RRT- LINDSEY JONES
Status Asthmaticus:
Definition, Clinical Evidence, Chest xray, ABG,PFT & Key interventions
**EXAM Challenge: Questions on this will challenge your ability to recognize
impending vent. failure. It is very important that you treat it before full vent
failure. There is a frequent need to repeat actions, such as bronchodilator
treatments, which may make you uncomfortable. Do not be afraid to administer
several bronchdilators in succesion. The same is true of the subcutaneous
epinephrine. If you give one dose, you will likely have to give another, and
possible another. Continue if symptoms show no signs of relief. - ANSWERS-D:
Asthma that will not respond to bronchodilators, persists 24'
C.E.: HX non-response to bronodilators "needs many tx" to feel better, acc. musc.
use and retractions, dyspnea, wheezing, congested cough, wet-clammy skin,
pulses paradoxes
XR: hyperinflation, scatter infiltrates, flat diaphragm
ABG: Pos. Resp. Acid., alkalosis due to anxiety, maybe hypoxic
K.I.: May deteriorate quickly, intubate and MV before full vent fail. Use sub-cue
epi-- 1mL of 1:1000 strength, may need to give Q 20min for up to 3 consecutive
doses. Address 3 parts of asthma
INFLAMMATION- corticosteroids
BRONCHOCONSTRICTION- bronchodilators
SPUTUM- airway clearance, hydration, thinning of sputum if needed.
,Myasthenia Gravis : Restrictive- neural
Definition, Clinical Evidence & Key interventions
**EXAM Challenge: This can be a very tricky simulation and it is likely that it will
show up on the exam. Especially important is your use of Tensilon to diagnose it
and an understanding of the dangerous effects it could have. Must always be
prepared to assume ventilation. Vt, VC, MIP are key in monitoring this patient for
degradation in ventilatory status. - ANSWERS-D: Neuromuscular abnormality
where muscles experience paralysis starting from the head to the feet.
C.E.: Hx of MG if not initial onset, droopy facial features (ptosis) patient will
describe slowly feeling weakness generally but feels better with rest, diplopia,
dysphagia, shrinking Vt, VC, MIP, tensilon challenge test-- pos. for myasthenia
crisis if improvement up the administration.
K.I.: If crisis noted, anticholinesterase therapy is indicated including: neostigmine
(prostigmine), Mestinon (Pyridostigmine)
Ok to do additional tensilon challenge to check progression, if symptoms improve
with tensilon and then worsen, must reverse anticholinesterase with atropine.
Always monitor spontaneous Vt, VC & MIP. Be prepared to intubate. When VC
falls below 1.0L the intubate and MV.
Drug Overdose :
Definition, Clinical Evidence, ABG & Key interventions
**EXAM Challenge The most important part of this pathology is the need for
immediate intubation while recognizing that there may not be a need to MV until
Vent status deteriorates. - ANSWERS-D: Potential loss of ventilatory drive as a
result of OD. Usually narcotics.
, C.E.: Hx of drug use, sometimes poor hygiene, emaciated (thin) RR and pattern is
low and or shallow
ABG: often show pur resp. acidosis and/or vent failure
K.I.: #1 priority in this case is intubation to protect the airway, prevent aspiration
of stomach contents and facilitate manual ventilation. monitor closely as
ventilation can cease in an instant (due to suppresion of the CNS) If narcotic OD,
then use narcotic reversing meds such as NARCAN (nalaxon) Support ventilation
until drugs are of system
Other Neuromuscular :
Definition, Clinical Evidence & Key interventions
**EXAM Challenge: If faced with these diseases, simply apply general respiratory
monitoring principles and facilitate ventilation when needed. - ANSWERS-D: Other
neuromuscular diseases include poliomyelitis, tetanus, muscular dystrophy, and
botulism poisoning.
