ABG treatments?

dadfirst · Aug 28, 2011

What is a max tidal volume without causing damage to the lungs? You see 500-650 as the norm, and in my very young career I haven't questioned that yet.

Thanks for the quick lesson. I love this site because of the access to all of the experience!!!!!!

GreyGull · Aug 28, 2011

We really ought to try to make things as simple (in the sense of well-organized) as possible.
Thanx
PapawJohn

But then over simplification is why some don't understand ABGs the way they should especially if they are in a position to assess and maybe treat.

Over simplification is also why some still use "no more than 2 L for COPD" or toss out something like "hypoxic drive" without of an explanaton thus leaving some patients struggling at 88% and hypoxic.

Over simplification is also what has led to the misuse of the term "high flow" and not taking time to explain inspiratory demand.

Over simplification has led some to believe BiPAP is a life support ventilator and a misunderstanding about the "rate" which is set on it.

Over simplification has led some to believe CPAP pushes lung water out.

Over simplification can lead to a misunderstanding of all the components of the acid-base and fluid/electrolyte systems.

Over simplification has led to a misunderstanding about when to give NaHCO3 for a low pH and when it is total inappropriate.

Over simplification has led some to believe a "normal" or "compensated" ABG means everything is okay or "let's wait and see" without realizing it can very much be like "shock" in a compensated stage. The crash and burn might happen very quickly and some just didn't see it coming because of over simplification.

Instead of always trying for the simplest approach, dissect the information given and study it thoroughly in pieces. ABGs should come after one has some indepth knowledge of fluids, electrolytes, acid-base, cardiac, circulation, BP and the respiratory components. A well structured approach to Anatomy and Physiology will help with this. Unfortunately ABGs are sometimes included with the respiratory section before some of the other components are covered, thus giving some the impression there no more to the story. The analysis of the ABG then becomes very limited.

GreyGull · Aug 28, 2011

What is a max tidal volume without causing damage to the lungs. You see 500-650 as the norm, and in my very young career I haven't questioned that yet.
Thanks for the quick lesson. I love this site because of the access to all of the experience!!!!!!

That would depend on the disease process (underlying and acute), the plateau pressures, the waveforms of the ventilator and at what stage of the acute or recovery/rehabilitative process the patient is in.

ARDS protocols will run from 6- 8 ml/kg (emphasis on plateau pressure as a guide) but will also allow for PEEP to make up the FRC and increase oxygenation.

http://www.ardsnet.org/system/files/6mlcardsmall_2008update_final_JULY2008.pdf

Specific criteria must also be met for ARDS and a package deal including possibly a buffer might be included for the protocol. In extreme cases paralytics might be used for the patient to tolerate the low VT and high RR.

Rehab units (SCI patients) may run from 10 - 20 ml/kg to inprove FRC, lower FiO2 and decrease secretion causing atelectasis and infection.

ORs may run high VTs and lower respiratory rates since they rarely will use PEEP. The ICU will then adjust the VT and RR to maintain the same minute volume achieved in the OR.

dadfirst · Aug 28, 2011

Very cool. I am a new nurse, but love the respiratory pts. I work in progressive care so we get "stable" vents, vision Bi-pap, C-pap. I am in the beginning stages of learning respiratory so thanks for taking time to educate, we need you.

I printed the link and will enjoy studying.

GreyGull · Aug 28, 2011

Very cool. I am a new nurse, but love the respiratory pts. I work in progressive care so we get "stable" vents, vision Bi-pap, C-pap. I am in the beginning stages of learning respiratory so thanks for taking time to educate, we need you.
I printed the link and will enjoy studying.

Then allow me to introduce you to the Philips elearning website. Philips bought Respironics who makes many pieces of RT equipment including the Vision. There is a good Vision inservice and NPPV courses along with ETCO2 and other noninvasive monitoring.

Registration is free and so are most of the courses.

https://theonlinelearningcenter.com/default.aspx

The Vision will be under Philips Hospital Respiratory Care.

The V60 is the next generation but the module is being updated.

NeoPediRN · Aug 28, 2011

Papaj you always give the best explanations for things :)

Do-over, ASN, RN · Aug 28, 2011

Papa and/or Greygull - I hope neither think I was being negative towards any of the more in-depth explanations... However, the OP is a nursing student.

BTW Grey - I had the "hypoxic drive" discussion with someone the other day. My thought is that if you do somehow slow the resps with too much O2 - that is what the Ambu bag is for.

papawjohn · Aug 29, 2011

Ms Do-Over, you are correct and wise. People do NOT die from CO2 narcosis; they die from lack of Oxygen. And the Ambu-bag is your and their best friend-in-need.

PapawJohn

allnurses Guide · Oct 9, 2011

Wow Grey Gull, pardon us here simple folks, shucks.