In the last several years, Clinical Exercise Testing has become an increasingly important tool for patient evaluation in clinical medicine due to a growing awareness of the limitations of traditional resting cardiopulmonary measurements. Emphasizing scientific and technological advances and focusing on clinical applications for patient diagnosis and management, this volume provides a comprehensive interdisciplinary review of clinical exercise testing, concentrating on Cardiopulmonary Exercise Testing (CPET). 25 reader-friendly chapters discuss important topics, including the physiologic responses to exercise in normal subjects, in the aged and in various disease states; the set-up of an exercise lab; the methodology and protocols used for clinical exercise testing; and an integrative approach to the interpretation of CPET results. CPET in heart failure, deconditioning, COPD, ILD, pulmonary vascular disease, neuromuscular disease, and asthma is thoroughly discussed.
An emergency medical response plan, coupled with periodic emergency drills, should be in place in any facility that conducts clinical exercise testing.
In support of previously published guidelines and a recent AHA scientific statement, it is the consensus of this writing group that, in most cases, clinical exercise tests can be safely supervised by properly trained nonphysician health professionals if the individual supervising the test meets competency requirements for exercise test supervision, is fully trained in cardiopulmonary resuscitation, and is supported by a physician skilled in exercise testing or emergency medicine who is in close proximity for pretest assessments or complications that may arise.
The qualified nonphysician exercise test supervisor should secure and strive to maintain competencies consistent with his/her assigned duties, education, and credentialing. Preferably, this may be accomplished by maintaining active status with an appropriate professional credential and engaging in continuing education activities. These individuals also should interact with the medical director in jointly conducted clinical exercise tests and emergency drills. Maintenance of skills related to basic life support training also is essential, including use of an automated external defibrillator. The nonphysician delegate supervising any exercise test may be expected to activate a physician-directed emergency response when a need arises.
|Learning Outcomes (LO)||
Upon completion of this unit, students will be able to: