Patient Data
36%of exam
Equipment + Infection Control
14%of exam
Interventions
50%of exam
Quick Facts
- Exam
- TMC
- Credential
- CRT
- Questions
- 160 total
- Scored
- 140 scored
- Time
- 3 hours
- Pass
- Low cut = CRT
- High cut
- CSE eligibility
- Fee
- $190 new
- Repeat
- $150 repeat
- Retakes
- 3 then 120 days
- 2027
- RT exam replaces TMC
ROME
Respiratory opposite, metabolic equal.
Resp oppositeMetabolic equalpH first
CRT vs RRT Path
CRT
- TMC low cut
- Credential awarded
RRT path
- TMC high cut
- Then CSE
High cut is eligibility
Data Picker
- Need acid-base→ABG
- Need oxygen trend→Pulse ox
- Need ventilation trend→Capnography
- Need airway position→Chest x-ray
- Need obstruction pattern→Spirometry
- Need preload status→Hemodynamics
Exam Structure
- TMC
- Therapist Multiple-Choice
- CRT
- Low cut score
- RRT path
- High cut + CSE
- Scored items
- 140 count
- Pretest items
- 20 unscored
- Time pace
- 68 sec/item
- New attempt
- $190
- Repeat attempt
- $150
Oxygenation vs Ventilation
Oxygenation
- PaO2/SaO2 problem
- FiO2/PEEP fix
Ventilation
- PaCO2 problem
- Minute ventilation fix
O2 is not CO2
ABG Basics
- pH
- 7.35-7.45
- PaCO2
- 35-45 mmHg
- HCO3
- 22-26 mEq/L
- PaO2
- 80-100 mmHg
- SaO2
- 95-100%
- Acidemia
- pH below 7.35
- Alkalemia
- pH above 7.45
- ROME
- Resp opposite, metabolic equal
Obstructive vs Restrictive
Obstructive
- Low FEV1/FVC
- Air trapping
Restrictive
- Low TLC
- Small volumes
Ratio separates patterns
Oxygenation
- P/F ratio
- PaO2 / FiO2
- Mild ARDS
- P/F 200-300
- Moderate ARDS
- P/F 100-200
- Severe ARDS
- P/F below 100
- A-a gradient
- Gas exchange gap
- CaO2
- Hb drives content
- COHb
- False normal SpO2
- MetHb
- SpO2 near 85%
Assessment
- Dyspnea
- Work of breathing
- Accessory use
- Respiratory distress
- Cyanosis
- Late hypoxemia sign
- Clubbing
- Chronic hypoxemia
- Tracheal shift
- Pressure or collapse
- Fremitus
- Vibration through chest
- Crepitus
- Subcutaneous air
- Pulsus paradoxus
- Severe obstruction
Imaging
- Pneumothorax
- No lung markings
- Tension PTX
- Shift away
- Atelectasis
- Volume loss
- Pneumonia
- Air bronchograms
- Pleural effusion
- Meniscus sign
- Pulmonary edema
- Bat-wing pattern
- ARDS
- Bilateral infiltrates
- ETT tip
- 2-6 cm above carina
PFT + Monitoring
- Obstruction
- Low FEV1/FVC
- Restriction
- Low TLC
- Reversibility
- Bronchodilator response
- DLCO low
- Diffusion impairment
- EtCO2
- Ventilation trend
- CVP
- Right preload
- PCWP
- Left preload
- RSBI
- f / VT
DOPE
Sudden vent crash: check DOPE.
DisplacementObstructionPneumothoraxEquipment
PIP vs Plateau
PIP
- Resistance + compliance
- Rises with secretions
Plateau
- Compliance only
- Rises with stiff lungs
Subtract to find resistance
Troubleshooting Picker
- High pressure alarm→Check secretions
- Low pressure alarm→Check disconnect
- SpO2 suddenly drops→Check patient/circuit
- Analyzer reads wrong→Recalibrate
- Cylinder near empty→Replace tank
- Bronchoscope reuse→High-level disinfection
Oxygen Devices
- Nasal cannula
- Low-flow oxygen
- Simple mask
- Moderate FiO2
- Venturi
- Precise FiO2
- NRB
- High FiO2
- HFNC
- Flow + FiO2
- CPAP
- Continuous pressure
- BiPAP
- IPAP + EPAP
- Reservoir bag
- Prevent collapse
Contact vs Droplet
Contact
- Touch spread
- Gown + gloves
Droplet
- Large respiratory drops
- Surgical mask
TB is airborne
Equipment Troubleshooting
- High pressure
- Resistance or compliance
- Low pressure
- Disconnect or leak
- High PIP only
- Airway resistance
- High plateau
- Low compliance
- Auto-PEEP
- Air trapping
- Circuit leak
- Low exhaled VT
- Dead battery
- No analyzer reading
- Sensor drift
- Recalibrate or replace
Low Flow vs High Flow
Low flow
- Patient entrains air
- Variable FiO2
High flow
- Meets inspiratory demand
- Controlled FiO2
Venturi controls FiO2
Quality Control
- O2 analyzer
- Room air + source
- Room air
- 21% calibration
- Source oxygen
- 100% calibration
- ABG analyzer
- Daily QC
- Spirometer
- 3-L syringe
- Levey-Jennings
- QC trend chart
- Westgard
- QC rejection rules
- E cylinder
- Factor 0.28
Infection Control
- Standard
- All patient care
- Contact
- Gown + gloves
- Droplet
- Surgical mask
- Airborne
- N95 + AIIR
- TB
- Airborne precautions
- MRSA
- Contact precautions
- Influenza
- Droplet precautions
- C. diff
- Soap and water
SODA
Secretions need suction, oxygen, depth, airway.
