C02 waveforms
Bronchoconstriction
-Uneven alveolar emptying due to bronchoconstriction
What care plan do most uncomplicated patients fall into for vent strategies?
Normal Lung and Restrictive
Lung care plan
Under the CPAP indication- Respiratory distress, what 3 things are required?
Accessory muscle use, sp02 <92%, Resp Rate >25
When in Cardiac arrest, how much PEEP do you use?
Zero! After ROSC and reassessment, you would add PEEP in
What are these lung sounds? What do they mean? What type of patients would you see them in?
Use tablet
You are transporting a intubated patient with your ACP partner. You are ventilating the patient and notice this waveform on the monitor. What is it and what does it mean?
Patients sedation is wearing off, attempts to breathe at the the end of exhalation
What do all vent strategies START with for settings?
PEEP, I:E ratio, RR, Fi02 100%, VT
PEEP: 5 cmH20
IE ratio:1:4
Fi02: 100%
VT: 6-8ml\kg
RR: all are 10-14 except for Obstructive lung is 10-12 for a starting RR
What are your starting pressures to use in CPAP for Asthma, Pulmonary edema and COPD?
What is your maximum?
Asthma: 5 cmH20
COPD/Pulmonary edema: 7.5 cmH20
Max of 10cmH20, then call med control
Put the bag valve mask together properly in 20 seconds. Challange someone else from the other team
Time starts now
You are caring for an asthma patient. They have a presentation of a RR of 40, Normal c02 value with a "bronchoconstriction" wave form, accessory muscle use & tripoding. What could this suggest?
Impending respiratory failure. They are in distress and possible getting tired/worsening with air trapping starting to occur.
3 stages with Etc02 findings
ETC02 is the gold standard in confirming airways. Your partner inserted an ET tube. You should bag the patient at least _____ times to confirm. You then suddenly notice this wave form, what do you think happened.
6 breaths
Tube not in place or lost placement
What are 3 examples of patients you may see in which you would follow the Metabolic acidosis care plan? What is the main concept to this plan?
-DKA, TCA or Salicylate overdose
What are the 5 indications for use
Hypoxemia secondary to CHF
Acute cardiogenic shock
Pulmonary edema
Asthma/COPD
Respiratory distress
What is the difference between PEEP and CPAP?
Continuous positive airway pressure: Constant flow of pressure
Positive end expiratory pressure: Pressure level maintained at the end of exhalation
Similar end goal!
Describe what CPAP does.
Decreases Pre-load and Afterload helping preserve Left Ventricle Function
•Distends alveoli preventing collapse on expiration
•Allows for greater surface area, which improves gas exchange
•Increases medication distribution when used for COPD/Asthma
Label the phases/segments on this ETC02 wave form
See picture
You have a patient showing s/s of cerebral herniation. What are your goals with Ventilation and why?
Decrease expiration of I:E ratio by 1
sec to a min of 1:2 until ETCO2 is
~33 mmHg
Allows for some vasoconstriction in the brain allowing more room for swelling in the brain and time to surgery/hospital
Challenge the other team to a duel to put the CPAP together properly in 20 seconds. You get to pick which one.
Time starts now!
What is the risk/side effects of using PEEP?
-Increased intrathoracic pressure (decreasing Cardiac output, since you may decrease venous return to heart)
-Barotrauma/Pneumo
-Right Ventricular strain (Excessive PEEP causes high pressures to Pulmonary circ)
-
When doing any sort of oxygen treatment/airway treatment or ventilation treatment what do you need to reassess to ensure its working?
-WOB, SP02, ETC02, Patient appearance, Vitals, Chest compliance
LOC ABC Skin
- If your treatment isn't working we need to trouble shoot or move on to our next plan!
ETC02 doesn't just measure ventilation status. What else does it measure and why?
-Shock states
-Metabolism is decreased and low pressure/flow due to hypotension(shock)
When is it acceptable to have permissive hypercapnia? How would you ventilate these patients and what things would you consider
If you think Obstructive shock is occurring with a "obstructive lung". ETCO2 over 45, with MAP below 65
-Ensure bronchodilators are given
-Consider active exhalation
-Decrease RR to 6-10 allowing a longer exhalation phase
Once Sp02 greater than 94% and MAP above 65 increase RR
What are the 6 Contraindications for CPAP
Pneumo/chest trauma
Hemodynamically unstable
Altered LOC
Trach
Actively vomiting
Upper GI bleed
You have a patient that is having severe bronchoconstriction. Demo how you would deliver Ventolin to this patient when your partner is ventilating. Don't forget your 6Rs!
MDI port/move HEPA if needed
-max two puffs per vent
You are initiating CPAP, you have a 30 min transport to the hospital. You have a M tank with 800 psi, and want to run CPAP on this patient. Do you have enough 02
1.56
800-200 x 1.56/ 25= 19.52 min
Your flow rate can be anywhere from 15-140 lpm
-going to be dependent on RR/Chest/Seal as well