1. The document discusses various modes of mechanical ventilation including volume control, pressure control, SIMV, and PSV. It describes the settings, parameters, and considerations for each mode.
2. Initial ventilator settings should aim for adequate oxygenation and ventilation while minimizing work of breathing. Settings like tidal volume, respiratory rate, and PEEP are adjusted based on factors like patient size and condition.
3. Weaning from mechanical ventilation involves gradually reducing support through methods like spontaneous breathing trials, decreasing SIMV frequency, and lowering pressure support levels to assess the patient's ability to breathe independently. Readiness criteria and a stepwise protocol are
An excellent tool to treat refractory hypoxia. Target audience are ICU junior physicians and Respiratory Therapists. It will take away the fear of "What is APRV?" from your hearts and you will feel ready to give it a try.
An excellent tool to treat refractory hypoxia. Target audience are ICU junior physicians and Respiratory Therapists. It will take away the fear of "What is APRV?" from your hearts and you will feel ready to give it a try.
Patient ventilator interactions during mechanical ventilationDr.Mahmoud Abbas
Patient Ventilator Interaction during Mechanical Ventilation lecture presented by Dr.Lluis Blanch at Pulmonary Critical Care Egypt Meeting and Exhibition, January 2014. www.pccmegypt.com
Basic information on the Graphics displayed on the Ventilators. Prepared to educate about the graphics to train the professionals who work with Ventilators.
Non-invasive ventilation (NIV) is the use of breathing support administered through a face mask or nasal mask. Learn more about NIV in this presentation by Dr Somnath Longani, consultant Anaesthesiologist & Intensivist, Midland Healthcare & Research Center, lucknow
https://midlandhealthcare.org/
These slides represent how to manage patients on a mechanical ventilator? Easy understanding of using ventilators. indication of mechanical ventilator use. How to wean a patient from a mechanical ventilator? How to fine-tune the ventilator settings?
Critically ill patients requiring noninvasive or invasive ventilation often present to emergency departments, and due to hospital crowding and constrained critical care services, may remain in the emergency department for a prolonged duration. Compared with their intensive care unit counterparts, emergency department clinicians may have variable exposure to management of this patient population and may lack knowledge and expertise, particularly in their
longitudinal management beyond initial stabilization. This
review has discussed several key aspects of management
of noninvasive and invasive ventilation, with a particular emphasis on initiation and ongoing monitoring priorities,
and focused on maintaining patient safety and improving
patient outcomes.
Patient ventilator interactions during mechanical ventilationDr.Mahmoud Abbas
Patient Ventilator Interaction during Mechanical Ventilation lecture presented by Dr.Lluis Blanch at Pulmonary Critical Care Egypt Meeting and Exhibition, January 2014. www.pccmegypt.com
Basic information on the Graphics displayed on the Ventilators. Prepared to educate about the graphics to train the professionals who work with Ventilators.
Non-invasive ventilation (NIV) is the use of breathing support administered through a face mask or nasal mask. Learn more about NIV in this presentation by Dr Somnath Longani, consultant Anaesthesiologist & Intensivist, Midland Healthcare & Research Center, lucknow
https://midlandhealthcare.org/
These slides represent how to manage patients on a mechanical ventilator? Easy understanding of using ventilators. indication of mechanical ventilator use. How to wean a patient from a mechanical ventilator? How to fine-tune the ventilator settings?
Critically ill patients requiring noninvasive or invasive ventilation often present to emergency departments, and due to hospital crowding and constrained critical care services, may remain in the emergency department for a prolonged duration. Compared with their intensive care unit counterparts, emergency department clinicians may have variable exposure to management of this patient population and may lack knowledge and expertise, particularly in their
longitudinal management beyond initial stabilization. This
review has discussed several key aspects of management
of noninvasive and invasive ventilation, with a particular emphasis on initiation and ongoing monitoring priorities,
and focused on maintaining patient safety and improving
patient outcomes.
Inadequate respiratory drive
Inability to maintain adequate alveolar ventilation
Hypoxia
Decision to provide MV should be based on clinical examination and assessment of gas exchange by blood gas analysis. The principal goal of MV in the setting of respiratory failure is to support gas exchange while underlying diseased process is reversed.
This slide include information regarding ventilators, modes of ventilators , its parts, weaning process, nursing care of patient in mechanical ventilation.
Weaning and Discontinuing Ventilatory Supporthanaa
1) The epidemiology of weaning
2) Evidence-based weaning guidelines
3) The pathophysiology of weaning failure
4) Is there a role for different ventilator modes in weaning?
