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Tagum, Carmi Russel H. CSPC BSN-4B Mechanical Ventilation is a method to mechanically assist or replace spontaneous breathing.

This may involve a machine called a ventilator or the breathing may be assisted by a physician or other suitable person compressing a bag or set of bellows. Traditionally divided into negative-pressure ventilation, where air is essentially sucked into the lungs, or positive pressure ventilation, where air (or another gas mix) is pushed into the trachea.

Why does mechanical ventilation need to be used? There are two reasons why mechanical ventilation may be used. The first is for surgery. The second is when someone gets so sick that they can't breathe on their own. With many types of surgeries, general anesthesia is used. This is when you're "put to sleep" so that you don't remember any of the operation. Usually, a ventilator breathes for you during the operation. After it's over, you may be in the recovery area breathing on your own. In some cases, you may still rely on the ventilator to breathe for you after the surgery is over. This is common in heart and lung surgeries as well as other major operations. Sometimes, people may get sick with pneumonia. If they get so ill that they can't breathe on their own, a ventilator may be used to help them. A plastic breathing tube may be put into the mouth or nose. This tube gets connected to a

ventilator, which then does all the work. In most cases, there's no way of knowing how long the patient will need the ventilator. How does a ventilator work? The ventilator works by pushing air into the lungs. Using a built-in computer, it mixes different levels of oxygen and pressures of air. You can also change how fast it breathes and how much air it uses. The machine pushes the air into the tube that goes to the lungs.

Preparation The patient's respiratory status must be stable and they must be arousable and able to follow commands prior to initiating weaning. Patients who require mechanical ventilation are often kept sedated or even paralyzed with drugs to facilitate optimal ventilation. These drugs must be tapered off prior to weaning. Weaning criteria should be done to determine the patient's readiness to wean. The best indicators include a vital capacity of at least 10-15 cc/kg and a negative inspiratory fraction of greater than -30 cm H2O, however, many other factors are also measured. The patient should be suctioned prior to any weaning attempt, both orally and via the endotracheal tube or tracheostomy. A pulse oximeter and cardiac monitor should be applied if they are not already present. Weaning should be done when there is adequate staffing so the patient can be closely monitored. Aftercare The patient's respiratory status should be assessed after any period of weaning. The ventilator should be securely reconnected and the patient made comfortable and reassured if necessary.

Health care team roles The nurse and respiratory therapist share equal roles in ventilator management. Both are responsible for suctioning and monitoring the patient during weaning periods. Since the nurse is at the bedside the most, they have the primary monitoring role and are often able to predict the best time for a weaning trial. It is the nurse's responsibility to communicate with the respiratory therapist in planning when weaning trials will occur. The respiratory therapist is generally responsible for making the actual ventilator changes. Both the nurse and respiratory therapist document the ventilator change and their assessment of the patient's respiratory status before, during, and after the weaning period. Both are responsible for teaching and reassuring the patient and family regarding the weaning process. Patients may be fearful about weaning because it is difficult for them to communicate around the endotracheal tube or tracheostomy. They may be afraid no one will know if they're having difficulty breathing. The nurse should explain all procedures before performing them, reassure the patient that they will be closely monitored, and ensure that the patient's call light is within reach. It is important that the patient actually see the nurse enter the room frequently, as this is the only way they will know they are being monitored.

Defibrillation

Definition Defibrillation is a process in which an electronic device sends an electric shock to the heart to stop an extremely rapid, irregular heartbeat, and restore the normal heart rhythm. Purpose Defibrillation is performed to correct life-threatening fibrillations of the heart, which could result in cardiac arrest. It should be performed immediately after identifying that the patient is experiencing a cardiac emergency, has no pulse, and is unresponsive.

Precautions Defibrillation should not be performed on a patient who has a pulse or is alert, as this could cause a lethal heart rhythm disturbance or cardiac arrest. The paddles used in the procedure should not be placed on a woman's breasts or over a pacemaker. Description Fibrillations cause the heart to stop pumping blood, leading to brain damage and/or cardiac arrest. About 10% of the ability to restart the heart is lost with every minute that the heart stays in fibrillation. Death can occur in minutes unless the normal heart rhythm is restored through defibrillation. Defibrillators deliver a brief electric shock to the heart, which enables the heart's natural pacemaker to regain control and establish a normal heart rhythm. The defibrillator is an electronic device with electrocardiogram leads and paddles. During defibrillation, the paddles are placed on the patient's chest, caregivers stand back, and the electric shock is delivered. The patient's pulse and heart rhythm are continually monitored. Medications to treat possible causes of the abnormal heart rhythm may be administered. Defibrillation continues until the patient's condition stabilizes or the procedure is ordered to be discontinued.

Preparation After help is called for, cardiopulmonary resuscitation (CPR) is begun and continued until the caregivers arrive and set up the defibrillator. Electrocardiogram leads are attached to the patient's chest. Gel or paste is applied to the defibrillator paddles, or two gel pads are placed on the patient's chest. The caregivers verify lack of a pulse, and select a charge.

Placement Resuscitation electrodes are placed according to one of two schemes. The anterior-posterior scheme (conf. image) is the preferred scheme for long-term electrode placement. One electrode is placed over the left precordium (the lower part of the chest, in front of the heart). The other electrode is placed on the back, behind the heart in the region between the scapula. This placement is preferred because it is best for noninvasive pacing. The anterior-apex scheme can be used when the anterior-posterior scheme is inconvenient or unnecessary. In this scheme, the anterior electrode is placed on the right, below the clavicle. The apex electrode is applied to the left side of the patient, just below and to the left of the pectoral muscle. This scheme works well for defibrillation and cardioversion, as well as for monitoring an ECG. Aftercare After defibrillation, the patient's cardiac status, breathing, and vital signs are monitored until he or she is stable. Typically, this monitoring takes place after the patient has been removed to an intensive care or cardiac care unit in a hospital. An electrocardiogram and chest x ray are taken. The patient's skin is cleansed to remove gel or paste, and, if necessary, ointment is applied to burns. An intravenous line provides additional medication, as needed.