Flashcards in Intesive care, intensive care rehab, mechanical ventilation, positive pressure Deck (28)
bowels law fialure, key forms of positive venitlation. invasive ventilation and non invasive, (BIPAP)
In picture there is:
screen for patient info
patient observation machines
levels of care
three levels of patients we have in hospitals:
level 2 - cardiac patients, HDU style stuff, regular observations but not in multisystem failure. may needmechanical ventiliation
level 3 - at least 2 organ systems failing, RER? These patients need machanical ventilation .
why you need mechanical ventilation?
fatigue from beingin type 1 for a long time, breathing fast for long time
altered drive - drug over dose, alcohol
peri operatively - for major surgery
type of eg tubes
goes into the airway
can be nasal intubation thoguh trachea, goes below vocal chords whcih means they cant speak
inflate cuff to keep it safe.
dont want it to go too far down into the bronchus
careful when moving ptient with a tube
mechanical venitlation principles
type 1 and 2 resp failure.
watch vid on mech vent
aims of mechnical ventialtion
presreu control vs volime control
volumedependant on complaince...
you can set one but you ned to check the other one
SIMV - ocntrol them completly
bilevel - two pressures, set a pressure so doesnt go all the way down to 0
PEEP - not letting them breath all the way out
Trigger - set trigger low, so patient can breaht if they want to
** look at notes below slides
hypervenitltion to help with brin swelling
**again lok at notes below slides on powerpoint
extubation and weaning
pressure support - everytime they take a breath the ventilatier will support them but gradually reduce that support and peep (lowest peep of 5). then just give them peep during insp and exp and gradually wean og the peep support so patient can breath on their own.
** find lecture recording for this as explanation isnt good
difficutl - may not be awake
prolonged - like covid patients that are very weak, resp and also their muscles very weak
are they awake?
maximal insp pressure mip
use them to help us judge if someone is extubational or not? PCF main one
pcf main one. as long as great than 60lpm, if less then theyll fail extubtation.
if not meeting all these markers than their 80% of failing
more complex patients.
these things (on the slide) that make things like weaning more difficult
weaning, what is it? reasoning
its a physio thing to do
icu required weakness
these notes are befreo covid so will be more icu patients affected - see in notes
muscle waste. icu rehab is alot on muscle mass. in order to wean patients we need that msucle mass. think about the covid patients in icu since christmas- lots of loss of mass
cip cim cinm
shows your weak presentation of muscles. so you can,
over time muscle mass will improve. muscle takes time to regenerate, need or icu follow up to check this regeneration of muscle mass
reaseach around it and evidence of icu rehab - it is very safe. treatment - photos
see and make notes on the other slides she missed.
if surgical patints check patient check fluid balance and so on then sedate them agin. if they respnd an can do all tests plus neuro tests then start the weaning process.
words to search up
type of sedations. oonly sedate patient enough to be in sinc with ventilator