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Ed6305complete

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  • Pink puffers, blue bloaters
  • Introduce self, dept and announce you are there. What is the situation? Pt? Intubation: Bag, suction, ventilator
  • There are many more but these are the most obvious
  • First and most important controls to set for adequate ventilation are RR and Tidal volume VT set at 10ml/kg RR 8 to 12 breaths per minute
  • Oxygen should be set next 40-60% unless otherwise specified. PEEP Positive end expiration pressure at about 5-10 mg
  • Alphabet soup of mechanical vent,
  • Pt assessment includes vital signs, hemodynamics, breath sounds, sensorium etc.
  • Ventilatory wave forms can tell a lot about what’s happening a what to correct
  • ABG should show adequate oxygenation PFT should be within normal limits Verify that underlying disease process has been reversed
  • Pt may need to be reintubated,stridor treated with aerosol racemicepi.
  • Transcript

    • 1.
    • 2. Nothing else matters if you can’t breathe
    • 3. You are called stat to the ER
    • 4. You meet in the - ER
      First things first---
      What do you do?
      What do you know?
      What do you need?
    • 5. Respiratory Failure :
      Definition:
      “The inability to maintain either normal delivery of O2 to the tissues or the removal of CO2from the tissues”
    • 6. SIGNS and SYMPTOMS
      Patient will …..
      have an RR >28 bpm
      have a HR > 120 bpm
      be diaphoretic
      unable to speak in full sentences
      begin to tire
    • 7. Intubate and Ventilate
      Suction
      Bag
      Ventilate
      Intubate
    • 8. WHAT TO DO WHAT TO SET FIRST
      Delivery of Inspired
      O2
    • 9. Next Step
      FIO2
      AND
      PEEP
    • 10. MODES of MV
    • 11. PHASE II Monitoring and Assessing
      Monitor
      Adjusting - primary controls
      Correcting an ABG
      Adjusting – secondary controls
    • 12. Monitoring the patient
      Patient Assessment
      Hemodynamics
      Vital signs
    • 13. Adjusting ventilator controls
    • 14. Correcting an ABG
    • Adjusting Vent : Secondary ControlAKA fine tuning
      I:E ratio
      Adjust inspiratory plateau
      Positioning patient
      Adjust pressure support
      PEEP/CPAP therapy
      Calculate minimum flowrate
    • 28. Waveforms
    • 29. PHASE III –
      Weaning From The Ventilator
    • 30. Assessment for Weaning
      Decreasing Ventilator Settings
      Weaning Methods
    • 31. Assessment for Weaning
      ABG
      Bedside PFT
    • 32. Decrease Ventilator Settings
      Ventilator Settings : RR,FIO2,PEEP
      LOWEST POSSIBLE VENTILATOR SETTINGS
      SIMV/IMV 4 breaths
      FIO2 of 40%
      PEEP 0f 5cm H2O
    • 33. WEANING METHODS
      Traditional method/Trial and error/T-piece trial
      IMV/SIMV
      PSV
      IPAP support for difficult to wean
    • 34. Summary of adverse conditions
      ↑ HR by > 20 bpm
      Δ in Bp by 10-20 torr
      ↑ in PaCO2 by 10 torr
      RR ↑ 10 or > 30 bpm
      Stridor
    • 35. Chronically Ventilator-Dependent Patients
      23
      Definition:
      ventilator dependency remains following 3 months of weaning attempts.
      Once dependency established, goal is to restore highest level of independence.
    • 36. END of LIFE
      Terminal Weaning
    • 37.
      • Refers to weaning in the face of catastrophic and irreversible illness
      • 38. Decision is made by patient and/or family in consultation with physician.
      • 39. May be due to advanced directives, current patient decision, or very poor prognosis
    • SUMMARY
      3Phases of mechanical Ventilation:
      Phase 1 Initiating mechanical Ventilation
      Phase 2 Monitoring and adjusting ventilator
      Phase 3 Weaning and extubating from the ventilator