dmc_rrt

We teach all our long term trach pts to use these, or sterile saline through a syringe, when they need to clear their secretions. Its NBD

You can usually hear the different breath sounds with a vent. I don't know the circumstances, but rapid gunshots arn't normal vent sounds. I think you were probably hearing circuit noise. perhaps there was water in it?

Simply put: Resp distress, which is increased WOB, will lead to resp failure when the muscles can no longer do the work. similar to untrained legs trying to run a marathon. ARDS is filling of the alveoli with protiens leading to poor lung compliance. the muscles have to work harder to ventilate. This will lead to resp failure.

If the Hypoxic Drive to Breath theory is correct, it should happen immediatly as soon as the PaO2 becomes greater then 60mmhg. When the PaO2 is less than 60mmhg the peripheral O2 recepters kick in. As stated earlier PaO2 60mmhg = Sats of 90% (Approx.). COPDers rely on the PaO2 receptors for their drive to breath, unlike pts with normal lung function that rely on the CO2 receptors.

I agree with you, that oxygen toxicity does not fit. How can you get oxygen toxicity if you ventilate your pt with high volumes or pressures on an FiO2 of .21? High pressures and volumes do release inflamitory mediators in the lungs, and I would assume therefore increase the susceptibility of pneumonia, much the same way that asthmatics and COPDers are more susceptible to lung infections.

They might do a pharynoscopy to assess to compentency of the Larynx. This looks like a small bronchoscope.

As an RT I would definetly put the pt. on the NRB. Actually it sounds like the pt needed BiPap more then anything. I have never seen a COPDer stop breathing from too much O2, and if it does you remove the O2, and soon the pt will start breathing again(according to theory).

I understand she was palliative, so the main objective here is to make the pt. and her family comfortable. The removal of O2 should not have been a problem, the lack of proper sedation is more of a problem.

Here is the ARDSnet protcol: NHLBI ARDS Network INCLUSION CRITERIA: Acute onset of ,Tahoma],Tahoma]1. PaO2/FiO2 ≤ 300 (corrected for altitude) ,Tahoma],Tahoma]2. Bilateral (patchy, diffuse, or homogeneous) infiltrates consistent with pulmonary edema ,Tahoma],Tahoma]3. No clinical evidence of left atrial hypertension ,Tahoma] If a patient has the following we ventilate as per the ARDSnet Protocol

I say the Doc's retty lucky to have you there. I place femoral Central Lines and Have to get my own stuff together, and I am usually left alone, unlesss someone wants to watch. Tell him to quit his ********.

Coorifice crackles on expiration are usually due to secretions. I find that most pleural effusions present as diminished breath sounds. Remember the fluid is gravity dependant and will usually collect at the bases when the pt is sitting upright and along the back when lying supine. I find that pleural rubs are not that common.

Funny, an ER RN and myself were just talking about it this morning

For cost effectiveness, my hospital has those mouth-to-mouth thingys, which to my own personal opinion are a joke. I have yet to see them used effectivly at the beggining of a code. The pt is blue, as the Crash Cart is pulled over, so that proper vents can be given with the ambu bag. My last hospital I was at had an ambu bag stationed every 30 feet throughout the hospital. Felt a lot better knowing there were baggers near buy.

I've seen quite a few Drs. wear them too. they are all respected Pts. and peers.

I have one pt that uses his i-touch