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This document provides guidelines for adjusting ventilator settings and interpreting various medical readings. It includes formulas for calculating ideal body weight, lung compliance, desired oxygen levels and volumes. It also outlines signs of conditions like pulmonary embolism or heart attacks on EKGs. Finally, it describes strategies for ventilating patients with acute lung injury or ARDS, focusing on lung protective ventilation with targeted volumes, oxygenation, pH and plateau pressures.
This document provides guidelines for adjusting ventilator settings and interpreting various medical readings. It includes formulas for calculating ideal body weight, lung compliance, desired oxygen levels and volumes. It also outlines signs of conditions like pulmonary embolism or heart attacks on EKGs. Finally, it describes strategies for ventilating patients with acute lung injury or ARDS, focusing on lung protective ventilation with targeted volumes, oxygenation, pH and plateau pressures.
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This document provides guidelines for adjusting ventilator settings and interpreting various medical readings. It includes formulas for calculating ideal body weight, lung compliance, desired oxygen levels and volumes. It also outlines signs of conditions like pulmonary embolism or heart attacks on EKGs. Finally, it describes strategies for ventilating patients with acute lung injury or ARDS, focusing on lung protective ventilation with targeted volumes, oxygenation, pH and plateau pressures.
Copyright:
Attribution Non-Commercial (BY-NC)
Verfügbare Formate
Als DOC, PDF, TXT herunterladen oder online auf Scribd lesen
a. Female: 100 lb for 1st 5ft + 5lbs ea additional inch a. increase RR a. reduce Fio2 –60% b. Male: 106 lb for 1st 5 ft + 6lbs ea additional inch b. increase VT b. reduce PEEP to 5 2. Static Compliance: (VT/Static pressure – PEEP) 2. PaCo2 <35 c. reduce FiO2 a. Normal = 60-100 a. decrease rate b. <60 = lungs becoming less compliant b. decrease VT c. >25 is acceptable 3. PCO2 <90% or SaO2<60 d. <25 is unacceptable a. increase FiO2 to 60% 3. Desired FiO2 = Desired PaO2 + Known FiO2 b. increase PEEP Known PaO2 c. increase FiO2 to 100% 4. Desired Ve= Known Ve*Known PaCO2 Desired PaCO2 5. RAW: PIP–Plateau/ Flow, or PIP–plateau EKG and rhythm strip interpretations: 6. French size sx catheter = ETT size * 3/2 1. Pulmonary Embolism: 8. PAO2: (713 *Fio2 – PaCO2)/0.8or 0.1 if 100% O2 a. S wave in lead I 9. A-a gradient: PAO2 – PaO2 b. ST depression in lead II a. Normal on RA = 10-40 or on 100% = 25 – 70 c. Large Q wave in lead III b. Increased 66-300 = acute lung injury d. T wave inversion in lead III c. >300 = severe shunting, ARDS (unacceptable) 2. Basics: 10. Shunt % = A-a gradient/20; normal=20% a. ST depression = acute blood loss -- if >20 an increase in PEEP is indicated b. Q Wave makes diagnosis of infarct 11. a-A ratio: PaO2-PAO2 c. Q wave one small square is MI a. Normal = 80% (74% elderly) d. Inverted T-wave is ischemia b. 60% = V/Q imbalance 3. Posterior wall Infarct: c. 15% = shunting a. ST depression in V1 & V2 if acute 12. P/F Ratio: PaO2/FiO2 b. Large R in V1 and V2 a. Normal = 300 – 500 c. Maybe Q in V6 b. Acute lung injury = 200 – 300 d. Inverted mirror test V1 & V2 c. <200 = ARDS 4. Lateral wall Infarct: 13. Expected PaO2 = FiO2 x5 a. Q in leads I and AVL (V5, V6) a. Used to determine if pt oxygenating better 5. Inferior wall Infarct: b. Actual PaO2/ Expected PaO2 = % of patient a. Q in leads II, III, & AVF expected PaO2 b. ST elevated if acute 14. PS should be set to= RAW or > if therapy indicated. 6. Anterior wall Infarct: 15. e-cylinder time remaining=0.30(PSI) / LPM a. ST elevation V1 & V2 16. Oral intubation = 21-25cm @ lip. b. Q in V1, V2, V3 or V4 17. Nasal intubation = 26-29cm c. V1 & V2 = Anterioseptal 17. PEEP therapy = >6-8 CWP d. V3 & V4 = Anteriolateral 18. Humidity should be set at 37 degrees Celcius. 7. SVT: Narrow QRS & rate of 150-250 20. Suction:Adult=100-120,Child=80-100,Infant=60-80 8. LBBB: 2 R waves in V5 & V6 21. Pt.WOB=<0.8=normal, measures effectiveness of 9. RBBB: a. 2 R waves in V1 & V2 rise time and sensitivity. Measured in spont. mode. b. QRS wide and looks like an M 10. Acidosis: Smaller amplitude 11. COPD: Small amplitude, Right axis deviation Acute Lung Injury or ARDS Ventilator Strategy: 12. 2nd degree block type I: a. PR interval Lung Protective Ventilation becomes progressively longer until 1 QRS 1. Ideal VT = 6 ml/kg IBW skipped. b. blocked QRS after every 2-5 QRSs 2. Oxygenation target: a. PaO2 55-80 b. SpO2 88-95% c. QRS may be normal or wide if BBB 3. pH Goal: 7.45-7.30 13. 2nd degree type II: a. p waves for ea. QRS at a. >7.45: Decrease Rate ratio of 2:1, 3:1 or 4:1. b. Often wide w/RBBB b. <7.30: Increase Rate (maximum rate = 35) c. If rate >35, or CO2 <25, consider HCO3 d. < 7.15?, increase VT 1ml/kg (may exceed Static Pressure) Level of Consciousness: 1. Lethargic/ somnolence: sleepy 4. Plateau pressure: Dr. to select target pressure a. If >30? & due to VT, decrease VT by 50cc Q1 2. Stuporious/confused: responds inappropriately, OD, intoxication until p-plat < 30, but do not let VT get <4cc/kg b. If <25? & VT < ideal VT, increase VT by 3. Semi-comatose: responds only to painful stimuli 4. Comatose: does not respond to painful stimuli 50cc Q1 until ideal VT is reached, so long as p-plat remains < 30. 5. Obtunded: drowsy, maybe decreased cough/gag reflex 5. Pts usually tachypneic, may be uncomfortable, & may fight the ventilator. Increased sedation may be indicated. Respiratorytherapycave.blogspot.com 09/07/2009
Respiratory Therapy: 66 Test Questions Student Respiratory Therapists Get Wrong Every Time: (Volume 1 of 2): Now You Don't Have Too!: Respiratory Therapy Board Exam Preparation, #1
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