RESPIRATORY FAILURE
INTUBATION: -BVM and nasal/oral suction by bedside before procedure
-Attempts should not take longer than 30 sec!! BVM in between
-permit if not emergent
-Nasal is contraindicated in facial injuries
-SEDATE before NMB!!!!
-RSI (rapid sequence intubation): you don't need to do this if the pt is
unconscious/apneic
-supine position for protection: sniff pos-flex neck, extend head
Sellick Maneuver-cricoid pressure
* inflate cuff
* confirm placement by: color change at end of tube
ABG's will be lower than actual ABG
Won't hear L side breath sounds if in wrong place!!!
5 point auscultation
CHEST X-RAY FOR SURE!!!
DON'T WANT AIR IN BELLY!!!!
CUFF INFLATION: 10ml syringe at balloon
Min. occlusive vol-20-25mmHG
Mlt. min. leak technique- auscultate tracheal area till no air leak sounds than
aspirate .2ml till hear minimal leak
* ways to not overinflate cuff^^^^^
, SUCTION: insert catheter---> suction OFF!!....while withdrawing catheter---> suction
SHOULD NOT TAKE LONGER THAN 10 SEC!!!!!
When to suction: Secretions, rhonchi, coughing, PIP increaes/High pressure
COMPLICATIONS: Inc ICP, hypoxemia, brochospasm, hypo/hyperTN, mucosal dmg, bleeding
NSG CARE: Reassurance...touch...comfort...
CI OF SEDATIVES...MONITOR FOR S/E: hypoTN, bradycardia
Vigorous mouth care
Limit ADL's when having unstable O2
COMPLICATIONS: tube dislodgement
unplanned extubation
Aspiration----VAP (vent aquired pnemonia)
* AFTER D/C: SHOULD HAVE HOARSENESS!!!
SHOULD NOT HAVE STRIDOR----give epi to fix!!
VENTILATOR
SETTING: mode
TV- keep at 6ml/KG in ALI***** state if pt is a spontaneous breather***
FIO2-21-100% to maintain PO2>60, O2 Sat >90%
R/R- 6-20
Peak/ MAP- 15-20
INTUBATION: -BVM and nasal/oral suction by bedside before procedure
-Attempts should not take longer than 30 sec!! BVM in between
-permit if not emergent
-Nasal is contraindicated in facial injuries
-SEDATE before NMB!!!!
-RSI (rapid sequence intubation): you don't need to do this if the pt is
unconscious/apneic
-supine position for protection: sniff pos-flex neck, extend head
Sellick Maneuver-cricoid pressure
* inflate cuff
* confirm placement by: color change at end of tube
ABG's will be lower than actual ABG
Won't hear L side breath sounds if in wrong place!!!
5 point auscultation
CHEST X-RAY FOR SURE!!!
DON'T WANT AIR IN BELLY!!!!
CUFF INFLATION: 10ml syringe at balloon
Min. occlusive vol-20-25mmHG
Mlt. min. leak technique- auscultate tracheal area till no air leak sounds than
aspirate .2ml till hear minimal leak
* ways to not overinflate cuff^^^^^
, SUCTION: insert catheter---> suction OFF!!....while withdrawing catheter---> suction
SHOULD NOT TAKE LONGER THAN 10 SEC!!!!!
When to suction: Secretions, rhonchi, coughing, PIP increaes/High pressure
COMPLICATIONS: Inc ICP, hypoxemia, brochospasm, hypo/hyperTN, mucosal dmg, bleeding
NSG CARE: Reassurance...touch...comfort...
CI OF SEDATIVES...MONITOR FOR S/E: hypoTN, bradycardia
Vigorous mouth care
Limit ADL's when having unstable O2
COMPLICATIONS: tube dislodgement
unplanned extubation
Aspiration----VAP (vent aquired pnemonia)
* AFTER D/C: SHOULD HAVE HOARSENESS!!!
SHOULD NOT HAVE STRIDOR----give epi to fix!!
VENTILATOR
SETTING: mode
TV- keep at 6ml/KG in ALI***** state if pt is a spontaneous breather***
FIO2-21-100% to maintain PO2>60, O2 Sat >90%
R/R- 6-20
Peak/ MAP- 15-20
