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

I agee with dano. Prior to intubation, if the pt can hold their sats close to 100% by breathing on their own, then use the NRBM. Bagging can cause increased anxiety, and gastric insufflation.

I think that it means to sort through the BS of what you're tought, and find out for yourself what is real. Just because a teacher or a book tells you something doesn't make it true. This is why it is also important to critique research on your own, and not to rely on a journal publishing "good" studies.

Some of tythis stuff might have already been covered, but here's my 2 bits: 1. Get the bed ready, away from the wall, raisednup to about belly button level. 2. Suction ready 3. Pt on 100% O2 4. BP cuff on arm that does not have IV access in it. 5. Get ready to bolus pt with sedation, paralytics, pressors, fluid (Every Dr is different with what thaey want, depending on the type of pt they will be intubating) 6. have masks, face protection ready for staff assisting with intubation Gotta go now hope this helps

I would write up an incident report in regards to the lack of training by the MRI/ ultrasound staff. Any person in the hospital should know that sats of 40% is not acceptable. They should have called you for an assessment. As for calming down after a code, that just comes with more practice. I was told once that the first thing you do at a code is check your own pulse . That goes along way to keeping yourself calm along with the code team if needed.

Your plastic tank sounds like a refillable liquid O2 tank. The plastic housing can get banged up, but it is there to protect the metal tank inside.

We have a 14 bed ICU. We don't offer PRISMA, HFOV, ECMO, we have NO but have not used it in 3 yrs. Any heart pts get transferred out to other hospitals for surgery. Our long term vents get transferred to general wards, until they can be placed in long term care facilities in approx. 6 mnths.

I noticed when I suction my vegatative trach pts that it also seems to trigger a yawn.

Ok, I'm trying to follow this thread, but its a little confusing. PEEP is the constant, base level, minimum pressure applied to the lungs by the vent, helping to splint the airways open. Inspiratory Pressure is indeed added on top of that, when a pressure or volume is delivered. Plateau Pressure is the pressure applied to the lungs at end inspiration, with no flow occuring(why we do the insp. hold). Peak Inspiratory Pressure includes pressure due to flow. Peak Inspiratory Pressure(PIP) is a combination of the driving pressure(flow) and plateau Pressure. Plateau pressure reading includes PEEP. Static compliance tells us how "healthy" the lungs are. For a certain volume should exert, or create a pressure in the lungs. ARDS = 25mls per cmH2O pressure, normal lungs = 80 mls per cmH2O pressure exerted. Does this help?

Sorry about your Sister in Law, She sounds very sick. I don't know all the parts to this story, but here is my two bits:My guess is that the acidosis is probably caused by increased urea(ARF) and/or increased lactate from the liver failure. After two weeks she is ready for a trach. Sounds like your SIL has ARDS, which can take a long time to recover from. I would say that your SIL is probably far from being weaned from the vent. Paralysis and increased sedation will be required to improve ventilation and oxygenation. ECMO could be worth a try. I have seen people pull through ARDS after many weeks of being on the vent, but there are many factors to take into account.

under the connector hub of the ETT are the numbers, they are hard to see. A trick is to press your bare finger underneath the flange. The numbers will be pressed into your skin and you can then read them.