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86 Invasive Mechanical Ventilation (MV) Modes Pressure Support Ventilation (PSV): *NOTE: This mode is only for patients with an intact respiratory drive* • Patient initiates a breath, which is supported by vent at a preset pressure • Flow cycled NOT volume cycled like in SIMV/AC • “Pressure Support” = inspiratory pressure selected to achieve adequate TV and ventilatory support • Can be combined w/ SIMV to partially assist spontaneous breaths • Could be considered to make patient more “comfortable” on vent; also used for SBT at the appropriate level. Synchronized Intermittent Mechanical Ventilation (SIMV): • Patient receives vent support at a given tidal volume and respiratory rate. If patient initiates additional breaths, the vent provides no support to these breaths unless pressure support is added. • This mode has been proposed to prevent respiratory alkalosis; however, it requires more respiratory muscle work than AC. • Used primarily in SICU Assist-Controlled Mechanical Ventilation (AC): Can set volume targeted or pressure targeted. • When using volume targeted: Patient receives vent support at a given tidal volume and respiratory rate. If patient initiates additional breaths, the vent delivers the pre-set tidal volume with each additional breath. • If the patient is tachypnic, then hyperventilation can occur Other modes to minimize lung injury: • High Frequency Jet Ventilation/Oscillation: Alveoli are kept fully open as if the patient is kept at full inspiration while gases are exchanged by oscillating the air at high frequency Indications for intubation • Refractory hypoxemia • Hypercapnea with respiratory acidosis (note that patients w/ COPD often live w/ pCO2 b/t 50-70)
87 • Ineffective respiratory effort, ie, Agonal Breathing or Respiratory Muscle Weakness (Max Inspiratory Force 1d) I:E Ratio = 1:2 to 1:4 which is determined by your Inspiratory Flow Rate. TV and respiratory rate in Volume Controlled Ventilation Positive End Expiratory Pressure (PEEP) = 0-10 cm of H20 (may have to increase more if clinically indicated) • Higher levels of PEEP in asthmatics and COPD patients may worsen auto-peeping • In ARDS, may have to use higher level of PEEP for any given FiO2 (see ARDS)
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BUMC BASICS
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• Status Epilepticus • Stroke m
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5 Welcome to Baylor University Medi
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7 Rounding on your patients: • Se
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9 2. gloves only. During codes, if
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11 • There is one resident and 3
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Chest pain 13 DDx to consider • M
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SOB DDx • Pneumonia • PE • An
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17 • Heparin • Lidocaine • Ni
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19 TPC (cont’d) Pager Cell Phone
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21 Gen Surgery Neurologists Urgent
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23 OBTAINING A CONSULT AT BAYLOR Ob
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25 • Enter 2 initial zeros and th
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27 • Albuterol/Atrovent nebulizer
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29 CARDIOLOGY CCU IN GENERAL You ar
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31 Unstable Angina/NSTEMI • Can u
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33 Post PCI Complications — In yo
Page 35 and 36: 35 function, elevated troponin T is
Page 37 and 38: 37 **0-1 point non-cardiogenic, 2 p
Page 39 and 40: 39 • Erythromycin • Phenothiazi
Page 41 and 42: 41 Therapy — Therapy is guided by
Page 43 and 44: 43 Nitroglycerine (Onset in 2-5 min
Page 45 and 46: 45 Treatment: • Vasovagal: Recogn
Page 47 and 48: 47 GI/HEPATOLOGY GI CONSULTS AND GR
Page 49 and 50: 49 hepatitis, obesity), then they p
Page 51 and 52: 51 timing and necessity of ERCP for
Page 53 and 54: 53 the liver transplant ICU) where
Page 55 and 56: 55 GI bleeding (**See above under G
Page 57 and 58: 57 • Barium Enema (clear liquids
Page 59 and 60: 59 Pseudomonas: • Piperacillin/Ta
Page 61 and 62: 61 • Neoplasm: Lymphoma, leukemia
Page 63 and 64: 63 mortality. It lowers mortality i
Page 65 and 66: Pneumonia (immunocompromised) (cont
Page 67 and 68: 67 BRAIN DEATH EXAM • Can order b
Page 69 and 70: 69 SEIZURES Can use BZD ativan IV o
Page 71 and 72: 71 3. Stop anticoagulants and rever
Page 73 and 74: 73 ONCOLOGY THE ACUTE LEUKEMIC “T
Page 75 and 76: Timeline*: 75 Day 0 (admit) — Bon
Page 77 and 78: 77 PALLIATIVE CARE AND CLINICAL ETH
Page 79 and 80: 79 release oxycodone, and hydromorp
Page 81 and 82: 81 • Institutional Ethics and Pal
Page 83 and 84: 83 PULMONARY ARDS Definition: Need
Page 85: 85 MECHANICAL VENITALTION Oxygen su
Page 89 and 90: 89 - Daily sedation vacations at 07
Page 91 and 92: 91 • After 1 wk of intubation det
Page 93 and 94: 93 - Sustained changes in the heart
Page 95 and 96: 95 PULMONARY EMBOLUS (PE) Evaluatin
Page 97 and 98: 97 RADIOLOGY RADIOLOGY HINTS IF YOU
Page 99 and 100: Superficial Abscess/Mass Abscess/Ma
Page 101 and 102: 101 RENAL ACID/BASE DISTURBANCES Qu
Page 103 and 104: 103 ACUTE KIDNEY INJURY Acute Kidne
Page 105 and 106: 105 Mg
Page 107 and 108: 107 CHRONIC KIDNEY DISEASE Stage GF
Page 109 and 110: Hypovolemic Hyponatremia EABV low R
Page 111 and 112: 111 fluid pulled off and into the p
Page 113 and 114: 113 Colorectal Surgery, and Plastic
Page 115 and 116: 115 • Social work: Circle Social
Page 117 and 118: Ear Health Antipyrine/Benzocaine ot
Page 119 and 120: Magnesium Oxide 400mg tab Prenatal
Page 121 and 122: 121 DUEWALL’S FAVORITE MNEMONICS
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