GUIDE • Mark Klimek’s Lecture
Lecture 1— Acid-Base Balance Dumping/HH
Ventilators Electrolytes: K+, CA, MG,
and NA
Lecture 2— Alcohol TX for HyperKalemia
Wernicke
Overdose and Withdrawal Lecture 7— Thyroid (Hyper-, Hypo-)
S/Sx Adrenal Cortex (Addison
Aminoglycosides Disease, Cushing)
Peak and Trough Toys
Laminectomy
Lecture 3— Drug Toxicities (Lithium,
Lanoxin, Dilantin, Bilirubin, Lecture 8— Lab Values
Aminophylline) Five Deadly Ds
Kernicterus Neutropenic Precaution
Dumping/HH
Electrolytes: K+, CA, MG, Lecture 9— Psych Drugs
and NA Tri
TX for HyperKalemia Benzo
MAOI
Lecture 4— Crutches Lithium
Canes Prozac
Walkers Haldol
Delusions Clozaril
Hallucinations Zoloft
Psychosis
Psychotic and Non-Psychotic Lecture 10— Maternity and Neonatology
Hallucination
Illusion Lecture 11— Fetal Complications
Delusion Stages of Labor
Assessments
Lecture 5— Diabetes Mellitus Variations for NB
Diabetes Insipidus Maternity Meds
SIADH Medication Hints
Insulin Psych Tips
DKA Operational Stages
HHNK
Lecture 12— Prioritization
Lecture 6— Drug Toxicities (Lithium, Delegation
Lanoxin, Dilantin, Bilirubin, Staff Management
Aminophylline) Guessing Strategies
Kernicterus
Page 1 of 92
,Page 2 of 92
, Lecture 1 • Mark Klimek • 92:21
Acid/Base Balance (Start times: 30:00)
In order to solve acid-base disorders, it is
important to know the normal values for
pH, CO2 and HCO3 (bicarbonate), which
are shown below
• pH 7.35 to 7.45
• CO2 35 to 45
• HCO3 22 to 26
The first value to look at in an acid-base
disorder is the pH
• If pH is <7.35, the acid-base imbalance
is acidotic
• If pH is <7.45, the acid-base imbalance
is alkalotic
Now, to determine if the imbalance is metabolic or respiratory, determine whether HCO3 goes
in the same or opposite direction with pH
• Rule of the Bs: If pH and Bicarb move both in the same direction, then the acid-base
=
imbalance is metabolic … Otherwise, it is respiratory ROME
E
Example #1
• pH 7.3 Acidotic d
• HCO3 20 Metabolic ↓
• This is an example of metabolic acidosis When pH gos use
>
-
pt you up
Example #2
• pH 7.58 Alkalotic ↑
When p H gor
down >
-
pt gor d
• HCO3 32 Metabolic↑
• This is an example of metabolic alkalosis
Example #3
• pH 7.22 Acidosis ↓
• HCO3 35 Respiratory N
• This is an example of respiratory acidosis
As the pH goes, so goes my patient, except for Potassium … That means 43 : 40
• If pH is low, everything is low, except potassium
• If pH is high, everything is high, except potassium
Page 3 of 92
, Ventilator lil
A ventilator is a machine designed to move breathable air into and out of the lungs, aids patients
who are physically unable to breathe, or breathing insufficiently to breathe … A ventilators is
equipped with a high and a low-pressure alarm
High pressures alarms are
always triggered by increased
push resistance to air flow. Look
for obstructions, i.e.,
• Kinks in tubing …
Solution: unkink the tube
• Condensed water in the
dependent tube …
Solution: empty it
• Mucus plugs … Solution:
Ask pt to turn, cough, deep
breathe; or suction the
tubing PRN
What is the appropriate order
to address high pressure alarm
in a mechanical ventilator?
• (1) Unkink. (2) Empty
water out of tubing. (3) turn pt, ask pt to cough or deeply breathe, and (4) suction
Low pressures alarms are always triggered by decrease in resistance. This can be caused by
• Main tubing disconnection
• O2 sensor tube disconnection
• In both cases, reconnect the disconnected tubing unless tube is on floor … Bag pt and call
Respiratory Therapist
The ventilator may be set too high or too low
• Setting is too high … Pt is overventilated
o Respiratory Alkalosis … Panting
• Setting is too low … Pt is underventilated
o Respiratory Acidosis … Pt is retaining CO2
Question
The physician wants to wean pt off vent in the morning. At 6 am, the ABGs say respiratory
acidosis. What would you do next?
