Chapter 1 History of Respiratory Care
description
Transcript of Chapter 1 History of Respiratory Care
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
Chapter 1
History of Respiratory Care
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc. 2
Learning Objectives
1. Define “respiratory care.”
2. Summarize some of the major events in the history of science & medicine.
3. Explain how the respiratory care profession got started.
4. Describe the historical development of the major clinical areas of respiratory care.
5. Name some of the important historical figures in respiratory care.
6. Describe the major respiratory care educational, credentialing, & professional associations.
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc. 3
Learning Objectives
7. Explain how the important respiratory care organizations got started.
8. Describe the development of respiratory care education.
9. Predict future trends for respiratory care.
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History of Respiratory Medicine & Science
Ancient Times Early cultures developed herbal remedies for
many diseases Foundation of modern medicine: attributed to
“father of medicine,” Hippocrates, Greek physician living during 5th & 4th centuries BC
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History of Respiratory Medicine & Science (cont.)
Ancient Times (cont.) Hippocratic medicine:based on four essential
fluids: phlegm, blood, yellow bile, & black bile Hippocrates believed air contained essential
substance distributed to body via heart The Hippocratic oath: calls for physicians to follow
certain ethical principles• Given to most medical students at graduation
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History of Respiratory Medicine & Science (cont.)
Ancient Times (cont.) Other great scientists of this time period
• Aristotle (342322 BC)first great biologist
• Erasistratus (330240 BC)developed pneumatic theory of respiration in Egypt
• Galen (130199 AD)anatomist who believed air had substance vital to life
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History of Respiratory Medicine & Science (cont.)
Middle Ages Fall of Roman empire (476 AD): resulted in period
of slow scientific progress Intellectual rebirth in Europe began in 12th century Leonardo da Vinci (14531519) determined
subatmospheric pressures inflated lungs Andreas Vesalius (15141564) performed human
dissections & experimented with resuscitation
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History of Respiratory Medicine & Science (cont.)
Enlightenment Period 1754: Joseph Black described properties of CO2
1774: Joseph Priestley describes his discovery of oxygen - “dephlogisticated air”
• Lazzaro Spallazani describes tissue respiration
1787: Jacques Charles describes relationship between gas temperature & volume - “Charles law”
1778: Thomas Beddoes uses oxygen to treat various conditions at Pneumatic Institute
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History of Respiratory Medicine & Science (cont.)
19th & Early 20th Century 1801: John Dalton describes his law of partial
pressures 1808: Joseph Louis Gay-Lussac describes
relationship between gas temperature & pressure 1831: Thomas Graham describes law of diffusion
for gases (Graham’s law)
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History of Respiratory Medicine & Science (cont.)
19th & Early 20th Century (cont.) 1865: Louis Pasteur advanced his “germ theory” &
suggestes that some diseases were result of microorganisms
1846: spirometer & ether anesthesia invented 1896: William Roentgen discoveres x-ray - opens
door for modern field of radiology
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Which scientist described his law of diffusion for gases in the 19th century?
A. John Dalton B. Thomas Graham C. Jacques CharlesD. Joseph Louis Gay-Lussac
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Development of the Respiratory Care Profession
1940s: technicians hauled O2 cylinders & apply O2 delivery devices
1950s: positive-pressure breathing devices applied to patients
1960s: Formal education programs for inhalation therapists Development of sophisticated mechanical
ventilators in the 1960s expanded role of respiratory therapist (RT)
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Development of the Respiratory Care Profession (cont.)
RTs responsible for arterial blood gas & pulmonary function laboratories
1974: designation “respiratory therapist” becomes standard
Practice of Respiratory Therapy, originally U.S. & Canada now expands globally
1980: Respiratory Care Week established nationally to promote profession & importance of good lung health
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How long after initially applying positive pressure breathing devices to patients did the first sophisticated mechanical ventilator become available, expanding the role of Respiratory Therapists?
A. 10 yearsB. 20 yearsC. 30 yearsD. 40 years
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Development of the Respiratory Care Profession (cont.)
Oxygen Therapy 1907: Large-scale production of O2 developed by
Karl von Linde. 1910: Oxygen tents first used 1918: O2 masks first used
1940s: O2 therapy widely prescribed
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Development of the Respiratory Care Profession (cont.)
1960s: Clark electrode first developed - allows measurement of arterial PO2
1974: Ear oximeter invented 1980s: Pulse oximeter invented
1960: Venti mask to deliver specific FIO2
introduced
1970s: Portable liquid O2 systems for long-term
oxygen therapy (LTOT) in home introduced
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Development of the Respiratory Care Profession (cont.)
21st century marks further advances in home oxygen therapy equipment
New equipment introduced for Long Term Oxygen Therapy include: Oxygen concentrators with pressure booster
(allows transfilling in home) Smaller, lightweight portable oxygen concentrators
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Development of the Respiratory Care Profession (cont.)
Aerosol Medications1910: aerosolized epinephrine introduced as
treatment for asthma1940s-1950s: Isoproterenol (1940) & isoetharine
(1951) introduced as bronchodilators1971s: Aerosolized steroids first used to treat
acute asthma
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Development of the Respiratory Care Profession (cont.)
