Your SlideShare is downloading. ×
0
Ed6305complete
Ed6305complete
Ed6305complete
Ed6305complete
Ed6305complete
Ed6305complete
Ed6305complete
Ed6305complete
Ed6305complete
Ed6305complete
Ed6305complete
Ed6305complete
Ed6305complete
Ed6305complete
Ed6305complete
Ed6305complete
Ed6305complete
Ed6305complete
Ed6305complete
Ed6305complete
Ed6305complete
Ed6305complete
Ed6305complete
Ed6305complete
Ed6305complete
Ed6305complete
Ed6305complete
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×
Saving this for later? Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime – even offline.
Text the download link to your phone
Standard text messaging rates apply

Ed6305complete

153

Published on

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total Views
153
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
7
Comments
0
Likes
0
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide
  • 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

    ×