• Notify the physician that the pt is not ready to be weaned off the respirator
o Pt is is respiratory acidosis, which means that he is underventilated … Therefore not ready
to be weaned off the ventilator
o If pt were in respiratory alkalosis (overventilated), he should be ready to be weaned off
Page 5 of 92
Lecture 1— Acid-Base Balance Dumping/HH
Ventilators Electrolytes: K+, CA, MG,
and NA
Lecture 2— Alcohol TX for HyperKalemia
Wernicke
Overdose and Withdrawal Lecture 7— Thyroid (Hyper-, Hypo-)
S/Sx Adrenal Cortex (Addison
Aminoglycosides Disease, Cushing)
Peak and Trough Toys
Laminectomy
Lecture 3— Drug Toxicities (Lithium,
Lanoxin, Dilantin, Bilirubin, Lecture 8— Lab Values
Aminophylline) Five Deadly Ds
Kernicterus Neutropenic Precaution
Dumping/HH
Electrolytes: K+, CA, MG, Lecture 9— Psych Drugs
and NA Tri
TX for HyperKalemia Benzo
MAOI
Lecture 4— Crutches Lithium
Canes Prozac
Walkers Haldol
Delusions Clozaril
Hallucinations Zoloft
Psychosis
Psychotic and Non-Psychotic Lecture 10— Maternity and Neonatology
Hallucination
Illusion Lecture 11— Fetal Complications
Delusion Stages of Labor
Assessments
Lecture 5— Diabetes Mellitus Variations for NB
Diabetes Insipidus Maternity Meds
SIADH Medication Hints
Insulin Psych Tips
DKA Operational Stages
HHNK
Lecture 12— Prioritization
Lecture 6— Drug Toxicities (Lithium, Delegation
Lanoxin, Dilantin, Bilirubin, Staff Management
Aminophylline) Guessing Strategies
Kernicterus
Page 1 of 92
,Page 2 of 92
, Lecture 1 • Mark Klimek • 92:21
Acid/Base Balance (Start times: 30:00)
In order to solve acid-base disorders, it is
important to know the normal values for
pH, CO2 and HCO3 (bicarbonate), which
are shown below
• pH 7.35 to 7.45
• CO2 35 to 45
• HCO3 22 to 26
The first value to look at in an acid-base
disorder is the pH
• If pH is <7.35, the acid-base imbalance
is acidotic
• If pH is <7.45, the acid-base imbalance
is alkalotic
Now, to determine if the imbalance is metabolic or respiratory, determine whether HCO3 goes
in the same or opposite direction with pH
• Rule of the Bs: If pH and Bicarb move both in the same direction, then the acid-base
=
imbalance is metabolic … Otherwise, it is respiratory ROME
E
Example #1
• pH 7.3 Acidotic d
• HCO3 20 Metabolic ↓
• This is an example of metabolic acidosis When pH gos use
>
-
pt you up
Example #2
• pH 7.58 Alkalotic ↑
When p H gor
down >
-
pt gor d
• HCO3 32 Metabolic↑
• This is an example of metabolic alkalosis
Example #3
• pH 7.22 Acidosis ↓
• HCO3 35 Respiratory N
• This is an example of respiratory acidosis
As the pH goes, so goes my patient, except for Potassium … That means 43 : 40
• If pH is low, everything is low, except potassium
• If pH is high, everything is high, except potassium
Page 3 of 92
, Ventilator lil
A ventilator is a machine designed to move breathable air into and out of the lungs, aids patients
who are physically unable to breathe, or breathing insufficiently to breathe … A ventilators is
equipped with a high and a low-pressure alarm
High pressures alarms are
always triggered by increased
push resistance to air flow. Look
for obstructions, i.e.,
• Kinks in tubing …
Solution: unkink the tube
• Condensed water in the
dependent tube …
Solution: empty it
• Mucus plugs … Solution:
Ask pt to turn, cough, deep
breathe; or suction the
tubing PRN
What is the appropriate order
to address high pressure alarm
in a mechanical ventilator?
• (1) Unkink. (2) Empty
water out of tubing. (3) turn pt, ask pt to cough or deeply breathe, and (4) suction
Low pressures alarms are always triggered by decrease in resistance. This can be caused by
• Main tubing disconnection
• O2 sensor tube disconnection
• In both cases, reconnect the disconnected tubing unless tube is on floor … Bag pt and call
Respiratory Therapist
The ventilator may be set too high or too low
• Setting is too high … Pt is overventilated
o Respiratory Alkalosis … Panting
• Setting is too low … Pt is underventilated
o Respiratory Acidosis … Pt is retaining CO2
Question
The physician wants to wean pt off vent in the morning. At 6 am, the ABGs say respiratory
acidosis. What would you do next?
• Notify the physician that the pt is not ready to be weaned off the respirator
o Pt is is respiratory acidosis, which means that he is underventilated … Therefore not ready
to be weaned off the ventilator
o If pt were in respiratory alkalosis (overventilated), he should be ready to be weaned off
Page 5 of 92
