Mark Klimek Audio Tapes 1-12
ACID BASE BALANCE
1. Rule of B’s
a. If the pH and the Bicarb are Both in the same direction, then it is
metabolic
2.
... [Show More] Signs and Symptoms
a. As the pH goes, so goes my patient, except for potassium
i. as pH goes up, systems gets irritable
ii. as pH goes down, systems shut down
1. UP pH (Alkalosis)
a. HTN
b. Tachycardia
c. Tachypnea
d. Seizures
e. Irritability
f. Spastic
g. Diarrhea
h. Borborygme
i. Hyperreflexia, (3,4)
j. Hypokalemia
2. DOWN pH (Acidosis)
a. Hypotension
b. Bradycardia
c. Constipation
d. Absent bowel sounds
e. Flaccid
f. Bradypnea
g. Hyperkalemia
h. Lethargy
i. Obtunded (one step down from lethargy)
j. Paralytic ileus
k. Coma
l. Respiratory arrest
b. MacKussmaul
i. The only acid base to cause Kussmaul respirations is Metabolic
Acidosis
3. Causes
a. First ask yourself, “Is it lung?” If yes, then it’s respiratory. Then ask
yourself: “Are they overventilating or underventilating. If
overventilating, pick alkalosis. If underventilating, pick acidosis.
b. If it is not lung, then it is metabolic. If the patient has prolonged
gastric vomiting or suction, pick alkalosis. For everything else that
isn’t lung, pick metabolic acidosis. When you don’t know what to
pick, choose metabolic acidosis.
VENTILATORS
1. High pressure alarms are triggered by increased resistance to air flow.
2. High pressure alarms are triggered by resistance to airflow and can be
caused by obstructions of 3 types: kinked tube, (unkink) action, water in
tube (empty) action, mucus in airway (turn, cough and deep breathe)
action. Lastly suction
3. Low pressure alarms are triggered by decrease resistance to airflow and can
be caused by disconnections of the tubing (reconnect it) or oxygen sensor
tube (reconnect it UNLESS tube is on the floor- bag them and call RT if
this happens) (black coated wirey tubing that piggy backs the tubing,
measure FiO2)
4. Respiratory alkalosis means the ventilator settings may be too high.
5. Respiratory acidosis means the ventilator settings may be too low.
6. What does “wean” mean? Gradually decrease with the goal of getting off
altogether
Mark Klimek Audio Tape 2 [Show Less]