Egan’s Fundamentals of Respiratory Care (12th Edition)

Description

Learn the principles and skills you’ll need as a respiratory therapist! Egan’s Fundamentals of Respiratory Care, 12th Edition provides a solid foundation in respiratory care and covers the latest advances in this ever-changing field. Known as “the bible for respiratory care,” this text makes it easy to understand the role of the respiratory therapist, the scientific basis for treatment, and clinical applications. Comprehensive chapters correlate to the 2020 NBRC Exam matrices, preparing you for clinical and exam success. Written by noted educators Robert Kacmarek, James Stoller, and Albert Heuer, this edition includes new chapters on heart failure as well as ethics and end-of-life care, plus the latest AARC practice guidelines.

Key Features

• Updated content reflects the newest advances in respiratory care, preparing you to succeed in today’s health care environment.
• UNIQUE! Mini-Clinis provide case scenarios challenging you to use critical thinking in solving problems encountered during actual patient care.
• Decision trees developed by hospitals highlight the use of therapist-driven protocols to assess a patient, initiate care, and evaluate outcomes.
• Rules of Thumb highlight rules, formulas, and key points that are important to clinical practice.
• Learning objectives align with the summary checklists, highlighting key content at the beginning and at the end of each chapter, and parallel the three areas tested on the 2020 NBRC Exam matrices.
• Learning resources on the Evolve companion website include an NBRC correlation guide, image collection, lecture notes, Body Spectrum electronic anatomy coloring book, and an English/Spanish glossary.
• Student workbook provides a practical study guide reflecting this edition of the text, offering numerous case studies, experiments, and hands-on activities. Available separately.
• Full-color design calls attention to the text’s special features and promotes learning.
• Glossary includes key terms and definitions needed for learning concepts.

