Respiratory Therapy Guides

A systematic approach to lung auscultation — the listening sequence, normal vesicular and bronchial sounds, and an adventitious-sounds table covering crackles, wheezes, rhonchi, stridor, and pleural rubs with their mechanisms and causes.

How the respiratory system is built and how it moves air: the conducting and respiratory zones, the alveolar-capillary membrane and surfactant, the pleura, the muscles of ventilation, and the pressures that drive every breath.

How oxygen moves from alveolus to mitochondria: diffusion across the alveolar-capillary membrane, the oxyhemoglobin dissociation curve and its shifts, oxygen content and delivery, and how carbon dioxide is carried back.

Why matching airflow to blood flow is the key to gas exchange: the normal V/Q ratio and its regional gradient, dead space versus shunt, hypoxic pulmonary vasoconstriction, and the five mechanisms of hypoxemia.

How the body regulates ventilation breath to breath: the medullary and pontine centers, central and peripheral chemoreceptors, the dominant role of CO₂ and pH, and the hypoxic drive that matters in chronic CO₂ retention.

A systematic bedside respiratory assessment: history and the cardinal symptoms, then inspection, palpation, percussion, and auscultation, plus the vital signs and work-of-breathing signs that flag a deteriorating patient.

Low-flow, high-flow, and reservoir oxygen devices compared — nasal cannula, simple and Venturi masks, partial and non-rebreathers, and HFNC — with flow rates, approximate FiO₂, and the bedside rules RTs use to pick the right one.

How to set SpO₂ targets, climb the oxygen escalation ladder, and recognize when a patient needs to step up — with the correct mechanism behind oxygen-induced hypercapnia in COPD and why you never withhold oxygen from a hypoxemic patient.

How heated, humidified high-flow nasal cannula works and where it fits — the flow, FiO₂, dead-space washout, and modest PEEP it delivers, the indications, the ROX index for tracking success, and how to set it up and wean it.

Oxygen is a drug with real harms — pulmonary and CNS oxygen toxicity, absorption atelectasis, oxygen-induced hypercapnia in COPD, retinopathy of prematurity, and fire risk — and the targeted SpO₂ strategy that avoids them.

The RT's role in endotracheal intubation — preparation and equipment, preoxygenation, assisting the laryngoscopy, gold-standard tube confirmation with waveform capnography, securing, and the immediate post-intubation checks.

The seven Ps of rapid sequence intubation — preparation through post-intubation management — with the induction agents and paralytics, the RT's preoxygenation and confirmation role, and the common pitfalls.

Endotracheal and tracheostomy suctioning the right way — open vs closed systems, suctioning only when indicated, catheter size and pressure limits, hyperoxygenation, and the complications to anticipate.

The airway side of extubation — the cuff-leak test, the extubation procedure, post-extubation stridor and laryngeal edema, racemic epinephrine, and when reintubation or NIV is the right call.

Predicting and preparing for the difficult airway — the LEMON and 3-3-2 assessment, Mallampati classes, the mask and supraglottic difficulty mnemonics, and where video laryngoscopy and rescue devices fit.

When the lungs can no longer oxygenate or ventilate - the difference between Type I (hypoxemic) and Type II (hypercapnic) failure, what causes each, how to recognize impending failure, and the escalation ladder from oxygen to HFNC to NIV to intubation.

The respiratory therapist in the adult code - high-quality CPR, the airway and ventilation sequence, the right ventilation rates with and without an advanced airway, how capnography confirms the tube and tracks CPR quality and ROSC, and why hyperventilation kills.

The poisoning a pulse oximeter cannot see - how carbon monoxide binds hemoglobin and left-shifts the curve, why SpO₂ reads falsely normal, the role of co-oximetry and 100% oxygen, and the airway threat of smoke inhalation and inhalation injury.

A breath-by-breath emergency - how air trapped under pressure collapses the lung and shifts the mediastinum, the signs that separate a simple from a tension pneumothorax, why it is a clinical (not radiographic) diagnosis, and the needle decompression and chest tube that fix it.

When the airway is closing - how to recognize anaphylaxis fast, why intramuscular epinephrine is the immediate first-line drug, the adjuncts (oxygen, nebulized epinephrine, bronchodilators, antihistamines, steroids), and the airway plan when angioedema threatens to obstruct.

How aerosolized drugs reach the lungs — respirable particle size, the deposition mechanisms, and the pMDI, DPI, nebulizer, and soft-mist devices with the technique each demands and how to match one to the patient.

The two bronchodilator families RTs give every shift — β₂-agonists (SABA and LABA) and antimuscarinics (SAMA and LAMA) — with mechanism, the rescue-vs-maintenance split, side effects, and what to monitor.

The controller side of inhaled therapy — inhaled corticosteroids, ICS/LABA combinations, and leukotriene modifiers — how they work over time, the rinse-and-spit that prevents thrush, and why they are never rescue drugs.

The drugs that thin, hydrate, or break down secretions — N-acetylcysteine, dornase alfa, hypertonic saline, and expectorants — how each works, the bronchospasm cautions, and why they pair with airway clearance.

The specialty inhaled agents RTs manage in the ICU — inhaled nitric oxide and prostacyclins, inhaled antibiotics, and racemic epinephrine — with how each works, the monitoring, and the withdrawal cautions.

