CSE notes
COPD zWeaning zscenario. zIf zyour zscenario zopens zwith zCOPD zon zlow zsettings zon zthe zvent. z- zAnswer z-
zSteps: zWeaning, zSBT zand zthen zExtubate. zCan zstart zweaning zif zRSBI zis z< z105 zand zVT, zVC z> z700mL
zNIF/MIP, zRR, zLOC, zVitals, zand zABG zis zgood. zIf zpatient zis zGOOD zStart zSBT zwith? zPSV z< z10 zor zT-piece zwith
zan zFiO2 zof z< z40% zand zPEEP z<10. zIF zGOOD zON zTHIS zSTEP znext zis? zExtubate zto z2 zLPM zor z28%/titrate
z(SpO2 z88-92). zIf zhowever zBAD: zDo znot zstart zSBT zand zif zpt zneeds zLong zterm zMV z(SIMV zmode).
zREMEMBER: zIf zRSBI zis z< z105 zand zthe zrest zof zweaning zparameters zare zborderline, zit zis zokay zto zextubate
zyour zpatient.
COPD zIntubate zand zMV zyour zpatient.. z- zAnswer z- zFiO2 z40-60% zor zsame zFiO2 zthey zwere zon. z10-14 zRR.
zVT z5-8 zmL/kg z(350-500) zPEEP z0-5 zcmH2O. zCheck zMinute zVentilation z5-8 zLPM.
How zto zfix zair-trapping z- zAnswer z- zDecrease zi-time, zIncrease zI:E, zIncrease zFlow z(if zon zVC zmode).
zDecrease zRR, zVT. z
REMEMBER ztho: zIf zthe zpt zcan't ztrigger zthe zvent, zthen zyou zwant zto zadd zPEEP.
Troubleshooting zLow zVT, zPIP, zMinute zVentilation.. z- zAnswer z- zIt zmeans zthere's za zleak. zCheck: zTubing,
zalarms, zcuff, zexhalation zvalve zfor zleaks, zexhaled ztidal zvolume z(no zmore zthan z25-50).
Troubleshooting zHigh zPIPs.. z- zAnswer z- zIt zmeans zthere's zan zobstruction. zCheck: zsuction, zmucus zplugs,
zkink zin ztube, zpeak zpressures, zexhalation zvalves zfor zobstruction.
REMEMBER zto zNever zpick: zCheck zFiO2 zanalyzer/check zoxygen zand zgas zconnections, zchange
zalarms/silence, zor zcircuit zcompliance.
COPD z- zNIPPV zand/or zMedical zTreatment zin zthe zhospital. zie: zCOPD zpt zin zthe zER zneeds zBiPAP zor zother
zrespiratory ztreatment z- zAnswer z- zThere zwill zbe za zlot zof zinformation zgathering. zStart zNIPPV zwhen zits
zappropriate, zAdjust zyour zoxygen zas zneeded zto zmaintain zSpO2 zof z88-92%. zFiO2 zat z2L zor z28%, zif zboth zis
zan zoption, zchoose zVenti zMask. zPatiens zmay zbe ztrached zin zthese zscenarios. zNo zSpiriva zfor ztrach
zpatients. zOrder zEKG's zand zyou'll zsee zright zaccess zdeviation zand zCor zPulmonale.
Breathing ztreatments zfor zCOPD. z- zAnswer z- zSteroids, zA+A, zadd zLABA, zICS z(going zhome). zIV zsteroids zie:
zSolumedrol, zand zthen zAntibiotics z(If zIncreased zfever zand zWBCs).
