Respiratory therapy最新文献

The Problem-Oriented Medical Record (POMR) is a five-part patient care documentation system widely used throughout North America. This article concerns the progress-notes component of the POMR and describes techniques for acquiring this information.

The difficulties that face the patient with chronic respiratory disease are complex and interrelated. Caring for such patients requires a holistic approach, including psychologic support and education of patient and family, combined with physical therapy, administration of bronchodilators, and oxygen therapy.

Health care is faring better than most professions hard-hit by the recession, but the impacts are starting to filter into hospitals. New legislation aimed at reducing the cost of ancillary services threatens to hinder respiratory therapy expansion efforts and may force directors to cut personnel.

The recommendations set forth here are based partly on empirical clinical data and partly on physiologic principles. Because both sources of information are incomplete, some of the advice offered will doubtless prove incorrect. The techniques must be individualized, and this requires first a good understanding of the pathophysiology involved and then a process of manipulation of variables with careful monitoring of their effect by appropriate "dependent variables." Optimal ventilator management is possible only with a good working relationship among physician, nurse, and respiratory technologist.

The victim of a traffic accident, a person with severe respiratory distress secondary to chronic pulmonary disease, and a tiny neonate born in a hospital lacking the necessary facilities for intensive care all can benefit from recent developments in ground and air emergency transport.

RTs wil have many contributions to make to the home health care team when their role is officially recognized and reimbursed. Training for the special needs of home care patients, including problems of dependence and motivation, is already a part of many RT training programs.

The increased popularity of bronchoscopy performed outside the operating room has created a need for the bronchoscopy assistant service. The Stanford (Calif) University service is described here as a guide for departments establishing a bronchoscopy assistant service or restructuring an existing one.

The past 20 years have seen striking changes in ventilators for use in infants and children. Early in this period, we relied on traditional machines and techniques that were largely borrowed from adult medicine. The availability of second-generation machines brought better understanding of pulmonary physiology, particularly as it relates to oxygen transport. Today, third-generation ventilators very different from the others have forced abandonment of dogma concerning the manner in which molecules of gas enter and leave the lung. Their full impact cannot yet be judged, but they have shown great clinical promise and no doubt will change further our understanding of pulmonary physiology.

Routine measurements of vital capacity, forced expired volume in one second, and forced expiratory flow are easy to make, and so are errors in these measurements. Even if the technologist observes all the rules in performing the tests, there is still a potential source of error in the machine.

Conventional test lungs and commercial lung simulators have the capacity for varying compliance and resistance, but none generates reproducible spontaneous respiratory efforts. The lung simulator described here, used with a variable-flow, piston-driven ventilator, can simulate and reproduce spontaneous respiratory effort. It may be useful in education, clinical management, and preventive maintenance.