Clinical Simulation Exam Strategies 100% correct answers already graded A+

Information Gathering 1. Visual 2. Bedside 3. Basic Labs 4. Special Test Visuals General appearance, color, inspection Height and Weight History Pulse (pick last) Sensorium Posture anything gathered on a monitor If CHF pick pedal edema Bedside Interview of patient Palpitation Percussion Tracheal devation auscultation B/P Temp Vent Settings Bowel Movement only with NG or newborn Reflex only with neurological patients (same w/pupil) Vt, MIP, VC only with neuromuscular problems peak flow only with asthma Coombs - pregnant Moro - babies Capillary - MI, chest pain Basic Labs CBC - never for baby after birth ABG 12 Lead EKG Electrolytes CXR (if lab found abnormal keep choosing until normal) Special Test CT scan for PE if not seen then choose V/Q Scan (if long plane ride or vericous vein choose V/Q) Pulmonary angiography for PE as well Echocardiogram if pre/post ductal 15 (dx shunt in babies) Sweat Chloride test CF Tenslion Test - MG (facial droop ect...) APGAR - newborn Special test continue ELISA - HIV Blood Sugar for obesity Cardiac Enzymes - chest pain Polysomnography - sleep study (OSA) Cultures - if infection is expected Lateral Neck - epiglotittis BUN/Creatine - kidney PFT Bronchoscopy Thoracentesis - Pleural effusions 3 Procedures to keep doing If upper airway is obstructed - abdominal thrust Merconium Aspiration - suction until clear PEEP - keep raising unless something bad happens Intubate/Mechanically intubate apnea, acute vent failure, impending resp failure, oxygenation as last resort (ARDS) Compliance 25ml/cmH20 A-a 300, Os/Qt 20% burns around face Initial vent settings Vt 6-8ml/kg, 4-8 w/ards and asthma RR 10-20 FIO2 - on room air or unknown 40 - 60% Choose what was picked prior to intubation 100% with cardiac or other emergencies IE CO poisoning, pulmonary edema, crushed chest PEEP 2-6, match level of CPAP Mode-Any mode is fine PC Choose plateau pressure taken from VC or acheive target Vt with a pressure or equal to 35cmH2O IBW esitmation male 50kg + (2 x inches over 5ft) +2 IBW estimation female 50kg + (2 x inches over 5ft) - 2 Decrease PaCO2 remove mechanical Vd (unless is SIMV) increase Vt or PIP Increase Rate Increase PaCo2 evaluate cause and fix (hypoxemia/pain/anxiety) decrease RR unless PT is breathing above vent (switch to SIMV) decrease Vt or PIP Fixing Low Oxygenation issues 1. increase FIO2 by 5-10% 2. increase PEEP 2-5cmH20 until negative effects occur Fixing High Oxygenation issues 1. If PaO2 is elevated decrease until 60% is reached 2. Lower PEEP Eliminate Vent Choices 1. FIO2 2. PEEP 3. RR 4. Vt Infant Settings SIMV/IMV Rate 20 - 30 Insp Pressure 20 - 30 (4-6ml/kg) Room air no prior O2 40-60% PEEP same as CPAP or 2-4cmH20 Flow 5-6LPM I time .5 - .6 Babies PaO2 60 - 80mmHg APGAR 0-3 resuscitate 4-6 stimulate, warm, give O2 7 - 10 routine care