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After initiating mechanical ventilation, what should be assessed?Gas exchangePulse oximetryMonitoring oxygenationO2 consumptionHemodynamicsInitial assessment of mechanically ventilated pts?inspection, palpation, auscultation of chestAssessment of airway and cuff inflationAssessment of HR, BP, Sat, and EKG (vitals)Inspection of pt vent system breathing circuit, humidifier, vent settings and findingAnalysis of ABG valuesInspection of CXRTroubleshooting Pt’s physiological response to:Pain: pain relieversInappropriate vent settings: adjust setting appropriatelyHypoxemia: adjust FiO2 and PEEP levels accordinglyTests measurements performed on vent ptsNIF/MIPVCFormulasDesired PaO2: Current FiO2 x Desired PaO2/Current PaO2RSBI: RR/Vt (L)VE: Vt x fTank Duration: PSI x tank factor/Liter flowWhat are the normal values of:VC >10ABGs: pH 7.35-7.45 PCO2 35-45 PO2 80-100RSBI <100VE <10MIP > -20MEP > 40Vt >5CVP 2-6mmHg/4-12cmH2OPAP 25/8 mean 14mmHgPCWP 4-12mmHgSteps to normalize blood gas parametersHigh PaCO2: decrease deadspace increase Vt increase fLow PaCO2: increase deadspace decrease f decrease VtHigh PaO2: decrease FiO2 below 60% decrease PEEPLow PaO2: increase FiO2 up to 60% Add or increase PEEPTreatment for post extubation distressExpiratory wheezes: racemic epiMarked stridor: reintubateIndications for intubationImpending respiratory failurerespiratory failureNIV poorly toleratedNeed to protect airwayWhat is the main contraindication for weaning?Underlying cause is not allievatedReasons to weaning failureAnxietyPsychological dependencyOver sedationFatiguePurpose of discharge plannerPerson in charge of a pt’s discharge planMost common type of O2 concentrator found in home care settingmolecular sieveTroubleshooting wave graphics:Exp flow does not return to baseline before next breath: airtrapping/ AutoPEEP Tx: decrease Ti, increase flowBroken loop: leak Tx: fix leakNarrow flow/volume loop: high airway resistance Tx: bronchodilator, suctioningVolume/pressure loop laying on side: low compliance Tx: PEEP, surfactantBeak: overdistention Tx: decrease Vt, Change to PCVInitial ventilator settingsVt: 4-10mL/kg IBWRR 8-14FiO2: 40-60%PEEP: 0-10cmH2OTroubleshooting ventilator alarmsLow pressure: find and fix leakHigh pressure: H2O in circuit (drain it)pt needs suctioning (suction pt)kink in tubing (find and fix)clogged HME (change out)Pharmacology for mechanical ventilationBronchodilators: Adrenergic (front door): SABA: Albuterol Levalbuterol Terbutaline PirbuterolLABA: Salmeterol Formoterol ArformoterolAnticholingeric (back door): Atropine sulfate Ipratropium bromide Tiotropium bromide Oxitropium bromideBenzodiazepine: sedation/anxiety Diazepam Lorazepam Midazolam AlprazolamNarcotics: pain control Morphine Hydromorphine/Dilaudid Fentanyl Codeine Hydrocodone Oxycodone Meperidine/DemerolCorticosteroids: reduces inflammation Fluticasone Beclomethasone Budesonide Flunisolide Triameinolone Prednisone Methylpredisolone SolumedrolParalytics: paralyze pt/neuromuscular block Succinycholine (short acting) Pancucuronum bromide Vecuronium bromide Rocuronium Atracurium CisatracuriumReversal agents: For benzos: Remazicon For narcotics: NarcanWhat are the goals of mechanical ventilation?Decrease WOBVentilationOxygenationSynchrony of pt and ventilatorWhat CV parameters are monitored with every pt?BPHRWhat is the most common problem after extubation?Sore throatWhat formula is used for optimal PEEP?Cstat= Vt/ Plat-PEEPWhat does an ARDS pt need?low VtHigh rateWhat is normal Cardiac Index (CI)?2-4L/min ................
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