Weaning from mechanical ventilation , also called ventilator liberation, refers to the process of the patient assuming more and more of the work of breathing and finally demonstrating that ventilator support is no longer required.
Simply it means the process of withdrawing mechanical ventilatory support and transferring the work of breathing from the ventilator to the patient . Weaning can be accomplished with an endotrachel tube ( ETT) or a tracheostomy tube in place.
In the case of the ETT, the final step in the process is the removal of the tube( extubation). With a tracheostomy, the final step may be the ability to breath spontaneously for a designated period of time with the tube in place.
Weaning success is defined as absence of ventilatory support 48 hours following the extubation.
While the spontaneous breaths are unassisted by mechanical ventilation, supplemental oxygen, bronchodilators, low level pressure support ventilation or continuous positive airway pressure (CPAP) may be used to support and maintain adequate spontaneous ventilation and oxygenation.
Purpose
The purpose is to assess the probability that mechanical ventilation can be successfully discontinued.as
75% of mechanically ventilated patients are easy to be weaned off the ventilator with simple process.
10-15% of patients require a use of a weaning protocol over a 24-72 hours.
5-10% require a prolonged weaning plan.
1% of patients become dependent on chronic mechanical ventilation.
Indication
Improvement of the cause of respiratory failure.
Absence of major system dysfunction.
Appropriate level of oxygenation.
Adequate ventilatory status.
Intact airway protective mechanism.
Contraindication
Altered sensorium either drowsiness or restlessness.
Spo2 ˂90%
Rising PaCO2 with drop in PH
Tachypnoea ˃35/ min
Tachycardia ˃120 /min
Drop in systolic blood pressure
Sweating
Cold clammy skin
Signs of diaphragmatic weakness
Paradoxical abdominal wall movement
Assessment of readiness for weaning
Hemodynamic stability
Minimum inotropic support
Adequate cardiac output
Afebrile
Hematocrite greater than 25%
Respiratory stability
Improved chest x-ray
Arterial oxygen tension (PaO2) greater than 60mm Hg with fraction of inspired oxygen ( FiO2) less than 0.5
PaO2/FiO2 greater than 300 mm Hg
Positive end expiratory pressure (PEEP) less than 0-5 cm H2O
Vital capacity (VC) 10-15ml/kg
Spontaneous tidal volume (VT) 5ml/Kg
Respiratory rate less than 30 breaths/mim
Minute ventilation 5-10 L/min
Negative inspiratory pressure greater than -20cm H2O
Rapid shallow breathing index (RSBI) less than 105
metabolic factors stable
Electrolytes within normal range.
ABGs( Arterial blood gases) normalized
Other
Adequate management of pain and anxiety.
Patient is well rested
Weaning criteria
Weaning criteria are used to evaluate the readiness of a patient for a weaning trial and the likelihood of weaning success.
Clinical criteria
Ventilatory criteria
Oxygenation criteria
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
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Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
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Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
1. Dr. Sangeeta Dhanger
Assistant Professor
Department of Anaesthesiology
and Critical Care
IGMC & RI
Puducherry
BASIC MODES OF
MECHANICAL
VENTILATION
2. What should we know?
• Need for mechanical ventilation?
• Type of mechanical ventilation?
• Modes of mechanical ventilation?
• Initial setting of ventilator?
• Weaning from ventilator?
3. Need for mechanical ventilation?
•Assessment of patient for respiratory
distress:
•Patient’s level of consciousness.
•Appearance and texture of the patient’s skin?
•Nail beds or lips for evidence of cyanosis?
•Pale and diaphoretic (sweating)?
•Patient’s vital signs
6. Need for mechanical ventilation?
Aim:
1. Adequacy of oxygenation and ventilation
2. Decrease WOB
3. Increase Patients comfort
4. Synchrony with the ventilator
7. Parts of Ventilator
1. Power source
2. Control system
3. Control panel
4. Patient’s circuit
5. Adjuncts to the patient’s circuit
6. Gas supply system
11. •Resistance :
•The frictional forces that must be overcome during
breathing.
•Depends on the gas viscosity, gas density, the
length and diameter of the tube, and the flow rate
of the gas through the tube
Raw=(PIP−Pplateau)/ Flow
• High on intubated patients
12. Compliance
• Described as the relative ease with which the structure distends.
• Normal compliance
• Spontaneously breathing patients: 50 to 170 mL/cm H2O
• Intubated patients: 40 to 50 mL/cm H2O.
