Complex Oxygenation

ABGs

100

pH = 7.24

CO2 = 29

HCO3 = 12

partially compensated metabolic acidosis

200

pH = 7.42

CO2 = 26

HCO3 = 16

fully compensated respiratory alkalosis

300

pH = 7.51

CO2 = 27

HCO3 = 18

partially compensated respiratory alkalosis

400

pH = 7.36

CO2 = 51

HCO3 = 24

NORMAL

500

pH = 7.43

CO2 = 30

HCO3 = 19 

fully compensated respiratory alkalosis

Intubation

100

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

200

At what point, do you need to trach someone instead of intubate?

1. Prolonged ventilation (>14 days)

2. Upper airway obstruction

300

How do you confirm an ET tube is in the right place?

Auscultate, Capnography, Chest X-ray (GOLDEN)

400

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

500

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

Ventilator

100

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

200

What would cause a low peak pressure?

ETT cuff deflating, disconnection, TV set too low, air escaping through other orifices or tubes

300

What would you do if a high peak pressure alarm is going off?

Suction

400

What would you do if a low peak pressure alarm is going off?

Call RT

500

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

Chest Tubes

100

What is a chest tube used for?

to drain air, fluid, or blood from the pleural space

200

What are the emergency supplies for a chest tube?

tape

dry gauze

petroleum gauze

sterile water bottle

300

What do you never do a chest tube?

milk it

400

What do you do if the chest tube dislodges from the chamber?

Stick the end in sterile water bottle

500

What do you do if the chest tube dislodges from the patient?

Cover with petroleum gauze, then dry gauze, then tape

ARF/ARDS/PE

100

What meds are you giving for ARF?

Depends on the cause... FIX the PROBLEM

200

What is the most common clinical manifestation for ARDS?

persistent hypoxemia

300

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

400

What is the treatment for ARDS?

mechanical ventilation with PEEP

500

Who can not be placed in prone positioning?

hemodynamically unstable

facial trauma

increased ICP

spinal instability