Tutorial Systems RRT decision making (clin sims) 100% correct answers already graded A+

SpO2 and PaO2 4,5,6 - 7,8,9 mild hypoxemia (PaO2 : 75) 2L Nasal cannula, recheck SpO2 atelectasis incentive spirometry SOB bronchodilator treatments CHF digitalis, diuretics impending hypercapnic respiratory failure initiate NPPV Acute Hypercapnic Respiratory Failure pH: 7.30, PaCO2: >50 - intubate and initiate MV COPD avoid high FiO2 "marked" severe/emergency condition, requires immediate and maximal response (usually 100% FiO2) significant Q wave, elevated ST segment acute MI ventricular tachycardia defibrillation steps for defibrillation -CPR until available turn the defibrillator on -select energy level (200 joules) -check if synchronizer of turned off -apply conductive materials to the chest (right sternum just below the clavicle and the other to the left on the apex) progressive cyanosis and asymmetrical chest movement right mainstem intubation rapid evaluation of newborns tone, breathing/crying, gestational age The Golden Minute initial minute after birth. if baby has not shown improvement at this point, begin PPV -radiant warmer, open and clear airway heart rate and respirations HR < 100 bpm (neonate) initiate PPV bag valve mask resuscitation gestational age < 35 weeks, RR: 40-60 bpm, FiO2 : .24-.30, ventilating pressure of 20-25 cmH2O, PEEP: 5 cmH2O, flowmeter : 10 lpm HR < 60 (neonate) begin resuscitation (3:1 ratio of chest compressions to ventilations) drug overdose intubation is a priority, initiate MV if in resp. failure P/F ratio <200 = severe hypoxemia and moderate ARDS as ARDS progresses increase both PEEP and FiO2 vent adjustments ARDS reduction in Vt to reduce ventilating pressure, increase PEEP/FiO2 to increase P/F ratio, Asthma severity Mild: FEV1> 80% pred. Moderate: FEV1 60-80% Severe: FEV1 < 60% Asthma Impairment Intermittent: symptoms up to 2 days a week Mild Persistent: symptoms > 2 days/week Moderate Persistent: symptoms daily Severe Persistent: symptoms throughout day long term control of asthma Inhaled corticosteroids (fluticasone/salmeterol MDI) if you suspect NM problem monitor MIP, FVC, and initiate incentive spirometry when to intubate with NM disorders when VC falls below 1.0 L with marked hypoxemia correct overventilation lower rate or lower tidal volume severe hypoxemia PaO2 < 40 mmHg with any apparent heart problem supplemental oxygen is always first priority (NRB for severe hypoxemia) CHF key points cardiomegaly, diffuse infiltrates, pedal edema suspected MI? anticoagulant therapy recent MI use ultrasound to identify cause of CHF immediate emergency care placement of airway and 100% o2 severe metabolic acidosis administer sodium bicarbonate high pressure alarm suction patient increasing chest pain? obtain a CXR pleural effusion perform thoracentesis Epiglottitis priority is intubation DM epiglotitis sedation and wrist restraints if thrashing, ABX, monitor pulse ox, ventilatory support Diagnosing Epiglottitis thumb sign on lateral neck xray croup KI loud, barking cough, steeple sign cystic fibrosis diagnosis Sweat chloride test, CXR CF drugs CTFR (ivacaftor), nebulized Tobraymycin, pulmozyne Ventilation/Oxygenation draw ABG on room air if able, follow with 2L nasal cannula status asthmaticus administration of corticosteroids (Solu-Medrol) and aggressive bronchodilators (Albuterol) treatment of newborn hypoxemia nasal CPAP, use lowest FiO2 to achieve SpO2 > 90% treatment of RDS in newborn surfactant replacement therapy