Table of Contents

1. Cover image
2. Title Page
3. Table of Contents
4. Copyright
5. Dedication
6. Contributors
7. Reviewers
8. Preface
9. Organization
10. Features
11. New to This Edition
12. Learning Aids
13. For the Instructor
14. Section I Foundations of Respiratory Care
15. 1 Early History of Respiratory Care
    1. Definitions
    2. History of Respiratory Medicine and Science
    3. Development of the Respiratory Care Profession
    4. Professional Organizations and Events
    5. Respiratory Care Education
    6. Summary Checklist
    7. References
16. 2 The Profession of Respiratory Therapy
    1. Introduction
    2. Scope of Respiratory Care Practice Today
    3. Practice Settings
    4. Respiratory Therapy Department Composition
    5. Designations and Credentials of Respiratory Therapists
    6. Professional Respiratory Care Organizations Today
    7. Other Organizations Affecting Respiratory Care
    8. Respiratory Therapy Education
    9. State Licensure
    10. Professionalism
    11. The Future of Respiratory Care
    12. Summary Checklist
    13. References
17. 3 Quality, Patient Safety, and Communication
    1. Quality Considerations
    2. Safety Considerations
    3. Communication
    4. Conflict and Conflict Resolution
    5. Summary Checklist
    6. References
18. 4 Principles of Infection Prevention and Control
    1. Spread of Infection
    2. Strategies for the Prevention of Infection
    3. Disinfection and Sterilization
    4. Equipment-Handling Procedures
    5. Surveillance for Hospital-Acquired Infections
    6. Summary Checklist
    7. References
19. 5 Ethical and Legal Implications of Practice
    1. Philosophical Foundations of Ethics
    2. Ethical Dilemmas of Practice
    3. Codes of Ethics
    4. Ethical Theories and Principles
    5. Ethical Viewpoints and Decision-Making
    6. Legal Issues Affecting Respiratory Care
    7. Interaction of Ethics and the Law
    8. Professional Licensure Issues
    9. Respiratory Therapists Who Speak Out About Wrongdoing
    10. Healthcare and Change
    11. Summary Checklist
    12. References
20. 6 Physical Principles of Respiratory Care
    1. States of Matter
    2. Change of State
    3. Gas Behavior Under Changing Conditions
    4. Fluid Dynamics
    5. Summary Checklist
    6. References
21. 7 E-Medicine in Respiratory Care
    1. The Electronic Health Record and the Electronic Medical Record
    2. Applications for Patient Care
    3. Informatics and Clinical Decision Support
    4. Telehealth and Telemonitoring
    5. Sources of Health Information
    6. Applications in Healthcare Administration
    7. Applications in Training and Education
    8. Future of E-Medicine
    9. Summary Checklist
    10. References
22. 8 Fundamentals of Respiratory Care Research
    1. Overview of Respiratory Care Research
    2. How to Review and Evaluate the Literature
    3. Evaluating the Quality of Research
    4. How to Begin Doing Research
    5. How to Submit a Paper for Publication
    6. Summary
    7. Summary Checklist
    8. References
23. Section II Applied Anatomy and Physiology
24. 9 The Respiratory System
    1. Development of the Respiratory System
    2. Transition From Uterine to Extrauterine Life
    3. Postnatal Lung Development
    4. Respiratory System in the Adult
    5. Pulmonary Vascular, Lymphatic, and Nervous Systems
    6. Anatomy of the Respiratory Tract
    7. Summary Checklist
    8. References
25. 10 The Cardiovascular System
    1. Functional Anatomy
    2. Control of the Cardiovascular System
    3. Events of the Cardiac Cycle
    4. Summary Checklist
    5. References
    6. Bibliography
26. 11 Ventilation
    1. Mechanics of Ventilation
    2. Static Versus Dynamic Mechanics
    3. Mechanics of Exhalation
    4. Work of Breathing
    5. Distribution of Ventilation
    6. Efficiency and Effectiveness of Ventilation
    7. Summary Checklist
    8. References
27. 12 Gas Exchange and Transport
    1. Diffusion
    2. Variations From Ideal Gas Exchange
    3. Oxygen Transport
    4. Carbon Dioxide Transport
    5. Abnormalities of Gas Exchange and Transport
    6. Summary Checklist
    7. References
28. 13 Solutions, Body Fluids, and Electrolytes
