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Mech Vent and ARDS

Mechanical Ventilation and ARDS

Bilevel Positive Airway Pressure (Bi-PAP) noninvasive; patient must breath spontaneously and cooperate; most often for pts with sleep apnea or pulmonary issues; if pt is on it for 4hrs and no change then it will probably not work for them
Rapid Sequence Intubation rapid, concurrent administration of a paralytic agent and a sedative during emergency airway management
Who can intubate? NURSES can not! Respiratory therapists only intubat NICU babies; acute care practitioners are ok to intubate, care flight nurses can intubate if all else fails
Hemodynamic stability with Intubation b/c pt with respiratory failure have been in fight mode, be prepared for the BP to totally bottom out (due to vasodilation), have a liter of saline just in casey you have to bring that BP back up!
Suctioning you can hyperoxygenate but do not hyperventilate; rule of thumb hold breath while suctioning pt so you know when to stop
Saline Bullets pink and usually contain 10ml; they are not used to loosen secreation b/c there is not enough saline to help with loosening; it acutally stimulate carina to initiate cough, also helps prevents rust on catheter
Mechanical Ventilation 21%(room air) is moved into and out of lungs by a mechanical ventilator
Indications of Mechanical Ventilation apnea or impending inability to breathe; acute respiratory failure; severe hypoxia; respiratory muscle fatigue
Assist Control patient receives a set amount of respirations and set volume; if they breath about amoungt of respirations they stil get same amount of volume (so the rest is whatever they can pull from atmosphere); start questioning if pt can be pulled off ventilator
Prone Positioning "recruiting the lungs"; when you prone somebody you float their lungs which recruits air space; if there is no improvement within a few hrs than this will probably not work for the patient
Tracheostomy surgical incision into the trachea to establish an airway that results in a stoma
Advantages of a tracheostomy less risk of long-term damage to airway; increased comfort; patient can eat; increase mobility because tube is more secure
Speech with Tracheostomy passing murror valves allow air to pass over vocal cords which allows speech to occur; usually only able to have this done for 10-15 minutes, b/c pt can only tolerate it for so long
Decannulation when patient can adequately exchange air and expectorate; stoma closed with tape and occlusive dressing; trachs begin to heal within 24-48hrs, they heal from inside, out creating fibrin tissue
Acute Respiratory Distress Syndrome sudden progressive form of acute respiratory failure; alveoli fill with fluid (intravascular fluid) which allows no oxygen exchange
Characteristics of ARDS severe dyspnea/tachypnea; hypoxia/hypoxemia; decreased lung compliance; alveolar collapse; diffuse pulmonary infiltrates
Direct Mechanisms (Injury) of ARDS aspirationg of gastric contents; pneumonia; toxic inhalation; pulmonary contusion or PE; O2 toxicity; near-drowning; radiation
Indirect Mechanisms (Injury) of ARDS *spesis*; trauma; massive transfusion; pancreatitis; drug OD; burns; DIC; shock; something outside the lungs has caused a histamine/cytokine release, which starts to destroy lung tissue
Pancreatitis: the pancreas releases a lot of juices and they flood in everywhere (the diaphragm squeezes up to avoid the juices), causes the lungs to not fully expand which leads to atelectasis in the bases
Whose at risk for ARDS? anyone with a respiratory illness
How do you know its ARDS? Initial Hypoxemia and Respiratory Alkalosis then Respiratory Acidosis; Pulse Ox: body is starting to vasconstrict, and trying to pull all the O2 it can and bring it back to the core; less O2 to the extremities
Created by: sydleigh