• Static Compliance:
• Reflects the elastic resistance of the lung and chest wall
• Dynamic Compliance:
• Reflects the condition of airway resistance (nonelastic resistance)
14. • Plateau pressure:
• The pressure needed to maintain lung inflation in the absence of
airflow.
• Measured by inspiratory hold.
• Peak inspiratory pressure:
• The pressure used to deliver the tidal volume by overcoming nonelastic
(airways) and elastic (lung parenchyma) resistance.
• Highest pressure during inspiration.
15. • Positive end-expiratory pressure(PEEP):
• Operator selects a higher pressure to be present at the end of
exhalation.
• Ventilator prevents the patient from exhaling to zero (atmospheric
pressure).
• PEEP therefore increases the volume of gas remaining in the lungs at
the end of a normal exhalation and
19. Indications :
• At least two of the following factors should be present:
• Respiratory rate >25 breaths/min
• Moderate to severe acidosis: pH, 7.25 to 7.30; PaCO2, 45 to 60 mm Hg
• Moderate to severe dyspnea with use of accessory muscles and
paradoxical breathing pattern
Contraindications:
• Upper airway obstruction
• Inability to protect the airway
• Inability to clear secretions
• Facial or head surgery or trauma
• Cardiovascular instability
• Uncooperative patient
21. Noninvasive Ventilation
There are two methods
• Continuous positive airway pressure (CPAP)
• Provides positive airway pressure during spontaneous
breaths and it does not include any mechanical breaths
• Bilevel positive airway pressure(BiPAP): Has two
pressure levels
• Inspiratory positive airway pressure (IPAP) setting that
provides mechanical breaths and
• Expiratory positive airway pressure (EPAP) level that
functions as positive end-expiratory pressure
(PEEP).
22. Circumstances in Which Noninvasive Positive
Pressure Ventilation Should Be Changed to Invasive
Ventilation
• Respiratory arrest
• Respiratory rate >35 breaths/min
• Severe dyspnea with use of accessory muscles and paradoxical breathing
• Life-threatening hypoxemia: PaO2 < 40 mm Hg or PaO2/FIO2 < 200
• Severe acidosis (pH <7.25) and hypercapnia (PaCO2 >60 mm Hg)
• Cardiovascular complications (hypotension, shock, heart failure)
• Failure of noninvasive positive pressure ventilation
25. Volume Control:
• It guarantees a specific volume delivery, regardless of
changes in lung compliance and resistance or patient effort.
• The goal of volume-targeted ventilation is to maintain a
certain level of PaCO2.
• Factors That affect Pressures During Volume-Controlled
Ventilation :
• Patient Lung Characteristics
• Inspiratory Flow Pattern
• Volume Setting
• Positive End-Expiratory Pressure (PEEP)
• Auto-PEEP
26. Pressure control:
• Allows to set a maximum pressure, which reduces the risk of
over distention of the lungs by limiting the amount of
positive pressure applied to the lung.
• The ventilator delivers a decelerating flow pattern during
pressure control ventilation
• It is considered a component of lung protective strategies.
• It also may be more comfortable for patients who can
breathe spontaneously and reduce WOB
• Disadvantages
1. Volume delivery varies.
2. Less familiar with pressure-control ventilation
3. VT and VE decrease when lung characteristics deteriorate
27. Factors that affect volume delivery during
pressure-controlled ventilation:
•Pressure Setting
•Pressure Gradient
•Patient Lung Characteristics
•Inspiratory Time
•Patient Effort
28. Trigger Variable
• Pressure-triggered: Initiation of
a mechanical breath based on the
drop in airway pressure that occurs
at the beginning of a spontaneous
inspiratory effort.
• Flow-triggered: Flow-triggering
strategy uses a combination of
continuous flow and demand flow.
Time-triggered :Initiation of a mechanical breath based on
the set time interval for one complete respiratory cycle
(inspiratory time and expiratory time).
29. Cycle Variable :
•A measurement that causes the breath to end.
• Pressure-cycled,
• Volume-cycled,
• Flow-cycled,
• Time-cycle.
• Must be measured by the ventilator and used as a feedback
signal to end inspiratory flow delivery, which then allows
exhalation to begin.