Aerosol Medications 1980: Advances in bronchodilator therapy -
Albuterol sulfate introduced & still used today 2000: Levalbuteral introduced Newer aerosol medication delivery devices include
dry powder inhaler (DPI) Innovative designs for small volume nebulizers
(SVN’s) invented
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Development of the Respiratory Care Profession (cont.)
Mechanical Ventilation1928: Iron lung introduced by Philip Drinker1940s-1950s: Jack Emerson develops improved
version of iron lung used for polio victims1950s: Negative-pressure “wrap” ventilator
introduced
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Development of the Respiratory Care Profession
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Mechanical Ventilation
Originally, positive-pressure ventilation used during anesthesia
The Drager Pulmotor (1911), Spiropulsator (1934), the Bennett TV-2P (1948) & Bird Mark 7 (1958) were positive-pressure ventilators
Bennett MA-1, Ohio 560, & Engstrom 300 were introduced in 1960s as volume-cycled ventilators.
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Development of the Respiratory Care Profession
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Development of the Respiratory Care Profession
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Mechanical Ventilation (cont.)
More advanced volume ventilators became available in 1970s: Servo 900, Bourns Bear I & II, & MA II
First microprocessor-controlled ventilators developed in 1980s (Bennett 7200)
Ventilators with capability of applying advanced modes of ventilation became available in 21st century
Due to use of endotracheal tube, mechanical ventilation increases risk for ventilator-associated pneumonia (VAP)
Non-invasive ventilation, when applicable, can prevent this risk.
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All of the following are true about ventilator associated pneumonia (VAP), except:
A. it can occur in both mechanically ventilated & spontaneously breathing patientsB. death is a potential risk of VAPC. non-invasive ventilation may be used to avoid VAPD. there are very costly consequences when a patient acquires VAP
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Airway Management
1980: William MacEwen successfully applied first endotracheal tube to patient
1913: laryngoscope introduced 1941: First suction catheter described 1970s: Low-pressure cuffs for endotracheal
tubes introduced
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Cardiopulmonary Diagnostics
1800: Measurement of lung’s residual volume first performed
1846: first water-sealed spirometer developed by John Hutchinson
1967: rapid arterial blood gas analysis becomes available
1980s: Polysomnography becomes routine
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Professional Organizations
Inhalation Therapy Association (ITA) founded in 1947
ITA became American Association for Inhalation Therapists (AAIT) founded in 1954
AAIT became American Association for Respiratory Therapy (AART) founded 1973
AART became American Association for Respiratory Care (AARC) founded in 1982
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Professional Organizations (cont.)
1980s: state licensure for RTs begins State licensure based on RTs passing entry level
exam offered by National Board for Respiratory Care (NBRC)
NBRC offers certification & registry examination for RTs
State licensing laws set minimum educational requirements & determine competence to practice
State licensing boards also set required amount of continuing education credits (CEU’s) required to keep license to practice
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Professional Organizations (cont.) AARC advocates for profession to legislative &
regulatory bodies, insurance industry & public AARC sponsors continuing professional educational
activities, including conferences to gain CEU’s - go to www.AARC.org
AARC publishes monthly science journal RESPIRATORY CARE & news magazine: AARC Times
AARC members may join any of 10 Specialty Sections
2002: AARC, NBRC, & CoARC formally express support for all RT’s to seek & obtain RRT credential
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In what year did it become a requirement for Respiratory Therapists to be licensed by the state in which they practice?
A. 2000B. 1990C. 1980D. 1970
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Respiratory Care Education
1950: First formal RT program was offered in Chicago
1960s: Programs multiply - many hospital based Currently: Associates (AS) Degree in Respiratory
Care (RC) is minimum educational requirement AS Degree’s represent majority of all educational
programs More than 350 RT education programs exist in
U.S. 2003: AARC formally encourages development
of baccalaureate & graduate education in RC
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Which of the following sets the minimum educational requirements & the method of determining competence to practice Respiratory Care?
A. AARCB. BOMAC. State licensing lawsD. NBRC
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Respiratory Care Education
Due to aging population(baby boomers): Increased demand for RC services & RT’s
As baby boomers age: More will have asthma, COPD, & other
cardiopulmonary diseases As treatments & technology continue to
advance: RT’s will require more educational preparation
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Respiratory Care Education
RT’s of future will focus more on: Prevention Protocol administration Care plan development Disease management & rehabilitation Family & patient education Tobacco cessation counseling
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Future of Respiratory Care
“2015 & Beyond”—Special task force created by AARC Formed in 2007 as AARC recognized impending
overhaul of U.S. healthcare system Task—to envision potential roles & responsibilities
of RT by 2015 & beyond 3 strategic conferences held: 2008, 2009, 2010
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Future of Respiratory Care (cont.)
Aim: to answer 5 questions about future of profession:1. How patients will receive health care services
2. How respiratory care services will be provided
3. Knowledge, skills, attributes needed by RT’s
4. Educational & credentialing systems necessary
5. How to transition with little impact on practicing RT’s
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Future of Respiratory Care (cont.)
Task force concludes: RT’s need to be competent in 7 major areas by 2015:1. Diagnostics
2. Chronic disease state management
3. Evidence-based medicine & Respiratory Care protocols
4. Patient Assessment
5. Leadership
6. Emergency & Critical Care
7. Therapeutics