    1. Solutions, Colloids, and Suspensions
    2. Electrolytic Activity and Acid-Base Balance
    3. Body Fluids and Electrolytes
    4. Summary Checklist
    5. References
29. 14 Acid–Base Balance
    1. Hydrogen Ion Regulation in Body Fluids
    2. Acid Excretion
    3. Acid-Base Disturbances
    4. Clinical Acid-Base States
    5. Summary Checklist
    6. References
30. 15 Regulation of Breathing
    1. Medullary Respiratory Center
    2. Pontine Respiratory Centers
    3. Reflex Control of Breathing
    4. Chemical Control of Breathing
    5. Ventilatory Response to Exercise
    6. Carbon Dioxide and Cerebral Blood Flow
    7. Summary Checklist
    8. References
31. Section III Assessment of Respiratory Disorders
32. 16 Bedside Assessment of the Patient
    1. Interviewing the Patient and Taking a Medical History
    2. Physical Examination
    3. Summary Checklist
    4. References
    5. Bibliography
33. 17 Interpreting Clinical and Laboratory Data
    1. Interpreting Clinical Laboratory Tests
    2. Microbiology Tests
    3. Clinical Application of Laboratory Data
    4. Summary Checklist
    5. References
34. 18 Interpreting the Electrocardiogram
    1. Basic Principles of Electrophysiology
    2. Electrocardiogram Procedural Summary
    3. Summary Checklist
    4. References
35. 19 Analysis and Monitoring of Gas Exchange
    1. Invasive Versus Noninvasive Procedures
    2. Monitoring Fractional Inspired Oxygen
    3. Sampling and Analyzing Blood Gases
    4. Blood Gas Monitoring
    5. Oximetry
    6. Capnometry and Capnography
    7. Summary Checklist
    8. References
36. 20 Pulmonary Function Testing
    1. Pulmonary Function Testing
    2. Reference Values and Interpretation of Results
    3. Principles of Measurement and Significance
    4. Individual Tests and Measurements
    5. Interpretation of the Pulmonary Function Report
    6. Summary Checklist
    7. References
37. 21 Review of Thoracic Imaging
    1. Overview of the Chest X-Ray
    2. Pleura
    3. Lung Parenchyma
    4. Mediastinum
    5. Summary Checklist
    6. References
38. 22 Flexible Bronchoscopy and the Respiratory Therapist
    1. Flexible Bronchoscopy
    2. Diagnostic Bronchoscopy
    3. Therapeutic Bronchoscopy
    4. The Role of the Respiratory Therapist in Bronchoscopy
    5. Special Considerations for Bronchoscopy During Mechanical Ventilation
    6. Physiologic and Mechanical Alterations Associated With Flexible Bronchoscopy in Intubated Patients
    7. Emerging Bronchoscopic Interventions
    8. Conclusion
    9. Summary Checklist
    10. References
39. 23 Nutrition Assessment
    1. Nutrition Assessment
    2. Outcomes of Nutrition Assessment
    3. Macronutrients and Energy Requirements
    4. General Aspects of Nutrition Support
    5. Routes of Administration
    6. Nutrition Support in Specific Circumstances
    7. Summary Checklist
    8. References
40. Section IV Review of Cardiopulmonary Disease
41. 24 Pulmonary Infections
    1. Classification
    2. Pathogenesis
    3. Microbiology
    4. Clinical Manifestations
    5. Chest X-Ray
    6. Risk Factors for Mortality and Assessing the Need for Hospitalization
    7. Diagnostic Studies
    8. Antimicrobial Therapy
    9. Prevention
    10. Tuberculosis
    11. Role of the Respiratory Therapist in Pulmonary Infections
    12. Summary Checklist
    13. References
    14. 25 Obstructive Lung Disease
    15. Chronic Obstructive Pulmonary Disease
    16. Asthma
    17. Bronchiectasis
    18. Role of the Respiratory Therapist in Obstructive Lung Disease
    19. Summary Checklist
    20. References
42. 26 Interstitial Lung Disease
    1. Characteristics of Interstitial Lung Disease
    2. Selected Specific Types of Interstitial Lung Disease and Therapies
    3. Nonspecific Therapies
    4. Summary
    5. Role of the Respiratory Therapist in Interstitial Lung Disease
    6. Summary Checklist
    7. References
43. 27 Pleural Diseases
    1. The Pleural Space
    2. Pleural Effusions
    3. Pneumothorax
    4. Role of the Respiratory Therapist in Pleural Diseases
    5. Summary Checklist
    6. References
44. 28 Pulmonary Vascular Disease
    1. Venous Thromboembolic Disease
    2. Pulmonary Hypertension
