Nothing else matters if you can’t  breathe<br />
You are called stat to the ER<br />
You meet in the - ER<br />First things first---<br />What do you do?<br /> What do you know?<br /> What do you need?<br />
Respiratory Failure :<br />Definition:<br />“The inability to maintain either normal delivery of O2 to the tissues or the ...
SIGNS and SYMPTOMS<br />Patient will …..<br />have an RR >28 bpm<br />have a HR > 120 bpm<br /> be diaphoretic<br />unable...
Intubate and Ventilate<br />Suction<br />    Bag<br />Ventilate<br />Intubate<br />
WHAT TO DO WHAT TO SET FIRST<br />Delivery of Inspired<br />                   O2<br />
Next Step<br />FIO2<br />AND<br />PEEP<br />
MODES of MV<br />
PHASE II Monitoring and Assessing<br />Monitor<br />Adjusting - primary controls<br />Correcting an ABG<br />Adjusting – s...
Monitoring the patient<br />Patient Assessment<br />Hemodynamics<br />Vital signs<br />
Adjusting ventilator controls<br />
Correcting an ABG<br /><ul><li>To normalize a high PaCO2
↓ or remove deadspace
↑ Vt
↑ f
To normalize a low PaCO2
↑Deadspace
↓ f
↓ Vt
Increase a low PaO2
FIRST -↑ FiO2 by 5-10% up to 60%
THEN - ↑ PEEP by 5
Decrease a high PaO2
FIRST - ↓ FiO2 to < 60%
THEN  -↓ PEEP</li></li></ul><li>Adjusting Vent : Secondary ControlAKA fine tuning<br />I:E ratio<br />Adjust inspiratory p...
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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.
  • Ed6305complete

    1. 1.
    2. 2. Nothing else matters if you can’t breathe<br />
    3. 3. You are called stat to the ER<br />
    4. 4. You meet in the - ER<br />First things first---<br />What do you do?<br /> What do you know?<br /> What do you need?<br />
    5. 5. Respiratory Failure :<br />Definition:<br />“The inability to maintain either normal delivery of O2 to the tissues or the removal of CO2from the tissues”<br />
    6. 6. SIGNS and SYMPTOMS<br />Patient will …..<br />have an RR >28 bpm<br />have a HR > 120 bpm<br /> be diaphoretic<br />unable to speak in full sentences<br />begin to tire<br />
    7. 7. Intubate and Ventilate<br />Suction<br /> Bag<br />Ventilate<br />Intubate<br />
    8. 8. WHAT TO DO WHAT TO SET FIRST<br />Delivery of Inspired<br /> O2<br />
    9. 9. Next Step<br />FIO2<br />AND<br />PEEP<br />
    10. 10. MODES of MV<br />
    11. 11. PHASE II Monitoring and Assessing<br />Monitor<br />Adjusting - primary controls<br />Correcting an ABG<br />Adjusting – secondary controls<br />
    12. 12. Monitoring the patient<br />Patient Assessment<br />Hemodynamics<br />Vital signs<br />
    13. 13. Adjusting ventilator controls<br />
    14. 14. Correcting an ABG<br /><ul><li>To normalize a high PaCO2
    15. 15. ↓ or remove deadspace
    16. 16. ↑ Vt
    17. 17. ↑ f
    18. 18. To normalize a low PaCO2
    19. 19. ↑Deadspace
    20. 20. ↓ f
    21. 21. ↓ Vt
    22. 22. Increase a low PaO2
    23. 23. FIRST -↑ FiO2 by 5-10% up to 60%
    24. 24. THEN - ↑ PEEP by 5
    25. 25. Decrease a high PaO2
    26. 26. FIRST - ↓ FiO2 to < 60%
    27. 27. THEN -↓ PEEP</li></li></ul><li>Adjusting Vent : Secondary ControlAKA fine tuning<br />I:E ratio<br />Adjust inspiratory plateau<br />Positioning patient<br />Adjust pressure support<br />PEEP/CPAP therapy<br />Calculate minimum flowrate<br />
    28. 28. Waveforms<br />
    29. 29. PHASE III – <br /> Weaning From The Ventilator <br />
    30. 30. Assessment for Weaning<br />Decreasing Ventilator Settings<br />Weaning Methods<br />
    31. 31. Assessment for Weaning<br />ABG<br />Bedside PFT <br />
    32. 32. Decrease Ventilator Settings<br />Ventilator Settings : RR,FIO2,PEEP<br />LOWEST POSSIBLE VENTILATOR SETTINGS<br />SIMV/IMV 4 breaths<br />FIO2 of 40% <br />PEEP 0f 5cm H2O<br />
    33. 33. WEANING METHODS<br />Traditional method/Trial and error/T-piece trial<br />IMV/SIMV<br />PSV<br />IPAP support for difficult to wean<br />
    34. 34. Summary of adverse conditions<br />↑ HR by > 20 bpm<br />Δ in Bp by 10-20 torr<br />↑ in PaCO2 by 10 torr<br />RR ↑ 10 or > 30 bpm<br />Stridor<br />
    35. 35. Chronically Ventilator-Dependent Patients<br />23<br />Definition:<br />ventilator dependency remains following 3 months of weaning attempts.<br />Once dependency established, goal is to restore highest level of independence.<br />
    36. 36. END of LIFE<br />Terminal Weaning<br />
    37. 37. <ul><li>Refers to weaning in the face of catastrophic and irreversible illness
    38. 38. Decision is made by patient and/or family in consultation with physician.
    39. 39. May be due to advanced directives, current patient decision, or very poor prognosis</li></li></ul><li>SUMMARY<br />3Phases of mechanical Ventilation:<br />Phase 1 Initiating mechanical Ventilation<br />Phase 2 Monitoring and adjusting ventilator<br />Phase 3 Weaning and extubating from the ventilator<br />

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