Acute Care Skills

Question 1

Indications for ventilation

Answer 1

Blood gas(paO2<6.67kPa/PaCO2>6.67kPa)
TV<5ml/kg
Vital capacity<10ml/kg

Clinical
RR>30
Low LOC
Signs of Resp distress

During surgery
Shock

Question 2

In a patient who is ventilated If Sats low or PaO2 low, how can oxygenation be improved

Answer 2

• Increasing FiO2
• Increasing PEEP
• (Increasing Minute ventilation – tidal vol or respiratory rate. This should be the last change as it also affects your CO2)

Question 3

In a ventilated pt, If CO2 high, then can be fixed by:

Answer 3

Increase tidal volume
• Increase RR
• Decrease dead space
• If CO2 low, then can be fixed by:
• Decrease tidal volume
• Decrease RR

Question 4

Causes of increased/high airway pressures

Answer 4

Circuit
 Circuit kink
 HME saturated (filter saturated with blood or secretions)
 ET tube kink
 Tube down RMB

Patient
High BMI/pregnancy
Tube down Right Main Bronchus
Patient fighting ventilator Inadequate sedation/paralysis
Bronchospasm/ pulmonary oedema Tension Pneumothorax!

Question 6

ABG trouble shooting in ventilation

Answer 6

↓pO₂, normal CO₂
V/Q mismatch or low PEEP
↑PEEP, FiO₂

↑pCO₂, ↓pH
Hypoventilation
↑RR or Vt

↓pCO₂, ↑pH
Hyperventilation
↓RR or Vt

Answer 7

Ok

Question 8

Physiologically difficult airways

Answer 8

physiological derangements that make intubation dangerous or high-risk, even if the anatomy is normal.

1. Hypoxia: rapid desaturation during apnoea, so preO2 really well
2. Hypotension: induction agents worsen , so use Etomidate or ketamine and norepinephrine
3. Raised ICP: hypoxia or Hugh 02worsens it, consider lidocaine or fentanyl to blunt response
4. Metabolic acidosis worsens if ventilation is reduced so preO2 and avoid hypovent
5. RVF orPulmo HPT: PPV increases RV afterload, worsens RV failure so gentle ventilation, avoid hypoxia