    3. Role of the Respiratory Therapist in Pulmonary Vascular Disease
    4. Key Points
    5. References
45. 29 Acute Respiratory Distress Syndrome
    1. Physiology of Pulmonary Edema
    2. Definition and Diagnosis
    3. Key Features
    4. Therapeutic Approach
    5. Role of the Respiratory Therapist in Acute Respiratory Distress Syndrome
    6. Summary Checklist
    7. References
46. 30 Respiratory Management of Trauma, Obesity, Near Drowning, and Burns
    1. Life-Threatening Trauma
    2. Obesity
    3. Near Drowning
    4. Burns
    5. Summary Checklist
    6. References
47. 31 Acute Heart Failure
    1. Definition, Epidemiology, and Burden of Care
    2. Pathophysiology of Acute Heart Failure
    3. Medical Management of Acute Heart Failure
    4. Monitoring and Assessment of Cardiac Function
    5. Treatment
    6. Pharmacotherapy
    7. Alternative Interventions (Other Than Pharmacotherapy)
    8. Respiratory Support and Monitoring During Acute Heart Failure
    9. Summary Checklist
    10. References
48. 32 Lung Cancer
    1. Epidemiology
    2. Classification
    3. Pathophysiology
    4. Clinical Features
    5. Diagnosis
    6. Staging
    7. Preoperative Evaluation for Lung Resection Surgery
    8. Screening
    9. Treatment and Outcomes
    10. Future Scenario
    11. Role of the Respiratory Therapist in Managing Patients With Lung Cancer
    12. Summary Checklist
    13. References
49. 33 Neuromuscular and Other Diseases of the Chest Wall
    1. Pathophysiology and Pulmonary Function Testing
    2. Clinical Signs and Symptoms
    3. Monitoring and Assessing Patients With Neuromuscular Respiratory Weakness
    4. Management of Respiratory Muscle Weakness
    5. Specific Neuromuscular Diseases
    6. Disorders of the Thoracic Cage
    7. The Role of the Respiratory Therapist in Caring for Patients With Neuromuscular Weakness and Other Diseases of the Chest Wall
    8. Summary Checklist
    9. References
50. 34 Disorders of Sleep
    1. Pathophysiology
    2. Clinical Features
    3. Screening Questionnaires
    4. Laboratory Testing
    5. Treatment
    6. Role of the Respiratory Therapist in Disorders of Sleep
    7. Summary Checklist
    8. References
51. 35 Neonatal and Pediatric Respiratory Disorders
    1. Neonatal Respiratory Disorders
    2. Neonatal Resuscitation
    3. Pediatric Respiratory Disorders
    4. Role of the Respiratory Therapist in Neonatal and Pediatric Respiratory Disorders
    5. Summary Checklist
    6. References
52. Section V Basic Therapeutics
53. 36 Airway Pharmacology
    1. Principles of Pharmacology
    2. Adrenergic Bronchodilators
    3. Anticholinergic Bronchodilators
    4. Mucus-Controlling Agents
    5. Inhaled Corticosteroids
    6. Nonsteroidal Antiasthma Drugs
    7. Aerosolized AntiInfective Agents
    8. Inhaled Pulmonary Vasodilators
    9. Summary Checklist
    10. References
54. 37 Airway Management
    1. Suctioning
    2. Establishing an Artificial Airway
    3. Airway Trauma Associated With Tracheal Tubes
    4. Airway Maintenance
    5. Extubation or Decannulation
    6. Summary Checklist
    7. References
55. 38 Emergency Cardiovascular Life Support
    1. Causes and Prevention of Sudden Death
    2. Basic Life Support
    3. Advanced Cardiovascular Life Support
    4. Summary Checklist
    5. References
56. 39 Humidity and Bland Aerosol Therapy
    1. Humidity Therapy
    2. Bland Aerosol Therapy
    3. Selecting the Appropriate Therapy
    4. Summary Checklist
    5. References
57. 40 Aerosol Drug Therapy
    1. Characteristics of Therapeutic Aerosols
    2. Hazards of Aerosol Therapy
    3. Aerosol Drug Delivery Systems
    4. Assessment-Based Bronchodilator Therapy Protocols
    5. Special Considerations
    6. Controlling Environmental Contamination
    7. Summary Checklist
    8. References
58. 41 Storage and Delivery of Medical Gases
    1. Characteristics of Medical Gases
    2. Storage of Medical Gases
    3. Distribution and Regulation of Medical Gases
    4. Summary Checklist
    5. References
59. 42 Medical Gas Therapy
    1. Oxygen Therapy
    2. Hyperbaric Oxygen Therapy
    3. Other Medical Gas Therapies
    4. Summary Checklist
    5. References
60. 43 Lung Expansion Therapy
    1. Causes and Types of Atelectasis