C.E.: history of illness, shrinking VT, VC, MIP
K.I.: monitor for ventilatory failure generally through VT, VC, MIP and ABGs
Head Trauma :
Definition, Clinical Evidence & Key interventions
**EXAM Challenge: Unique to this situation is the need to monitor ICP readings
and avoid anything that increases MAP. You will likely need to suction this patient
to keep peak pressures down but the very act of doing so may elevate ICPs. -
Status Asthmaticus:
Definition, Clinical Evidence, Chest xray, ABG,PFT & Key interventions
**EXAM Challenge: Questions on this will challenge your ability to recognize
impending vent. failure. It is very important that you treat it before full vent
failure. There is a frequent need to repeat actions, such as bronchodilator
treatments, which may make you uncomfortable. Do not be afraid to administer
several bronchdilators in succesion. The same is true of the subcutaneous
epinephrine. If you give one dose, you will likely have to give another, and
possible another. Continue if symptoms show no signs of relief. - ANSWERS-D:
Asthma that will not respond to bronchodilators, persists 24'
C.E.: HX non-response to bronodilators "needs many tx" to feel better, acc. musc.
use and retractions, dyspnea, wheezing, congested cough, wet-clammy skin,
pulses paradoxes
XR: hyperinflation, scatter infiltrates, flat diaphragm
ABG: Pos. Resp. Acid., alkalosis due to anxiety, maybe hypoxic
K.I.: May deteriorate quickly, intubate and MV before full vent fail. Use sub-cue
epi-- 1mL of 1:1000 strength, may need to give Q 20min for up to 3 consecutive
doses. Address 3 parts of asthma
INFLAMMATION- corticosteroids
BRONCHOCONSTRICTION- bronchodilators
SPUTUM- airway clearance, hydration, thinning of sputum if needed.
,Myasthenia Gravis : Restrictive- neural
Definition, Clinical Evidence & Key interventions
**EXAM Challenge: This can be a very tricky simulation and it is likely that it will
show up on the exam. Especially important is your use of Tensilon to diagnose it
and an understanding of the dangerous effects it could have. Must always be
prepared to assume ventilation. Vt, VC, MIP are key in monitoring this patient for
degradation in ventilatory status. - ANSWERS-D: Neuromuscular abnormality
where muscles experience paralysis starting from the head to the feet.
C.E.: Hx of MG if not initial onset, droopy facial features (ptosis) patient will
describe slowly feeling weakness generally but feels better with rest, diplopia,
dysphagia, shrinking Vt, VC, MIP, tensilon challenge test-- pos. for myasthenia
crisis if improvement up the administration.
K.I.: If crisis noted, anticholinesterase therapy is indicated including: neostigmine
(prostigmine), Mestinon (Pyridostigmine)
Ok to do additional tensilon challenge to check progression, if symptoms improve
with tensilon and then worsen, must reverse anticholinesterase with atropine.
Always monitor spontaneous Vt, VC & MIP. Be prepared to intubate. When VC
falls below 1.0L the intubate and MV.
Drug Overdose :
Definition, Clinical Evidence, ABG & Key interventions
**EXAM Challenge The most important part of this pathology is the need for
immediate intubation while recognizing that there may not be a need to MV until
Vent status deteriorates. - ANSWERS-D: Potential loss of ventilatory drive as a
result of OD. Usually narcotics.
, C.E.: Hx of drug use, sometimes poor hygiene, emaciated (thin) RR and pattern is
low and or shallow
ABG: often show pur resp. acidosis and/or vent failure
K.I.: #1 priority in this case is intubation to protect the airway, prevent aspiration
of stomach contents and facilitate manual ventilation. monitor closely as
ventilation can cease in an instant (due to suppresion of the CNS) If narcotic OD,
then use narcotic reversing meds such as NARCAN (nalaxon) Support ventilation
until drugs are of system
Other Neuromuscular :
Definition, Clinical Evidence & Key interventions
**EXAM Challenge: If faced with these diseases, simply apply general respiratory
monitoring principles and facilitate ventilation when needed. - ANSWERS-D: Other
neuromuscular diseases include poliomyelitis, tetanus, muscular dystrophy, and
botulism poisoning.
C.E.: history of illness, shrinking VT, VC, MIP
K.I.: monitor for ventilatory failure generally through VT, VC, MIP and ABGs
Head Trauma :
Definition, Clinical Evidence & Key interventions
**EXAM Challenge: Unique to this situation is the need to monitor ICP readings
and avoid anything that increases MAP. You will likely need to suction this patient
to keep peak pressures down but the very act of doing so may elevate ICPs. -
