Most important indicator that a patient has a severe illness?
Tachypnea
3 respiratory types, and their criteria
Hypoxemic (PaO2
... [Show More] <50-60)
Hypercapnic (PaCO2 >50, pH <7.36)
Mixed
Delta gap (formula, when and why it's used)
Difference in AG from normal - Difference in HCO3 from normal
In AG metabolic acidosis it's used. It tells you if there's underlying metabolic alkalosis or respiratory acidosis with bicarb compensation IN ADDITION to the AG metabolic acidosis. Both of those would result in a high bicarb to begin with, and a smaller change in bicarb from normal.
Winter's formula (equation, what it measures)
1.5[HCO3] + 8 +/- 2
If compensation is adequate in acid/base issues
How AG changes with albumin changes
Decreases 2.5-3 for every 1 decrease in albumin
Hemodynamic changes after intubation
Hypo/hypertension
Arrhythmia
Tachycardia
Pressure support equation for BiPAP
IPAP - EPAP
3 types of vent cycles
Volume (preset tidal volume, relieves WOB the most)
Time (constant pressure of time)
Flow (constant pressure until inspiratory flow is below 25% of peak)
Goal tidal volume
10 cc/kg
Goal FiO2 on vent
Start at 1.0, then decrease as SpO2 tolerates (goal of 92-94 saturation)
Ppeak
Peak inspiratory pressure
Pplat (try to keep it below ?)
Inspiratory plateau pressure (shows alveolar distention)
30
AutoPEEP (what it is, what it causes, how to fix it)
Breath stacking
Decreases preload to the heart with positive pressure on the lungs --> hypotension
Decrease RR, decrease inspiration time (goal is to have more time for the lungs to exhale)
Danger of increased PEEP
Increases autoPEEP, increases Pplat
PaO2 we're usually happy with
>60
When to consider NPPV vs invasive
When it's a quickly solved problem in 1-2 days (e.g. COPD exacerbation)
When the patient can be compliant with working with NPPV
When to consider switching from NPPV to invasive ventilation support
If things aren't really improving in a matter of hours
If your therapeutic goals haven't been met in 4-6 hours
Manual decompression (when you use it)
If patient is air trapping like crazy on the vent, and you disconnect it and push up on the patients diaphragm to get everything out
What a high A-a gradient means
V/Q mismatch
Volume assist-control breath (Volume cycled)
Vent delivers preset tidal volume
Pressure assist-control breath (time cycled)
Vent delivers a constant pressure over a preset time
Pressure support breath (flow cycled)
Same as pressure assist-control breaths, but the vent cuts out when the flow rate decreases to 25% of initial peak flow rate
Assist-control ventilation
Either volume or time cycled breaths given
Usually the go to when you just started someone on the vent
Gives the pt a set tidal volume and preset flow rate respiratory rate. Very rigid. However, if the patient wants to take extra breaths if they trigger them.
Pressure support ventilation
Waits for patient to start breath, and then helps out with a set amount of pressure
Synchronized intermittent mandatory ventilation
SIMV
Delivers volume or time cycled breaths at a mandatory rate
Patient can breathe spontaneously between mandatory breaths
Spontaneous breaths count - this allows the patient to contribute to the mandatory tidal volume the machine requires them to breathe
When do you give tPA in ACS?
ONLY for a STEMI, and ONLY when PCI isn't readily available
Tx of an inferior MI
NO nitroglycerin
Give fluids instead
ABG findings in PE
Decreased CO2 (hyperventilating)
Decreased O2 (V/Q mismatch)
When to give tPA in PE
Only for huge ones and heparin's not working
Lovenox class
LMWH
Airway in hematemesis pt
Electively intubate it [Show Less]