SuctionOxygenateDepthAirway
CPAP vs BiPAP
CPAP
- One pressure
- Oxygenation support
BiPAP
- Two pressures
- Ventilation support
IPAP changes CO2
Intervention Picker
- COPD hypercapnia→BiPAP(If tolerated)
- Severe hypoxemia→Increase FiO2/PEEP
- Thick secretions→Suction + humidity
- Atelectasis→Lung expansion
- Bronchospasm→Bronchodilator
- ARDS refractory→Prone positioning
- Apnea→BVM/intubation
- Home hypoxemia→Long-term oxygen
Airway Care
- OPA
- Unconscious patient
- NPA
- Gag reflex present
- ETT cuff
- 20-30 cmH2O
- Adult ETT
- 7.0-8.5 mm
- Suction pressure
- Adults 100-150 mmHg
- Trach valve
- Cuff deflated first
- False passage
- Subcutaneous emphysema
- Extubation
- Leak + SBT ready
COPD Target
COPD oxygen target: 88 to 92.
Avoid hyperoxiaCheck ABGTitrate oxygen
Vent Change Picker
- PaCO2 high→Increase Ve
- PaCO2 low→Decrease Ve
- PaO2 low→Increase FiO2/PEEP
- Plateau high→Decrease VT
- Auto-PEEP present→Lengthen exhalation
- Dyssynchrony persists→Assess trigger/flow
Ventilation
- AC/VC
- Set VT
- AC/PC
- Set pressure
- SIMV
- Mandatory + spontaneous
- PSV
- Spontaneous support
- PRVC
- Volume-targeted pressure
- PEEP
- Raises FRC
- Plateau
- Alveolar pressure
- Driving pressure
- Plateau minus PEEP
Vent Targets
- ARDS VT
- 6 mL/kg IBW
- Plateau limit
- 30 cmH2O or less
- Driving target
- Below 15 cmH2O
- Initial PEEP
- 5 cmH2O
- Hypercapnia
- Increase minute ventilation
- Hypoxemia
- Increase FiO2/PEEP
- COPD SpO2
- 88-92%
- SBT pass
- Stable oxygenation
Meds + Gases
- Albuterol
- Beta-2 bronchodilator
- Ipratropium
- Anticholinergic bronchodilator
- Steroids
- Reduce inflammation
- Mucolytics
- Thin secretions
- Racemic epi
- Upper-airway edema
- Surfactant
- Neonatal RDS
- Heliox
- Lower gas density
- iNO
- Pulmonary vasodilator
Home + Emergency
- Home O2
- PaO2 <=55
- SpO2 criterion
- 88% or less
- BVM
- Immediate ventilation
- VF/pVT
- Defibrillate
- PE shock
- Thrombolysis consideration
- Chest tube
- Water seal drainage
- Transport vent
- Disconnect alarm essential
- Palliative dyspnea
- Opioids + positioning
Common Traps
Low Cut vs High Cut
Low cut earns CRT ≠ High cut opens CSE
SpO2 vs SaO2
SpO2 is estimated ≠ SaO2 is measured
PaO2 vs CaO2
PaO2 is dissolved ≠ CaO2 depends on hemoglobin
PIP vs Plateau
PIP includes resistance ≠ Plateau reflects compliance
Hypoxemia vs Hypercapnia
Hypoxemia needs FiO2/PEEP ≠ Hypercapnia needs ventilation
COPD Oxygen Trap
Do not chase 100% ≠ Target 88-92%
Airborne vs Droplet
TB needs N95 ≠ Flu needs mask
Pretest vs Scored
20 are unscored ≠ Answer all 160
Last Minute
- 1.TMC: 160 items, 3 hours
- 2.140 scored, 20 pretest
- 3.Low cut earns CRT
- 4.High cut opens CSE
- 5.Domains: 36/14/50
- 6.ABG: pH first
- 7.Oxygenation: FiO2 or PEEP
- 8.Ventilation: RR or VT
- 9.PIP-plateau = resistance
- 10.Plateau <=30 in ARDS
- 11.COPD target 88-92%
- 12.Home O2: SpO2 <=88%
- 13.ETT cuff 20-30
- 14.TB = airborne + N95
- 15.E tank factor 0.28
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