    2. Clinical Signs of Atelectasis
    3. Lung Expansion Therapy
    4. Initiation of Therapy
    5. Selecting an Approach
    6. Summary Checklist
    7. References
61. 44 Airway Clearance Therapy
    1. Physiology of Airway Clearance Therapies
    2. General Goals and Indications
    3. Determining the Need for Airway Clearance Therapy
    4. Airway Clearance Methods
    5. Selecting Airway Clearance Techniques
    6. Summary Checklist
    7. References
62. Section VI Acute and Critical Care
63. 45 Respiratory Failure and the Need for Ventilatory Support
    1. Hypoxemic Respiratory Failure (Type I)
    2. Hypercapnic Respiratory Failure (Type II)
    3. Chronic Respiratory Failure (Type I and Type II)
    4. Assessment of Respiratory Fatigue, Weakness, Failure, and Work of Breathing
    5. Choosing a Ventilatory Support Strategy for Different Causes of Respiratory Failure
    6. Summary Checklist
    7. References
64. 46 Mechanical Ventilators
    1. How Ventilators Work
    2. Identifying Modes of Mechanical Ventilation
    3. Comparing Modes of Mechanical Ventilation
    4. Types of Ventilators
    5. Summary Checklist
    6. References
65. 47 Physiology of Ventilatory Support
    1. Pressure and Pressure Gradients
    2. Effects of Mechanical Ventilation on Ventilation
    3. Effects of Mechanical Ventilation on Oxygenation
    4. Effects of Positive Pressure Mechanical Ventilation on Lung Mechanics
    5. Minimizing Adverse Pulmonary Effects of Positive Pressure Mechanical Ventilation
    6. Physiologic Effects of Ventilatory Modes
    7. Cardiovascular Effects of Positive Pressure Mechanical Ventilation
    8. Minimizing Cardiovascular Effects of Positive Pressure Mechanical Ventilation
    9. Effects of Positive Pressure Mechanical Ventilation on Other Body Systems (Box 47.2)
    10. Complications of Mechanical Ventilation
    11. Summary Checklist
    12. References
66. 48 Patient–Ventilator Interactions
    1. Effects of Poor Patient–Ventilator Interaction on Outcome
    2. Causes of Poor Patient–Ventilator Interactions
    3. Variables Controlled During Mechanical Ventilation
    4. Types of Asynchrony
    5. Causes of Asynchrony
    6. Flow Asynchrony
    7. Trigger Asynchrony
    8. Cycle Asynchrony
    9. Mode Asynchrony
    10. Patient–Ventilator Assessment
    11. Summary Checklist
    12. References
67. 49 Initiating and Adjusting Invasive Ventilatory Support
    1. Goals of Mechanical Ventilation
    2. Ventilator Initiation
    3. Initial Ventilator Settings
    4. Adjusting Ventilatory Support
    5. Oxygenation
    6. Ventilation
    7. Summary Checklist
    8. References
68. 50 Noninvasive Ventilation
    1. History and Development of Noninvasive Ventilation
    2. Indications for Noninvasive Ventilation
    3. Selecting Appropriate Patients for Noninvasive Ventilation
    4. Equipment Used for Noninvasive Ventilation
    5. Management of Noninvasive Ventilation
    6. Complications of Noninvasive Ventilation
    7. Time and Costs Associated With Noninvasive Ventilation
    8. Summary Checklist
    9. References
69. 51 Extracorporeal Life Support
    1. The Respiratory Therapist as Extracorporeal Membrane Oxygenation Specialist
    2. International Registry
    3. Patients Receiving Extracorporeal Membrane Oxygenation
    4. Physiology
    5. Equipment
    6. Anticoagulation Management
    7. Cannulas
    8. Types of Support
    9. Initiation of Support
    10. Maintenance of an Extracorporeal Membrane Oxygenation Run
    11. Transporting a Patient on Extracorporeal Membrane Oxygenation
    12. Risks and Complications
    13. Blood Products During Extracorporeal Membrane Oxygenation
    14. Weaning and Decannulation
    15. Summary Checklist
    16. References
70. 52 Monitoring the Patient in the Intensive Care Unit
    1. Principles of Monitoring
    2. History
    3. Pathophysiology and Monitoring
    4. Monitoring Oxygenation
    5. Arterial Pulse Oximetry
    6. Oxygen Consumption
    7. Monitoring Ventilation
    8. Capnography
    9. Monitoring of Inspired and Exhaled Gas Volumes
    10. Peak and Plateau Pressures
    11. Mean Airway Pressure
    12. Driving Pressure
    13. Resistance
    14. Monitoring Lung and Chest Wall Mechanics
