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Respiratory Talk

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Slideshow from Debbie O's Supplemental Learning Session on January 10th.

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Essentials of Respiratory Care Paul Barraza RRT, RCP Education Coordinator, Santa Clara Valley Medical Center Adjunct Faculty, Department of Biological Sciences, Foothill College
Contents ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Contents ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Anatomy and Physiology
Function ,[object Object],[object Object],[object Object],[object Object],[object Object]
Upper vs. Lower Respiratory Tract ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Upper vs. Lower Respiratory Tract
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Upper vs. Lower Respiratory Tract
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Upper vs. Lower Respiratory Tract
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Upper vs. Lower Respiratory Tract
[object Object],[object Object],[object Object],[object Object],[object Object],Alveoli
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Alveoli
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Alveoli
Alveolar Capillary Membrane ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Alveolar Capillary Membrane
Ventilation vs. Respiration ,[object Object],[object Object],[object Object],[object Object]
Diffusion/Perfusion ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Diffusion/Perfusion ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Barriers to Diffusion/Perfusion ,[object Object],[object Object],[object Object],[object Object],[object Object]
Diffusion/Perfusion Impairment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Ventilation/Perfusion Mismatch ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Ventilation/Perfusion Mismatch
 
Basics of Acid-Base Imbalances
Terminology ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Terminology ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Normal Adult Blood Gas Values at Sea Level 0 + 2 0 + 2 B.E. 24 mEq/L + 2 24 mEq/L + 2 HCO 3 - 70-75% 95% or better SaO 2 41-51 mmHg 40 mmHg (35-45) PaCO 2 35-40 mmHg 80-100 mmHg PaO 2 7.36 (7.31-7.41) 7.40 (7.35-7.45) pH Venous Arterial
Causes of Respiratory Acidosis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Signs & Symptoms of Respiratory Acidosis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Causes of Respiratory Alkalosis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Signs & Symptoms of Respiratory Alkalosis ,[object Object],[object Object],[object Object],[object Object],[object Object]
Causes of Metabolic Acidosis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Causes of Metabolic Alkalosis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Acid-Base Disorders and Parameter Changes     N chronic N N N   acute Respiratory Alkalemia (alveolar hyperventilation)  N    N chronic N N N   acute Respiratory Acidemia (ventilatory failure) Cl - K + HCO 3 - PCO 2 pH
Acid-Base Disorders and Parameter Changes    N  acute      partially compensated N N   N compensated Metabolic Acidemia N N   N compensated      partially compensated    N  acute Metabolic Alkalemia Cl - K + HCO 3 - PCO 2 pH
Acid-Base Disorders and Parameter Changes Cl - K + HCO 3 - PCO 2 pH      Combined Respiratory and Metabolic Alkalemia      Combined Respiratory and Metabolic Acidemia
Compensatory Mechanisms for Acid - Base Imbalances ,[object Object],[object Object],[object Object],[object Object]
Compensatory Mechanisms for Acid - Base Imbalances ,[object Object],[object Object],[object Object],[object Object]
Compensatory Mechanisms for Acid - Base Imbalances ,[object Object],[object Object]
PaO 2 ,[object Object],[object Object]
Hypoxemia ,[object Object],[object Object],[object Object],[object Object]
Arterial Blood Gas Interpretation
Steps for Interpretation ,[object Object],[object Object],[object Object]
Step 1: Acidemic or Alkalemic ,[object Object],[object Object],[object Object],[object Object]
Step 1: Acidemic or Alkalemic ,[object Object],[object Object],[object Object],[object Object],[object Object],X
Step 2: Primarily Respiratory or Metabolic ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],Step 2: Primarily Respiratory or Metabolic X X X
What if both PaCO2 & HCO3 are abnormal? ,[object Object]
Step 3: Assess for Compensation ,[object Object],[object Object],[object Object],[object Object],[object Object]
Step 3: Assess for Compensation ,[object Object],[object Object],[object Object]
Step 3: Assess for Compensation ,[object Object],[object Object],[object Object]
Step 3: Assess for Compensation ,[object Object],[object Object],[object Object]
Blood Gas Interpretation Practice ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Blood Gas Interpretation Practice ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Blood Gas Interpretation Practice ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
The Base Excess ,[object Object],[object Object]
The Base Excess ,[object Object],[object Object]
 
