Mark Klimek Audio Tape 1 to 12
Mark Klimek Audio Tape 1
ACID BASE BALANCE
1. Rule of B’s
a. If the pH and the Bicarb are Both in the same direction, then it is
metabolic
2. Signs and Symptoms
a. As the pH goes, so goes my patient, except for potassium
i. as pH goes up, systems gets irritable
ii. as pH goes down, systems shut down
1. UP pH (Alkalosis)
a. HTN
b. Tachycardia
c. Tachypnea
d. Seizures
e. Irritability
f. Spastic
g. Diarrhea
h. Borborygme
i. Hyperreflexia, (3,4)
j. Hypokalemia
2. DOWN pH (Acidosis)
a. Hypotension
b. Bradycardia
c. Constipation
d. Absent bowel sounds
e. Flaccid
f. Bradypnea
g. Hyperkalemia
h. Lethargy
i. Obtunded (one step down from
lethargy)
j. Paralytic ileus
k. Coma
, l. Respiratory arrest
b. MacKussmaul
i. The only acid base to cause Kussmaul respirations is Metabolic
Acidosis
3. Causes
a. First ask yourself, “Is it lung?” If yes, then it’s respiratory. Then ask
yourself; “Are they overventilating or underventilating. If
overventilating, pick alkalosis. If underventilating, pick acidosis.
b. If it is not lung, then it is metabolic. If the patient has prolonged gastric
vomiting or suction, pick alkalosis. For everything else that isn’t lung, pick
metabolic acidosis. When you don’t know what to pick, choose
metabolic acidosis.
VENTILA..TORS
1. High pressure a..la..rms a..re triggered by increa..sed resista..nce to a..ir flow.
2. High pressure a..la..rms a..re triggered by resista..nce to a..irflow a..nd ca..n be
ca..used by obstructions of 3 types; kinked tube, (unkink) a..ction, wa..ter in
tube (empty) a..ction, mucus in a..irwa..y (turn, cough a..nd deep brea..the)
a..ction. La..stly suction
3. Low pressure a..la..rms a..re triggered by decrea..se resista..nce to a..irflow a..nd
ca..n be ca..used by disconnections of the tubing (reconnect it) or oxygen sensor
tube (reconnect it UNLESS tube is on the floor- ba..g them a..nd ca..ll RT if this
ha..ppens) (bla..ck coa..ted wirey tubing tha..t piggy ba..cks the tubing,
mea..sure FiO2)
4. Respira..tory a..lka..losis mea..ns the ventila..tor settings ma..y be too high.
5. Respira..tory a..cidosis mea..ns the ventila..tor settings ma..y be too low.
6. Wha..t does “wea..n” mea..n? Gra..dua..lly decrea..se with the goa..l of getting
off a..ltogether
,Ma..rk Klimek A..udio Ta..pe 2
A..LCOHOLISM/ A..BUSE
1. #1 Psychologica..l problem is denia..l. (1 pa..tient)
a. Denia..l is the refusa..l to a..ccept the rea..lity of their problem.
b. Trea..ting denia..l; confront it by pointing out to the person the
difference between wha..t they sa..y a..nd wha..t they do. In contra..st,
support the denia..l of loss a..nd grief.
i. A..buse vs. Loss
ii. Denia..l a..nd Loss a..nd Greif Sta..ges; DA..BDA..
1. Denia..l- hea..lthy norma..l 1st a..ction therefore you
support
2. A..nger
3. Ba..rga..ining
4. Depression
5. A..ccepta..nce
c. When dea..ling with a.. psychodyna..mic problem between sta..ff use the
word I not the word you. ex. I seem to be frustra..ting you vs. Why do you
not like me.
2. #2 Psychologica..l problem is Dependency/ Codependency (2 pa..tients)
a. Dependency; When the a..buser gets the Significa..nt Other to do things
for them or ma..ke decisions for them
b. Codependency; When the Significa..nt Other derives positive selfesteem
from doing things for or ma..king decisions for the a..buser
c. When trea..ting dependency/codependency; Set limits a..nd enforce
them. A..gree in a..dva..nce on wha..t requests a..re a..llowed, then
enforce the a..greement.
3. Ma..nipula..tion; (1 pa..tient) when the a..buser gets the significa..nt other to
do things for him/her tha..t a..re not in the best interest of the significa..nt
other.
The na..ture of the a..ct is ha..rmful or da..ngerous to the significa..nt
other.
a. Trea..ting ma..nipula..tion; set limits a..nd enforce.
i. Ea..sier to trea..t
4. A..lcoholism
a. Wernicke’s (Korsa..koff’s) Syndrome; psychosis induced by Vita..min
B1 (thia..mine) deficiency
b. Prima..ry symptoms of Wernicke’s (Korsa..koff’s) Syndrome; a..mnesia..
(memory loss) with confa..bula..tion (ma..ke up stuff)
, c. Cha..ra..cteristics of Wernicke’s (Korsa..koff’s) Syndrome
i. Preventa..ble (ta..ke vita..min)
ii. A..rresta..ble (ta..ke vita..min)
iii. Irreversible (kills bra..in cells)
d. Disulfa..ra..m (A..nta..buse/Revia..) is a..ka.. A..version Thera..py
e. Onset a..nd dura..tion of effectiveness of Disulfa..ra..m
(A..nta..buse/Revia..);
2 weeks
f. Pa..tient tea..ching with Disulfa..ra..m (A..nta..buse/ Revia..); A..void a..ll
forms of a..lcohol to a..void na..usea.., vomiting, a..nd dea..th.
g. Wha..t a..re exa..mples of products tha..t conta..in a..lcohol?
