ABGs
pH = 7.24
CO2 = 29
HCO3 = 12
partially compensated metabolic acidosis
What is included in the VAP bundle?
1. Elevate HOB
2. Oral care Q4 (w/ Chlorhexadine Q12)
3. DVT prophylaxis
4. PUD prophylaxis
5. Sedation vacation
What would cause a high peak pressure alarm?
Biting, Kinking of tubing, coughing, gagging, secretions, mucous plug, Tube in R main bronchus, ventilator desynchrony, pneumothorax
What is a chest tube used for?
to drain air, fluid, or blood from the pleural space
What meds are you giving for ARF?
Depends on the cause... FIX the PROBLEM
pH = 7.42
CO2 = 26
HCO3 = 16
fully compensated respiratory alkalosis
At what point, do you need to trach someone instead of intubate?
1. Prolonged ventilation (>14 days)
2. Upper airway obstruction
What would cause a low peak pressure?
ETT cuff deflating, disconnection, TV set too low, air escaping through other orifices or tubes
tape
dry gauze
petroleum gauze
sterile water bottle
persistent hypoxemia
pH = 7.51
CO2 = 27
HCO3 = 18
partially compensated respiratory alkalosis
How do you confirm an ET tube is in the right place?
Auscultate, Capnography, Chest X-ray (GOLDEN)
Suction
What do you never do a chest tube?
milk it
What are the risk factors for a PE?
Travel (long distance immobility)
Hypercoagulable states (caner, pregnancy)
Recent surgery
Obesity or oral contraceptives
Malignancy
Blood clot history
Older age
Smoking
Immobilization
Stroke or spinal cord injury
pH = 7.36
CO2 = 51
HCO3 = 24
NORMAL
What are the 10 things you need when preparing to intubate?
- Continuous V/S monitoring
- Patient IV access (x2)
- Free flowing NS
- Various ET tube sizes
- Laryngoscope
- Ventilator machine
- Capnography/CO2 detector
- Stethoscope
- Restraints
- Emergency Equipment
What would you do if a low peak pressure alarm is going off?
Call RT
What do you do if the chest tube dislodges from the chamber?
Stick the end in sterile water bottle
What is the treatment for ARDS?
mechanical ventilation with PEEP
pH = 7.43
CO2 = 30
HCO3 = 19
fully compensated respiratory alkalosis
What 11 things do you need to prepare for tracheostomy?
1. Continuous V/S monitoring
2. Patient IV access (x2)
3. various tracheostomy tube sizes
4. oxygenation and humidification
5. Sterile supplies
6. Tracheostomy tray
7. Ventilator machine
8. Capnography/CO2 detector
9. Stethoscope
10. Restraints
11. Emergency equipment
Who is able to be weaned off the ventilator?
- Underlying condition improves
- Stable oxygenation
- Adequate respiratory mechanics
- Sufficient respiratory drive
- Cardiovascular stability
- Alert and able to follow commands
- Minimal secretions
- No longer in need of sedation
What do you do if the chest tube dislodges from the patient?
Cover with petroleum gauze, then dry gauze, then tape
Who can not be placed in prone positioning?
hemodynamically unstable
facial trauma
increased ICP
spinal instability