    15. Respiratory System Compliance
    16. Chest Wall Compliance
    17. Transpulmonary Pressure
    18. Lung Stress and Strain
    19. Monitoring the Patient–Ventilator System
    20. Stress Index
    21. Auto–Positive End-Expiratory Pressure (Intrinsic Positive End-Expiratory Pressure)
    22. Monitoring Breathing Effort and Patterns
    23. Lung Imaging at the Bedside
    24. Lung Ultrasound
    25. Electrical Impedance Tomography
    26. Cardiac and Cardiovascular Monitoring
    27. Electrocardiography
    28. Monitoring of Arterial Blood Pressure
    29. Monitoring of Central Venous Pressure–Right Atrial Pressure
    30. Monitoring of Pulmonary Artery Pressure
    31. Preload
    32. Contractility
    33. Afterload
    34. Cardiac Output
    35. Cardiac Muscle Injury
    36. Monitoring Renal Function
    37. Monitoring Liver Function
    38. Nutritional Monitoring
    39. Acute Physiology and Chronic Health Evaluation (APACHE)
    40. Neurologic Monitoring
    41. Troubleshooting
    42. Summary Checklist
    43. References
71. 53 Discontinuing Ventilatory Support
    1. Reasons for Ventilator Dependence
    2. Patient Evaluation
    3. Preparing the Patient
    4. Caregiver Preparation
    5. Methods
    6. Newer Techniques for Facilitating Ventilator Discontinuance
    7. Selecting an Approach
    8. Monitoring the Patient During Weaning
    9. Extubation
    10. Ventilator Discontinuance Failure
    11. Prolonged Mechanical Ventilation
    12. Chronically Ventilator-Dependent Patients
    13. Terminal Weaning
    14. Summary Checklist
    15. References
72. 54 Neonatal and Pediatric Respiratory Care
    1. Assessment of the Newborn
    2. Respiratory Care
    3. Continuous Positive Airway Pressure
    4. Mechanical Ventilation
    5. Specialty Gases
    6. Neonatal and Pediatric Transport
    7. Summary Checklist
    8. References
73. Section VII Patient Education and Long-Term Care
74. 55 Patient Education and Health Promotion
    1. Patient Education
    2. Teach Back or Echo Method
    3. Health Education
    4. Health Promotion and Disease Prevention
    5. Chronic Disease Management and Population Health
    6. Summary Checklist
    7. References
75. 56 Cardiopulmonary Rehabilitation
    1. Definitions and Goals
    2. Historical Perspective
    3. Physical and Psychosocial Basis
    4. Structure of a Pulmonary Rehabilitation Program
    5. Financial Considerations
    6. Cardiac Rehabilitation
    7. Conclusion
    8. Summary Checklist
    9. References
76. 57 Respiratory Care in Alternative Settings
    1. More Recent Developments and Trends
    2. Relevant Terms and Goals
    3. Standards
    4. Traditional Acute Care Versus Alternative Setting Care
    5. Discharge Planning
    6. Oxygen Therapy in Alternative Settings
    7. Ventilatory Support in Alternative Settings
    8. Other Modes of Respiratory Care in Alternative Sites
    9. Patient Assessment and Documentation
    10. Equipment Disinfection and Maintenance
    11. Summary Checklist
    12. References
77. 58 Ethics and the End of Life
    1. Introduction
    2. “Goals of Care” as an Essential Organizing Framework
    3. Management of Pain and Other Symptoms at the End of Life: Legal and Ethical Considerations
    4. Ethical Conflict at the End of Life
    5. The Respiratory Therapist as Ethical Practitioner
    6. Summary Checklist
    7. References
    8. Glossary
    9. A
    10. B
    11. C
    12. D
    13. E
    14. F
    15. G
    16. H
    17. I
    18. J
    19. K
    20. L
    21. M
    22. N
    23. O
    24. P
    25. Q
    26. R
    27. S
    28. T
    29. U
    30. V
    31. W
    32. X
    33. Z
    34. Index
    35. Abbreviations

Authors Biography

Robert Kacmarek

Affiliations and Expertise
Professor of Anesthesiology, Harvard Medical School; Director, Respiratory Care, Massachusetts General Hospital, Boston, MA

James Stoller

Affiliations and Expertise
Jean Wall Bennett Professor of Medicine, Cleveland Clinic,Cleveland Clinic Lerner College of Medicine Chair, Education Institute Cleveland Clinic

Al Heuer

Affiliations and Expertise
Program Director and Professor,Masters in Health Care Management Rutgers – School of Health Professions Newark