ABG
pH - 7.57
PaCo2- 40
HCO3- 40
What is Metabolic Alkalosis?
pH- 7.57 is Alkalotic
PaCo2- 40 (Normal)
HCO3- 30 Alkalotic
Improves Gas Exchange, decreases work of breathing, has a rate for back up. Patient must be able to maintain airway and manage own secretions.
What is BIPAP (Bilevel Positive Pressure Airway Support (and who is a good candidate for it)?
Respiratory Therapist, RN/Medic, ED Physician, Intensivist, or Anesthesiologist
Who are Intubation Personnel at CRMC?
RASS score is +3 and order is for RASS 0 to -2., patient is observed to have tachycardia and is restless.
What is increase dose of sedation and/or consider pain management?
Color change to yellow after assisted ventilation, equal chest rise and fall, no sounds heard over the epigastrium, breath sounds in all four lung fields.
What are the correct steps to assessing confirmation of ET Tube placement in the lungs?
pH- 7.32
PaCo2- 54
HCO3- 35
What is Respiratory Acidosis?
pH- 7.32 Acidotic
PaCo2- 54 Acidotic
HCO3- 25 Normal
Red flashing light on top of Vent, you will hear 5 tones will repeat twice, then pause, then repeat again.
What is a High Priority Alarm?
10 cc Syringe, lube, Colorimetric Device, BVM with O2 Source and mask, Suction, working IV, Gastric Tube, End Tidal CO2, ventilator, Restraints, RSI meds and sedation plan, foley catheter
What equipment and medications are needed for setting up for intubation?
Preoxygenate to 100% Fi02 and silence alarms
Pressure between 70-150mmHg
Depth should not go past the carina.
What are considerations when suctioning an intubated patient through the in-line (Ballard) suction catheter?
Displacement, Obstruction, Pneumnothorax, and Equipment
What is DOPE?
pH- 7.43
PaCo2- 20
HCO3- 13
What is Fully Compensated Respiratory Alkalosis?
pH- 7.43 (High Norm)
PaCo2- 20 Alkalosis
HCO3- 12 Acidic
In this mode, the patient can take any type of breath they want, big, small, fast or slow.
What is Pressure Control (PS) mode?
Can intubate at CRMC, but only in the presence of an ED Physician.
What are ED Medics?
Turning/positioning, HOB at least 30 degrees, oral care, administration of PPI's, VTE prophylaxis, sedation vacations
What are interventions to help reduce Ventilator Acquired Events (VAEs) and complications associated with mechanical ventilation?
With this intervention, the ICU nurse will turn off the patient sedation. RT may place patient in spontaneous mode on the vent. The RN will likely stay with the patient and assess for apnea alarms and tolerance. If the patients fails this, the sedation rate is started at half of the last set rate.
What is a Daily Awakening Trial?
pH- 7.50
PaCo2- 30
HCO3- 23
What is Respiratory Alkalosis?
pH-7.50 Alkalosis
PaCo2- 30 Alkalosis
HCO3- 23 (Normal)
This alarm can be triggered by a patient coughing or a blockage.
This blade is preferred for pediatric patients due to their more anterior airway.
What is a Miller (straight) blade?
Reserved for patients with severe ARDS and hypoxic respiratory failure, improves ventilation in the back of the lungs, which are the areas that receive the most blood flow. resulting in the better distribution of air in the lungs and improved oxygenation.
What is proning?
Size of tube, where it is located at the teeth or gums, ventilator settings, lung sounds, current sedation rates, medications used for RSI, patient neurological status prior to intubation, tolerance of procedure, type of restraints and time started.
What is important information to provide in hand off report from the ED to the ICU (or external facility transfer) specific to an intubated patient?
pH- 7.29
PaCo2- 56
HCO3- 26
What is Respiratory Acidosis?
pH- 7.29 Acidosis
PaCo2- 56- Acidotic
HCO3- 26 (high normal)
In this mode, the vent manages inspiratory pressure to achieve the desired tidal volume target, the patient is allowed to take a deeper breath, then the vent measures that breath and drops the peak pressure by 1-2 cm H20.
What is AC/VS +?
What is a sedative (i.e. etomidate, ketamine, propofol)?
Bring own Yankauer, BVM with mask, monitor, assess sedation, call RT, portable vent.
What is the essential equipment needed to transport with a patient on a vent?
7.35-7.45 normal value should be attached to every ventilated patient to monitor perfusion and metabolic status.
What is end tidal C02?