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Vent 101 Everything You Need to Know About Ventilators on One Whiteboard Vent 101 Everything You Need to Know About Ventilators on One Whiteboard

Vent 101 Everything You Need to Know About Ventilators on One Whiteboard - PowerPoint Presentation

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Vent 101 Everything You Need to Know About Ventilators on One Whiteboard - PPT Presentation

Really Doug Powell MD 4BN 3SFG A Surgeon Prolonged Field Care Working Group Staff Intensivist Womack Army Med Center Pathology of Respiratory Failure Hypoxic stuff in alveoli ID: 931463

benefits risks vent chest risks benefits chest vent respiratory tube pressure suction breathe rate increase stuff tidal oxygenation peep

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Slide1

Vent 101Everything You Need to Know About Ventilators on One Whiteboard

(Really)

Doug Powell, M.D.

4BN 3SFG (A) Surgeon

Prolonged Field Care Working Group

Staff

Intensivist

, Womack Army Med Center

Slide2

Pathology of Respiratory Failure

Hypoxic:

“stuff in alveoli”

Water: pulmonary edema

Pus: pneumonia

Blood: alveolar hemorrhage (rare)

Protein: ARDS

Collapsed alveoli: atelectasis

Slide3

Pathology of Respiratory Failure

Hypercapic

Won’t breathe

CNS: drugs! > injury, stroke, OSA, OHS, hypothermia

Can’t breathe

Peripheral nervous system (

Guillian

Barre

)

Respiratory muscles (

myesthenia

gravis

)

Chest wall, pleura (burn

eschar

, flail chest)

Upper airway (trauma, mass, edema compressing)

Can’t breathe enough

(PE, exacerbation of asthma, COPD)

Slide4

Physiology - ComplianceCauses problems with OXYGENATION

Intrinsic: Stuff in alveoli

Air > Water

> Blood

> Pus

> Protein

>> decreasing compliance/ harder to oxygenate >>

Extrinsic: Stuff outside of lungs

Body mass (obesity)

Rigid chest (

eschar

, paralysis

acutely)

Slide5

Ventilators on 1 Page

Slide6

The Only Vent Settings You Need to Know

Low tidal volume, volume assist control

(AC-V)

Tidal Volume (

Vt

): 6

8 cc/ kg (ideal body weight)

Rate: 14 (physiologic)

FiO2: 100% (turn down based on

pulseOx

)

PEEP: 5

Slide7

Monitoring

Clinical parameters

Respiratory rate (spontaneous)

Comfort

Chest, abdomen rise/ fall together

Cough, gagging

SpO2

(saturation of peripheral oxygenation/ Pulse Ox):

Goal: > 90%

ETCO2 (end

tidal CO2)

Goal: 40mmHg

Slide8

Problems w/OxygenationIncrease PEEP

Benefits: comfortable,

works without supplemental O2!

Risks: pressure overload, barotrauma

Increase FiO2 (i.e., crank the oxygen up)

Benefits: fast

Risks: burns through supplies, free radical toxicity (~ > 60%/ > 24 hours)

Slide9

Problems with CO2Increase

Vt

: never > 10cc/kg w/o consult

Benefits: it works

Risks:

volu

-trauma, increased mortality

Increase rate

Benefits: no risks

Risks: none

Slide10

Troubleshooting Vent

Pressure alarm

causes: treatments

Tube blocked: secretions, mucus plug

suction patient

Tube kinked: bite block (tape roll)

Bronchospasm: give albuterol

Abdominal pressure: place NG/ OG tube

Auto-peep: disconnect circuit

Uncertain: disconnect circuit

Patient uncomfortable:

Increase sedation (if ketamine, give Versed IV)

Telemedicine: if possible, send video clip

Slide11

Vent CareMouth care:

Vaseline lips

Move tube one side to other

Mouth/ tooth cleaning

Positioning: HOB 30 degrees (if possible)

Secretions: monitor for and suction

Don’t suction if you don’t need to (gurgling, pressure alarm, decreasing oxygenation)