Take my breath away
What is the ratio of Heliox:Oxygen we use at KGH?
80:20
How do you measure the insertion depth for the EBM?
Xyphoid->Earlobe ->Nose + 50-100mm
What dose of iNO do we use for pulmonary hypertension
How do we set flow on Airvo for pediatrics?
2L/kg/min
How often must you change out the Sedaconda device?
change Q24hrs, or earlier if needed
Name two indications for using Heliox
Asthma
Airway narrowing/inflammation/obstruction
What is normal value for transpulmonary PEEP?
PtpPEEP 0-5cmH20
When bagging on iNO why do we prime bagger prior to use?
NO and O2 in RA will mix to form NO2- Need to clear NO2
What are the starting settings for NIV for pediatrics? and what are the max settings?
Starting: 10/5
Max: 20/10
Name 3 potential complications of Sevoflurane use
1. Hypotension
2. New arrhythmias
3. Nephrotoxicity
4. Malignant Hyperthermia
Explain how you perform an Apnea test & what settings you would use.
Baseline ABG, place on FiO2 100% for 10-20 min prior. Keep on ventilator with the following settings: intentional hypoventilation
SIMV- Volume guarantee, RR 2, PS 0, PEEP as current, Vt 200mL, FiO2 100%, pressure trigger (lower sensitivity)
Draw ABG 5 min later- assess if requirements are met
Name the two reasons we use step 1 of the PV tool
Assess lung recruitability
Find optimal PEEP
SHAREPOINT
How do you administer nebs if a kiddo is on Airvo? Explain how this provides best deposition.
Aerogen through circuit (decrease flow to 0.25L/kg/min)
What is the first and last sign of Malignant hyperthermia?
First: Increased etCO2
Last: Increase temperature
What is the suggested dose range for continuous nebulization of ventolin?
10-20mg/hr
How do you know your EBM catheter is in good position?
Cardiac oscillations, CXR- radiopaque square is 5cm above the diaphragm, Dynamic occlusion test
How do we wean iNO if a patient was on 40ppm?
by 50% Q1H until 5ppm. Then decrease by 1ppm until off.
Inside net, clinical care resources (toolkits)
Also found in ED- filing cabinet in main
What is the max dose of Sevoflurane & what do we do if we get here?
20mL/hr
Discuss with physician about discontinuation if there are no positive clinical effects
At this time, consider ECMO
Name 3 reasons you would use an endobronchial tube
Lung isolation/prevent contaminuation (empyema)
ILV (unilateral lung disease)
Surgical procedure
When assessing for recruitability with the PV tool- An NMD% > _____% shows recruitabilit.
>41%
What blood test value should you monitor every shift? and what is your threshold to notify physician?
vomiting
decreased LOC
facial deformities/upper a/w/GI surgeries
Max NIV settings/FiO2 with worsening gases
Explain how you set the therapeutic dose in terms of syringe pump & Fet%/Esev%?
Fet% is the end tidal fractional exhaled concentration.
Set sevoflurane on syringe pump starting at 5mL/hr and titrate up in 2-5mL increments eveyr 10 min to achieve desired clinical effects:
Decreased airway resistance, Ppeak, PaCO2, AutoPEEP
Once clinical effects are met- look at monitor to see the Fet%.. this is the therapeutic Fet%