36. SN Setting
1 MV ( VE) Male = 4x BSA, Female 3.5 x BSA
2 TV ( V T) 4-8 ml/kg bw
3 RR VE / V T
4 FIO2 SPO2= 90-94%, PaO2=60-90mmHg
5 Flow
6 TI (Insp Time ) V T/Flow
7 T CT 60/ RR
8 Inspiratory pause
9 Peep
10 Trigger P or Flow
11 Pressure Support PIP-Pplatau /Flow
40. Weaning procedure
1.Spontaneous breathing trial (SBT):
• Use T-tube, CPAP
• Let patient breathe spontaneously for up to 30 min
• May use low level pressure support (up to 8 cm H2O) to augment
spontaneous breathing
2.SIMV :
• Reduce SIMV frequency by 1 to 3 breaths per min
• Monitor SpO2, obtain ABG as needed
3.PSV:
• In conjunction with spontaneous breathing or SIMV mode
• Start at a level of 5 to 15 cm H2O to augment spontaneous VT until a
desired VT (10 to 15 mL/kg) or spontaneous frequency (#25/min) is
reached
• Decrease pressure support level by 3 to 6 cm H2O intervals until a
level of close to 5 cm H2O is reached
41. Weaning Protocol for Mechanical Ventilation
Step 1
Does the patient show:
1. Evidence of some reversal of underlying cause?
2. Presence of inspiratory effort?
3. Hemodynamic stability?
4. Adequate oxygenation and acid-base status? (PaO2/F1O2 .150
mm Hg, PEEP <8 cm H2O and pH 7.25)
5. Light sedation or better? (brief eye contact to voice command)
If YES to all five questions, proceed to STEP 2. If NO to any one
question, postpone weaning until next day.
42. Step 2
• Is RSBI (f/VT), 100 breaths/min/L?
If YES, proceed to STEP 3. If NO, postpone weaning until next
day.
Step 3
• Can patient tolerate: Spontaneous breathing trial for up to 30
minutes without termination?
• If YES, proceed to ventilator discontinuance or evaluate for
extubation. If NO, repeat weaning until next day.
43.
44.
45. Q 1. Following admission to a hospital for
myocardial infarction, a 55-year-old man is
intubated and placed on ventilatory support. e
patient’s IBW is 70 kg and BSA is 1.5 m2. The
physician requests the VC-CMV mode. How
will you set the ventilator?
46. Q 2.A 65-year-old man with a history of
COPD is brought to the emergency
department complaining of severe shortness
of breath. SpO2 of 75% obtained while he was
breathing room air is very low. What will be
your next step?
47. Q 3 A 13-year-old girl with a history of severe
persistent asthma is brought to the emergency room
at 2:30 AM. Wheezing is audible without the use of a
stethoscope. A chest radiograph shows increased
radiolucency and depressed hemidiaphragms. ABGs
on a 2 L/min nasal cannula are: pH = 7.43; PaCO2 =
25 mm Hg; PaO2 = 43 mm Hg; HCO3− = 17 mEq/L.
Her SpO2 is 73%. She is started on bronchodilators
(albuterol and Atrovent) by continuous aerosol and
intravenous corticosteroids but the patient’s
condition does not improved over the next 5 hours,
in spite of therapy.
48. Q4. A 72-year-old woman with a history of COPD is
receiving NIV for ventilatory failure secondary to
postoperative pneumonia. The patient is wearing a
full facemask but is having difficulty swallowing and
coughing. She appears very weak and has become
more agitated and confused in the past hour. The
respiratory rate is 24 breaths/min, and the SpO2 is
92%. Oxygen is being bled into the patient’s mask at
the rate of 5 L/min. What action should be taken at
this time?
49. Q 5. A patient who appears to be ready for discontinuation of
ventilatory support is being weaned with SIMV. The data below
indicate the patient’s progress. No pressure-support ventilation or
continuous positive airway pressure is used to support
spontaneous breaths.
• Do you think the patient is being managed correctly during the
weaning process? If not, what would you recommend?
50. Q 6 A 76-year-old man with a history of chronic
obstructive pulmo- nary disease has been on ventilatory
support for 4 days, since he had an acute myocardial
infarction. The ventilator settings are VT = 700 mL;
SIMV rate = 8 breaths/min; FIO2 = 0.5; PEEP/ CPAP =
5 cm H2O. ABG results on these settings are: pH = 7.37;
PaCO2 =36mmHg;PaO2 =78mmHg;SpO2 =93%.
• The patient currently meets all criteria for weaning and
is placed on a T-piece. Within 10 minutes he develops
restless- ness, tachycardia, rapid, shallow breathing,
and diaphoresis. The SpO2 drops from 93% to 90%.The
patient does not complain of chest pain and has no
dysrhythmias.
• What do you think is responsible for the failed weaning
attempt?