Tutoring TMC
Help!
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| Levophep | Vasopressor, increases B/P
Decreases Pressures First
RT has to establish a CVP to administer
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| Norepinephrine | Decreases B/P
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| CVP | 2-6 mmHG
Measures RA pressure
Increased Cor Pul
decreased Vaso dilation
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| Plat | <30
Alveoli
Compliance drops PLAT would increases
Measured at end Inspiration
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| PIP | <40
Upper Airway + Alveoli
Compliance Drops PIP would increases
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| Low Pressure Alarms | Leak, Low Vt, Rupture in ETT or Cuff
Withdraw of ETT
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| High Pressure Alarms | Bitting ETT, Kinking , Secretions, Mucus plug, Pnemo
Right mainstem, Increased/too much Vt due to decreased compliance
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| Pneumothorax | B/P decrease's
Radiolucent-black
Hyperlucency-Black
Tracheal Deviation to opposite side from affected side
Tympanic/Hyyperreasonce
Unequal breath sounds
Unstable- Needle Depression Midclavicular 2-3
Stable- Chest Tube
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| Continuous Bubbling only acceptable in | Drainage seal
In-active Inhalation and exhalation
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| If there is continuous bubbling | Replace Tubing
Notify Physician
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| SBT | Ps/CPAP -30min- 2hrs
HR. RR, WOB, B/P, signs of resp distress
RR >35 for 5 mins (D/C SBT)
HR >130/20% increase for 5 mins or (D/C SBT)
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| RAW | 0.6-2.4 cmH20 (up to 6 for vented pts)
Secretions/Bronchoconstriction
Pip-Plat/Flow (L/S)
Secretions- SXN
Bronchoconstriction- Bronchodilator
If effective PIPS would decrease
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| Pre/Post Bronchodilator Test | Assess for revisability of disease
1st- Get baseline
2nd- Get post measurement
assess increase of 12% in FEV1 & FVC 200 ml
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| Flow loops | if they don't get back to baseline
-Airdropping/Obstruction/Decreased Exhalation
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| Secretions | Course crackles BS
Flow wave form (Snake)
Increased PIP
Vibrations in the chest
Q4 CPT
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| Pul. E | Sudden Desat
Young Kids
Long bone fracture
Rib Fractures
Chest pain
Post Ob pt in long periods of bed rest
Cough Nonproductive if productive it would be hemoptysis
Cyanotic
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| ARDS | P/f ratio <200
Increased PLAT
Refectory Hypoxemia
Ground glass / Honey combing
Increase PEEP Low VT
ARDS net Low Fio2 at 60% and High PEEP
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| when weaning off ARDs net | Drop first FIO2
then
Drop PEEP
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| Normal PEEP | PEEP 4-6 ml/Kg
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| VC | Pressure is SET
MG/GB
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| PC | Volume is SET
ARDS
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| Insp Flow | Increased insp flow it fix air trapping (autoPEEP) and air hunger
it will then Decreased i-Time
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| Increase PIP | Increase VT
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| Decrease MAP | Decrease itime, and Increase PIP
(improves Oxygenation and Improves Distribution of ventilation)
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| IPV | Hyperinflation/High freq pulse delivery
Improves ventilation, Mobilize secretions
Promoter Bronchial Hygiene
Vent Patients (Unconscious Patients)
But if they are in floors they don't qualify ( Unconscious patient)
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| IPPB | Correct Atelectasis
Improves & promotes Cough Mechanism
Follow commands
Surgical Patients
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| Cd | 40-60 cmH20
Measured at Inspiratory Hold and Expriatory
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| Cs | 60-100 cmH20
Measured at Inspiratory Hold
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| ICP | 5-10
to Decease ICP hyperventilate
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| CBC | Hb, Hct, RBC, Platelets
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| Auscultation of the chest | Asses for breathrng Pattern
SOB, Increased RR
Fever
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| Blood Cult | Asses for sepis
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| Confirm ETT | EZ-Cap 5% yellow
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| Position ETT |
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| Placement ETT |
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| Chest Xray findings | Broken Ribs, Diseases,
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| Toxicology Screen | Overdose/Alcohol Use/Pt fall down-Unresponsive
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| LOC | Mental Status
Orientation
Can they Follow commands
GCS >9
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| Integrity of ET and Airway | To asses patency
Increase PIP, Decrease PIP -Proper placement
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| Nasal SX | Weak/nonproductive cough
IF they are desating and large of continuous of secretion consider Intubation
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| Patient on 3L NC smoking leads to fire brought in brought by ambulant | NRB
Co-ximetry /hemoximeterr
Pink Cherry Red
Sp02 100% inaccurate
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| 12 ECG | Chest Pain
Increased HR
Cardiac Arrthtymias
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| Check electrolytes in what type of patients | Weak patients /nuromuscular disorders
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| If PIPs are high what do you give | Bronchodilator
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