chapter 7 (final set up considerations)
  14. Chapter 12 pgs. 244-252 (additional techniques)
  15. Chapter 17 (effects of Positive Pressure Ventilation on the pulmonary system)
  16. Chapter 13 (improving oxygenation)
  17. Chapter 23 pgs. 504-515(APRV & HFV)
  18. Egan’s Fundamentals of RC: OPTIONAL
  19. Chapter 23 – (COPD)
  20. Chapter 27 – (ALI, CHF, ARDS)
  21. Chapter 29 –( Neuromuscular & Chest Wall)
  22. Chapter 41 – (Respiratory Failure)
  23. Chapter 44 – (Initiating and Adjusting Ventilatory Support)
  24. Complete lab exercises as assigned by instructor:
  25. Mode review,
  26. Dual mode,
  27. Pressure modes,
  28. Aerosol therapy
  29. Butler – Chapter 40 – Ventilator Modes
  1. EVALUATION:
  2. Instructor constructed exams/quizzes
  3. Successful completion of lab exercises
  4. PERFORMANCE EVALUATIONS - Dual mode ventilation set-up
  5. PERFORMANCE EVALUATION - APRV

  1. MODULE D - Newborn And Pediatric Ventilation
  1. KEY TOPICS
  1. Use of CPAP
  2. Infant ventilation
  3. Pediatric ventilation
  4. Ventilator assembly.
  5. Operation verification
  6. Set up and adjustment of Ventilator
  7. Graphics monitoring and respiratory mechanics
  8. Humidification and therapeutics.
  9. Surfactant therapy
  10. Neonatal Time Cycled, Pressure-Limited Ventilation
  11. Adjuncts to conventional mechanical ventilatory support
  12. High frequency ventilation
  13. Liquid Ventilation
  14. Surfactant
  15. ECMO
  16. Nitric oxide
  1. OBJECTIVES:The student should be able to…
  1. Set-up and adjust the infant CPAP equipment
  2. Set up and adjust a neonatal ventilator given a neonatal scenario
  3. Set-up and adjust the Sensor medics HFOV 3100A
  4. Set-up and adjust a pediatric ventilator given a pediatric scenario
  1. CLASSROOM ASSESSMENT:
  1. Class attendance & participation
  2. Take notes and/or tape lecture
  3. Readings:
  4. Pilbeam: Read & do workbooks
  5. Chapter 22 (neonatal & pediatric ventilation)
  6. Egan’s Fundamentals of RC: OPTIONAL
  7. Chapter 31 – [Neonatal & Pediatric Respiratory Disorders (optional)]
  8. Chapter 48 –(Neonatal & Pediatric Respiratory Care)
  9. Complete lab exercises and any additional instructor assignments
  1. EVALUATION:
  2. Instructor constructed exams/quizzes

  1. MODULE E - Discontinuation From Ventilation And Long Term Care
  1. KEY TOPICS
  2. Assessment of weaning readiness
  3. Use of capnography with weaning
  4. Methods of weaning
  5. Ethical considerations
  6. Accessories (Passy-Muir valves…)
  7. Extubation & decannulation
  8. Special considerations in the home or ECF environment
  9. Infection control.
  10. Problems & troubleshooting
  1. OBJECTIVES: The student should be able to…
  1. Describe the evidence-based weaning recommendations.
  2. Perform a weaning readiness assessment.
  3. Follow a weaning protocol.
  4. Assess weaning tolerance.
  5. Describe the alternative equipment used for weaning and long term care.
  1. CLASSROOM ASSESSMENT:
  1. Class attendance & participation
  2. Take notes and/or tape lecture
  3. Readings:
  4. Pilbeam: Read & do workbooks
  5. Chapter 10pgs. 179-186 (CO2 monitoring)
  6. Chapter 20 (weaning & discontinuation)
  7. Chapter 21 pgs. 429-447 (long-term ventilation)
  8. Egan’s Fundamentals of RC:OPTIONAL
  9. Chapter 47 – (Discontinuing Ventilatory Support)
  10. Chapter 51 – (Respiratory Care in Alternative)
  11. Complete instructor lab exercises and any additional instructor assignments.
  1. EVALUATION:
  2. Instructor constructed exams/quizzes