COPD zOutpatient zmanagement. z- zAnswer z- zYou zwant zto zthink zabout: zPulmonary zRehab, zSmoking
zcessation, zPatient zEducation, zHome zO2 zConcentrator. zPulse zdose z- zgood zfor zmobile zand ztraveling,
zMaintenance z- zchange zfilters. zTroubleshooting z- zgo zto zback zup ztank. zIf ztraveling z- zuse za zportable zO2
zconcentrator. z
PFTs, zVaccines z(ie: zFlu, zPneumococcal, zbut zdon't zpick zHep zB). zFluids, zcall zMD zif zswelling, zLABA/ICS,
zLAMA, zand zNever zpick z"stop zmeds zof ztitrate"
COPD zWeaning zscenario. zIf zyour zscenario zopens zwith zCOPD zon zlow zsettings zon zthe zvent. z- zAnswer z-
zSteps: zWeaning, zSBT zand zthen zExtubate. zCan zstart zweaning zif zRSBI zis z< z105 zand zVT, zVC z> z700mL
zNIF/MIP, zRR, zLOC, zVitals, zand zABG zis zgood. zIf zpatient zis zGOOD zStart zSBT zwith? zPSV z< z10 zor zT-piece zwith
zan zFiO2 zof z< z40% zand zPEEP z<10. zIF zGOOD zON zTHIS zSTEP znext zis? zExtubate zto z2 zLPM zor z28%/titrate
z(SpO2 z88-92). zIf zhowever zBAD: zDo znot zstart zSBT zand zif zpt zneeds zLong zterm zMV z(SIMV zmode).
zREMEMBER: zIf zRSBI zis z< z105 zand zthe zrest zof zweaning zparameters zare zborderline, zit zis zokay zto zextubate
zyour zpatient.
COPD zIntubate zand zMV zyour zpatient.. z- zAnswer z- zFiO2 z40-60% zor zsame zFiO2 zthey zwere zon. z10-14 zRR.
zVT z5-8 zmL/kg z(350-500) zPEEP z0-5 zcmH2O. zCheck zMinute zVentilation z5-8 zLPM.
How zto zfix zair-trapping z- zAnswer z- zDecrease zi-time, zIncrease zI:E, zIncrease zFlow z(if zon zVC zmode).
zDecrease zRR, zVT. z
REMEMBER ztho: zIf zthe zpt zcan't ztrigger zthe zvent, zthen zyou zwant zto zadd zPEEP.
Troubleshooting zLow zVT, zPIP, zMinute zVentilation.. z- zAnswer z- zIt zmeans zthere's za zleak. zCheck: zTubing,
zalarms, zcuff, zexhalation zvalve zfor zleaks, zexhaled ztidal zvolume z(no zmore zthan z25-50).
Troubleshooting zHigh zPIPs.. z- zAnswer z- zIt zmeans zthere's zan zobstruction. zCheck: zsuction, zmucus zplugs,
zkink zin ztube, zpeak zpressures, zexhalation zvalves zfor zobstruction.
REMEMBER zto zNever zpick: zCheck zFiO2 zanalyzer/check zoxygen zand zgas zconnections, zchange
zalarms/silence, zor zcircuit zcompliance.
COPD z- zNIPPV zand/or zMedical zTreatment zin zthe zhospital. zie: zCOPD zpt zin zthe zER zneeds zBiPAP zor zother
zrespiratory ztreatment z- zAnswer z- zThere zwill zbe za zlot zof zinformation zgathering. zStart zNIPPV zwhen zits
zappropriate, zAdjust zyour zoxygen zas zneeded zto zmaintain zSpO2 zof z88-92%. zFiO2 zat z2L zor z28%, zif zboth zis
zan zoption, zchoose zVenti zMask. zPatiens zmay zbe ztrached zin zthese zscenarios. zNo zSpiriva zfor ztrach
zpatients. zOrder zEKG's zand zyou'll zsee zright zaccess zdeviation zand zCor zPulmonale.
Breathing ztreatments zfor zCOPD. z- zAnswer z- zSteroids, zA+A, zadd zLABA, zICS z(going zhome). zIV zsteroids zie:
zSolumedrol, zand zthen zAntibiotics z(If zIncreased zfever zand zWBCs).
COPD zOutpatient zmanagement. z- zAnswer z- zYou zwant zto zthink zabout: zPulmonary zRehab, zSmoking
zcessation, zPatient zEducation, zHome zO2 zConcentrator. zPulse zdose z- zgood zfor zmobile zand ztraveling,
zMaintenance z- zchange zfilters. zTroubleshooting z- zgo zto zback zup ztank. zIf ztraveling z- zuse za zportable zO2
zconcentrator. z
PFTs, zVaccines z(ie: zFlu, zPneumococcal, zbut zdon't zpick zHep zB). zFluids, zcall zMD zif zswelling, zLABA/ICS,
zLAMA, zand zNever zpick z"stop zmeds zof ztitrate"