Mechanical Ventilation
Iron Lung
Reasons for Mechanical Ventilation ,[object Object],[object Object],[object Object],[object Object]
Respiratory Insufficiency/Failure ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Signs & Symptoms of Respiratory Insufficiency/Failure
Respiratory Insufficiency/Failure ,[object Object],[object Object],[object Object],[object Object],[object Object]
Respiratory Insufficiency/Failure ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Airway Protection ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Inadequate Respiratory Drive ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Surgical/Procedural ,[object Object],[object Object],[object Object],[object Object]
Goal of Mechanical Ventilation ,[object Object]
Goals of Mechanical Ventilation ,[object Object],[object Object],[object Object],[object Object],[object Object]
Ventilation – Getting CO 2 Out ,[object Object],[object Object],[object Object],[object Object]
Ventilation - Getting CO 2 Out ,[object Object],[object Object],[object Object],[object Object]
Oxygenation - Getting O 2 In ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Oxygenation – Getting O 2 In ,[object Object],[object Object],[object Object],[object Object],[object Object]
Monitoring – How Are We Doing? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Monitoring – How Are We Doing? ,[object Object],[object Object],[object Object],[object Object]
Now Let’s Talk About Ventilation
Some Terms ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
PEEP
PEEP ,[object Object]
Modes of Ventilation ,[object Object],[object Object]
Modes of Ventilation ,[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],Modes of Ventilation
Breath Delivery Types ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Breath Delivery types ,[object Object],[object Object],[object Object]
Breath Delivery Types (cont) ,[object Object],[object Object],[object Object]
Breath Delivery Types (cont) ,[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],Spontaneous Breath Delivery Types
Spontaneous Breath Delivery Types ,[object Object],[object Object],[object Object],[object Object]
Spontaneous Breath Delivery Types ,[object Object],[object Object],[object Object]
Spontaneous Breath Delivery Types ,[object Object],[object Object],[object Object],[object Object],[object Object]
The Alphabet Game ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Determination of Ventilator Settings ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Patient Consideration ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Sedatives, Analgesics, and Paralytics
 
Sedatives ,[object Object],[object Object],[object Object]
Benzodiazepines ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Most common benzos in ICU ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Opioids ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Opioids ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Most common Opioids in ICU ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Neuroleptics ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Most common Neuroleptic Drug in ICU: ,[object Object],[object Object],[object Object],[object Object]
Anesthetics ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Anesthetics ,[object Object],[object Object],[object Object],[object Object],[object Object]
Paralytics ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Paralytics ,[object Object],[object Object],[object Object]
Paralytics ,[object Object],[object Object],[object Object],[object Object],[object Object]
Respiratory Diseases ,[object Object],[object Object],[object Object],[object Object]
Pneumonia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Pulmonary Embolism ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
ARDS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Chest Trauma ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Chest Trauma ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Questions?
Thank you

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Respiratory Talk

  • 1. Essentials of Respiratory Care Paul Barraza RRT, RCP Education Coordinator, Santa Clara Valley Medical Center Adjunct Faculty, Department of Biological Sciences, Foothill College
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  • 24. Basics of Acid-Base Imbalances
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  • 27. Normal Adult Blood Gas Values at Sea Level 0 + 2 0 + 2 B.E. 24 mEq/L + 2 24 mEq/L + 2 HCO 3 - 70-75% 95% or better SaO 2 41-51 mmHg 40 mmHg (35-45) PaCO 2 35-40 mmHg 80-100 mmHg PaO 2 7.36 (7.31-7.41) 7.40 (7.35-7.45) pH Venous Arterial
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  • 34. Acid-Base Disorders and Parameter Changes     N chronic N N N   acute Respiratory Alkalemia (alveolar hyperventilation)  N    N chronic N N N   acute Respiratory Acidemia (ventilatory failure) Cl - K + HCO 3 - PCO 2 pH
  • 35. Acid-Base Disorders and Parameter Changes    N  acute      partially compensated N N   N compensated Metabolic Acidemia N N   N compensated      partially compensated    N  acute Metabolic Alkalemia Cl - K + HCO 3 - PCO 2 pH
  • 36. Acid-Base Disorders and Parameter Changes Cl - K + HCO 3 - PCO 2 pH      Combined Respiratory and Metabolic Alkalemia      Combined Respiratory and Metabolic Acidemia
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  • 42. Arterial Blood Gas Interpretation
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  • 63. Signs & Symptoms of Respiratory Insufficiency/Failure
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  • 77. Now Let’s Talk About Ventilation
  • 78.
  • 79. PEEP
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