ABGs
pH = 7.49, PaCO2= 32, HCO3= 23, PaO2 = 74
What is Respiratory Alkalosis.
Goal: keep PaO2 >60 mmHg, between 60-80
O2 admin
MV (invasive & noninvasive)
Prone positioning to increase lung capacity
Sedation- Propofol, fentanyl
What are the treatments for ARDS.
Tidal volume delivered at a set rate independent of patient effort; rarely used. Apneic patients or those with little or no respiratory drive.
What is Controlled Mandatory Ventilation
In an emergency situation, after a respiratory or cardiac arrest, for example, this setting is commonly set at or greater than 60%. The typical goal of therapy is to keep the Sao2 at greater than 90% to 92% and this setting at less than 60% to prevent oxygen toxicity.
What is FiO2.
the presence of a ventilator circuit leak allowing air to escape into the atmosphere or when the patient becomes disconnected from the ventilator.
What are causes of Low Pressure Ventilator Alarms.
pH = 7.56, PaCO2= 20, HCO3= 20, PaO2 =88
What is partially compensated respiratory alkalosis
Direct: PNA< PE, inhalation of toxic gas, trauma to chest, near drowning
Indirect: SIRS, pancreatitis, burns, sepsis, multiple transfusion
What are causes of ARDS.
Tidal volume delivered at a set rate in response to patient effort; if patient fails to breathe at a predetermined time, ventilator will deliver a breath.
What is Assist-Control Ventilation (AC)
The amount of air that is delivered with each breath during the inspiratory phase, is prescribed by the health care provider for volume-cycled ventilators. This setting is set between 8 and 10 mL/kg of IBW to prevent lung injury. Hypoventilation occurs when this setting is set too low, whereas when this setting is set too high, it can result in ruptured alveoli, pneumothorax, and subcutaneous emphysema. Hemodynamic effects of higher VT include tachycardia and decreases in cardiac output and blood pressure.
What is Tidal Volume.
This alarm on the mechanical ventilator provides an emergency backup in the event that the patient’s breathing slows to an unacceptable level or stops. This alarm should be set for a length of time no longer than 20 seconds.
What is Apnea Alarm.
pH = 7.30, PaCO2= 60, HCO3= 30, PaO2 =58
What is Partially Compensated Respiratory Acidosis.
Fluids, Β-agonists, corticosteroids, neuromuscular blocking agents, statins, surfactant (for pediatric patients), vasodilators such as nitric oxide (improves oxygenation) and epoprostenol (rescue therapy for refractory ARDS cases).
What are pharmacological support for ARDS.
Tidal volume delivered at a low set rate in response to patient effort while allowing spontaneous breaths between patient who cannot sustain spontaneous ventilation for extended periods.
Patient breaths on own but cannot sustain breaths.
What is Synchronized Intermittent Mandatory Ventilation (SIMV)
This is left in the lungs at end of expiration to prevent alveoli from collapsing.
What is PEEP (Positive End Expiratory Pressure).
The ventilator alarm is going off. You check to be sure that the patient is connected to the ventilator. Ensure patient is ventilating adequately and is not over-sedated.
What is the low minute volume alarm.
pH = 7.36, PaCO2= 27, HCO3= 12, PaO2 = 70, SaO2 = 93%
What is Fully Compensated Metabolic Acidosis with Mild Hypoxemia.
Presentation 1 week post-clinical insult. normal PaO2/FiO2 ratio is 400-500 mmHg. However, patient presents with lower than normal PaO2/FiO2 (200-300 mmHg).
What are hallmark signs/typical patient presentation of ARDS.
Applies positive pressure during spontaneous breaths. Effective as a weaning trial or training mode in patients capable of spontaneous ventilation.
Patient is breathing on own with a bit of help!
What is Continuous Positive Airway Pressure.
MAX SPEED at which mechanical ventilation can deliver vital capacity.
Normal Rates: 60-100 liters/min, generally estimating the peak flow at four times the minute volume
What is Flow Rate.
Assess patient for anxiety. Check vital signs and assess patient for signs of hypoxia (tachycardia, hypertension, restlessness, cyanosis, accessory muscle use, etc.).
What is the high minute volume alarm.
pH = 7.52, PaCO2= 31, HCO3= 25, PaO2 =60, SaO2 = 90%
What is Uncompensated Respiratory Alkalosis with hypoxemia.
Most common cause of indirect Acute Respiratory Distress Syndrome (ARDS).
BONUS QUESTION!!
Low levels of oxygen in the blood that does not respond to oxygen administration (even at high levels such as a fraction of inspired oxygen of 0.60-1.0). Present in patients with intrapulmonary shunts such as in acute respiratory distress syndrome.
What is Refractory Hypoxemia.
Used to decrease a patient's work of breathing (usually 5-10 H2O).
What is Pressure Support.
Tubing is kinked or compressed. Assess need for suctioning and check for presence of ventilator dyssynchrony and coughing.
What is the high pressure alarm.