How respiratory therapists read the complete blood count — the white count and differential, hemoglobin and hematocrit and their link to oxygen-carrying capacity, and the platelet count before invasive procedures.

The basic metabolic panel through a respiratory lens — sodium, potassium, chloride and bicarbonate, the anion gap, and how potassium, phosphate, and magnesium affect respiratory muscle strength and weaning.

What a lactate tells the respiratory therapist — anaerobic metabolism and the oxygen-delivery/demand balance, type A versus type B lactic acidosis, the sepsis thresholds, and lactate clearance as a resuscitation target.

The biomarkers that help separate a cardiac from a pulmonary cause of dyspnea — BNP and NT-proBNP for heart failure, troponin for myocardial injury and right-heart strain, and D-dimer for venous thromboembolism.

Reading the respiratory micro lab — judging specimen quality on the Gram stain, recognizing the common pathogens by clinical setting, and understanding the culture, sensitivity, and acid-fast workup that guide antibiotic therapy.

A respiratory therapist's systematic approach to the chest radiograph — confirming tube and line placement after intubation, and recognizing the common patterns of consolidation, atelectasis, pneumothorax, effusion, and pulmonary edema.

The coagulation labs to check before an invasive respiratory procedure — PT/INR, aPTT, and the platelet count — what they measure, the anticoagulants that affect them, and the bedside thresholds for arterial puncture, bronchoscopy, and chest tubes.

Why a pulse oximeter cannot see carbon monoxide or methemoglobin, and how laboratory co-oximetry measures the true hemoglobin species — carboxyhemoglobin, methemoglobin, and sulfhemoglobin — to expose a saturation gap and guide treatment.

The point-of-care testing respiratory therapists own — bedside blood gas and co-oximetry analyzers — and the quality assurance that keeps results trustworthy: calibration, quality control, proficiency testing, and avoiding pre-analytic errors.

Making sense of a thoracentesis result — Light's criteria for separating a transudate from an exudate, and the pleural fluid pH, glucose, LDH, and cell counts that identify a complicated effusion needing drainage.

A systematic rate-rhythm-axis approach to the ECG for respiratory therapists, then the board-tested rhythm set — from sinus tach and atrial fibrillation to VT, VF, PEA, the AV blocks, and paced rhythms.

Surfactant-deficient lung disease of the premature newborn - why RDS happens, how it looks on exam and X-ray, and the modern management ladder of antenatal steroids, early CPAP, and surfactant (INSURE and LISA).

The delivery-room sequence every RT should own - the Golden Minute, the initial steps, effective positive-pressure ventilation and MR SOPA, when to escalate to compressions and epinephrine, and how oxygen is targeted in the newborn.

How children differ from adults - the anatomic and physiologic features that make them desaturate faster - plus the signs of respiratory distress, normal vitals by age, and the progression from distress to failure to arrest.

The most common lower-respiratory infection in infants - how RSV bronchiolitis presents, the evidence-based supportive approach (and what not to do), the role of high-flow nasal cannula and CPAP, and the apnea and red-flag signs that demand escalation.

Stridor in a child - the spectrum of upper-airway obstruction from viral croup to epiglottitis and bacterial tracheitis, how to grade severity, and the management that turns it around: keep the child calm, racemic epinephrine, and corticosteroids.

How to obtain an arterial blood gas sample — site selection, the modified Allen test, technique, and the pre-analytic errors that ruin a result.

How pulse oximetry works and where it fails — the two-wavelength principle, accuracy limits, and why carbon monoxide and methemoglobin demand co-oximetry.

Chest physiotherapy and airway clearance techniques — postural drainage, percussion, PEP, oscillatory devices, and HFCWO — with indications and key contraindications.

Incentive spirometry and lung expansion therapy for atelectasis — correct sustained-maximal-inspiration technique, indications, and when to use IPPB or CPAP instead.

Manual resuscitation with a bag-valve-mask — bag types, mask seal, oxygen delivery, rate and volume, and avoiding the harm of over-ventilation.

Routine and emergency tracheostomy care — inner cannula and stoma care, cuff pressure, humidification, securing the tube, and the decannulation emergency.

Humidity and bland aerosol therapy — humidifiers versus aerosol generators, when a bypassed airway must be humidified, and the bronchospasm risk of hypertonic saline.

Bedside respiratory measurements that guide weaning — vital capacity, MIP/NIF, MEP, minute ventilation, and the rapid shallow breathing index, with their thresholds.

Sputum induction and specimen collection — expectorated versus induced samples, hypertonic-saline technique, specimen quality, and airborne precautions for suspected TB.

Infection prevention in respiratory care — hand hygiene, transmission-based precautions, aerosol-generating procedures, equipment processing, and the VAP bundle.

How respiratory care equipment is reprocessed — the Spaulding classification, the cleaning-disinfection-sterilization hierarchy, and the specific agents and methods (glutaraldehyde, OPA, ethylene oxide, autoclave, pasteurization) used to make reusable devices safe between patients.

The safety hazards unique to respiratory care and how to control them — the oxygen-enriched fire triangle and the RACE and PASS responses, electrical macroshock versus microshock and leakage current, and safe compressed-gas cylinder handling and storage.