pulmaku

Question of the Week (QoW #06 – 2013)

  Here is a ventilator “screen grab” of a patient who was involved in a motor vehicle accident.  On day 10 of this ICU stay, the patient was placed on AC-PCV, RR=12, dP=24, ti=2 sec, FiO2=60% and PEEP=8 (see letter A).  His ABG on these settings:  pH 7.65  /  pCO2 = 22  /  pO2 = 82.  Corrective measures to normalize ABG:  AC-PCV, RR=8, dP=14, ti = 1.5 sec, FiO2=60% and PEEP=8...

pulmaku

Answer for Question of the Week (QoW #05 – 2013)

 1. Fluid intake requirement is high due to SVR being so low likely due to the  bioinflammatory mediators wreaking havoc on this patient’s system. 2.  As the daily intake accumulates and redistributes over time, PEEP should be offered as countermeasure in case fluid is starting to collect in the pulmonary system. 3. The total fluid accumulated would look like this: This patient received 55L of...

Jessica

For Profit Respiratory Program Taken to Court

Students, please be aware of false claims of job placement by for-profit respiratory programs. Concorde Career Colleges in California is being sued by a few of its students for falsely claiming that their job placement rate was 95%, when it was, in fact, ZERO percent. These students paid $40,000 to attend the private program. Here is the full article: http://www.courthousenews.com/2013/05/17/57725.htm Be...

pulmaku

Question of the Week (QoW #05 – 2013)

One of the earlier “Question of the Week” questions got a response of “monitor I&Os”.  Well, here is one charted for convenience. The picture underneath is another trauma patient’s I&Os charted for 112 days (from day of admission) – this patient also did well. (Click on picture for larger view). This was the I &  Os for a trauma patient who went on to...

pulmaku

Answer for Question of the Week – (QoW #04 – 2013)

  The problem: What was shown in simulation was a nick in the pilot balloon tube rom a shaving accident.  And it always seems this happens on the patient that is most critical or with the highest PEEP – at 4AM. Finding the nick:  run your finger over the pilot balloon tubing – you can usually feel it.  Trying wiping a very small amount of soapy water over the suspect area –...

pulmaku

Answer for Question of the week – (QoW #03-2013)

Answers: 1. The “stuff” in the collection bags is urine. 2. The green urine happened to be a patient that was receiving Methylene Blue for treatment of refractory hypotension / shock.  Suggested solution is to maintain ventilator parameters as if treating ALI / ARDS. 3. The red urine happened to be a case of hemoglobinuria.  Treatment is to alkalinize the urine to avoid acute renal failure...

pulmaku

Question of the week – (QoW #04 – 2013)

(Let’s pretend that the ETT shown above is still in the patient’s airway held in place appropriately with an ETT securement device). It’s 4:45am and you get a call that after nursing care, the patient has a moderate cuff leak on your 70kg patient that is need of 25cmH2O of PEEP due to new onset ARDS.  Patient’s VS: HR 111,  RR 25,  SpO2 87%.   Ventilator parameters: AC-VCV, ...