Airway
what glascow score do we typically support airway with?
8
does CO2 show a issue or an ventialation issue?
ventilation
SPO2 shows oxygenation
pH - 6.8
PaCO2 - 22
HCO3 - 6
what s/s would you expect?
patially compensated metabolic acidosis
S/S: Kussmauls respirations, N/V, coma, dysrhythmias
Patient comes in by wheelchair. She is in a tripod position. We put on vitals - SPO2 80%, HR 130, RR 26. what do we do?
put her on 2L O2 NC. get the doc have them increase O2
If that doesn't work put on NRB.
amiodarone
atropine
adenosine
epinephrine
norepinephrine
amiodarone - heart arrhythmia
atropine - symptomatic bradycardia
adenosine - SVT
epi - cardiac arrest, whole body rush
norepi - squeezing the vessels, BP support, only deals with vessels
how do you open the airway in a trauma patient?
jaw thrust
head lift is a risk with possible c-spine injury
what color should the end-tidal CO2 monitor show up when one is intubated correctly? is it diagnosic?
yellow
purple orignially and then yellow
p is before y in the alphabet
pH: 7.55
PaCO₂: 25
HCO₃⁻: 24
what are some s/s you would expect?
uncompensated respiratory alkalosis
S/S: hyperventilaiton, lightheadedness, palpations
what are some interventions for ARF
treat the cause, give really good O2, minimize demand of O2
list some of the people who come into the room when a code occurs
Team Leader – Running the code
Documentation RN
Timekeeper
Experienced ICU RN(s)-Code Nurse
Chest compressions
Med Nurse – IV nurse - can also be a pharmacist
Code Cart Nurse
Airway Management
Runners
Pastoral Care
Family Support Person
Security
when placing an ETT tube, where do you aim to place the tube correctly?
the true cords (show pic)
What is PEEP?
positive end expiration pressure
Incentive Spirometer helps reopen the alveoli and get the junk out
we dont want the alveoli to collapse so we have to set this
male brought in by EMS found on the street unconcious
RR of 6, SPO2 85%, HR 56, B/P 93/65
what are we thinking
AMBU bag
possible drug overdose
provider wants you to tell them when the patients SPO2 is outside of 85-92%
where do we want to set the alarm?
84 as the low
93 as the high
when do you insert an oropharyngeal airway?
alway unconcious
you never insert one of these on a concious person
what is FiO2?
amount of oxygen being delivered to a patient
21-100% --> 21% is RA
Patient is intubated
ventilator alarms - SPO2 is 78%
the patient is gurgling and restlessness
too many secretions
they need to be suctioned
19 M comes in with a productive cough, temp of 101F, SPO2 89%, HR 130, RR 30. patient reports roommate has been sick recently you auscultate crackles in BL lower lobes, chest x-ray shows white out
what are we doing/thinking?
ARDs
treat pneumonia, intubate - put on PEEP and make small TV
need nutritional support
how do you verify the placement of an NG/OG tube?
chest x-ray is the definitive way
where should the placement of the ETT tube be?
right above the carina in the bronchi
if wrong - most likely to go into the right lung
what is tidal volume?
how deep of breaths you are taking
large allows you to breathe off more CO2
pH - 7.32
PaCO2 - 52
HCO3 - 25
what s/s do you expect to see?
uncompensated respiratory acidosis
s/s: restlessness, lethargy, muscle weakness, dysrhthmias (increased K+), depends on cause to see hyper/hypo ventilation
what is the train of four
machine to monitor how well the paralytic is working
need baseline of 4 twitches
2/4 means the diaphragm is knocked out
where is the peg tube located in the digestive system?
J tube?
what if one comes out?
peg tube - gastric
J-tube - jejunum
if one comes out put a foley in and ask for help