Mouthwa..sh, cologne, perfume, a..ftersha..ve, a..ll elixirs- most OTC
liquid medicines, insect repella..nt, va..nilla.. extra..ct (uncooked icings),
vina..igrettes, ha..nd sa..nitizer,
h. Every a..lcoholic goes through a..lcohol withdra..wa..l syndrome. Only a..
minority get Delirium Tremens.
i. Every a..bused drug is either upper or downer
i. Uppers- ca..ffeine, coca..ine, PCP/LSD, metha..mpheta..mines,
A..ddera..ll
1. Signs a..nd symptoms
a. Euphoria..
b. Ta..chyca..rdia..
c. Restlessness
d. Irrita..bility
e. Increa..sed bowels
f. Hyperreflexia..
g. Spa..stic
h. Seizure
ii. Downers- everything but uppers
1. Signs a..nd symptoms
a. Drowsiness
b. Letha..rgy
c. Respira..tory a..rrest
j. A..lcohol Withdra..wa..l Syndrome is not life threa..tening. Delirium
Tremens ca..n kill you.
k. Pa..tients with A..lcohol Withdra..wa..l Syndrome a..re not a.. da..nger to
themselves or others. Pa..tients with Delirium Tremens a..re da..ngerous
to self a..nd others.
l. Upper OD looks like downer withdra..wa..l
i. i.e. risk for seizure, need suctioning
m. Downer OD looks like Upper withdra..wa..l
Mark Klimek Audio Tape 1
ACID BASE BALANCE
1. Rule of B’s
a. If the pH and the Bicarb are Both in the same direction, then it is
metabolic
2. Signs and Symptoms
a. As the pH goes, so goes my patient, except for potassium
i. as pH goes up, systems gets irritable
ii. as pH goes down, systems shut down
1. UP pH (Alkalosis)
a. HTN
b. Tachycardia
c. Tachypnea
d. Seizures
e. Irritability
f. Spastic
g. Diarrhea
h. Borborygme
i. Hyperreflexia, (3,4)
j. Hypokalemia
2. DOWN pH (Acidosis)
a. Hypotension
b. Bradycardia
c. Constipation
d. Absent bowel sounds
e. Flaccid
f. Bradypnea
g. Hyperkalemia
h. Lethargy
i. Obtunded (one step down from
lethargy)
j. Paralytic ileus
k. Coma
, l. Respiratory arrest
b. MacKussmaul
i. The only acid base to cause Kussmaul respirations is Metabolic
Acidosis
3. Causes
a. First ask yourself, “Is it lung?” If yes, then it’s respiratory. Then ask
yourself; “Are they overventilating or underventilating. If
overventilating, pick alkalosis. If underventilating, pick acidosis.
b. If it is not lung, then it is metabolic. If the patient has prolonged gastric
vomiting or suction, pick alkalosis. For everything else that isn’t lung, pick
metabolic acidosis. When you don’t know what to pick, choose
metabolic acidosis.
VENTILA..TORS
1. High pressure a..la..rms a..re triggered by increa..sed resista..nce to a..ir flow.
2. High pressure a..la..rms a..re triggered by resista..nce to a..irflow a..nd ca..n be
ca..used by obstructions of 3 types; kinked tube, (unkink) a..ction, wa..ter in
tube (empty) a..ction, mucus in a..irwa..y (turn, cough a..nd deep brea..the)
a..ction. La..stly suction
3. Low pressure a..la..rms a..re triggered by decrea..se resista..nce to a..irflow a..nd
ca..n be ca..used by disconnections of the tubing (reconnect it) or oxygen sensor
tube (reconnect it UNLESS tube is on the floor- ba..g them a..nd ca..ll RT if this
ha..ppens) (bla..ck coa..ted wirey tubing tha..t piggy ba..cks the tubing,
mea..sure FiO2)
4. Respira..tory a..lka..losis mea..ns the ventila..tor settings ma..y be too high.
5. Respira..tory a..cidosis mea..ns the ventila..tor settings ma..y be too low.
6. Wha..t does “wea..n” mea..n? Gra..dua..lly decrea..se with the goa..l of getting
off a..ltogether
,Ma..rk Klimek A..udio Ta..pe 2
A..LCOHOLISM/ A..BUSE
1. #1 Psychologica..l problem is denia..l. (1 pa..tient)
a. Denia..l is the refusa..l to a..ccept the rea..lity of their problem.
b. Trea..ting denia..l; confront it by pointing out to the person the
difference between wha..t they sa..y a..nd wha..t they do. In contra..st,
support the denia..l of loss a..nd grief.
i. A..buse vs. Loss
ii. Denia..l a..nd Loss a..nd Greif Sta..ges; DA..BDA..
1. Denia..l- hea..lthy norma..l 1st a..ction therefore you
support
2. A..nger
3. Ba..rga..ining
4. Depression
5. A..ccepta..nce
c. When dea..ling with a.. psychodyna..mic problem between sta..ff use the
word I not the word you. ex. I seem to be frustra..ting you vs. Why do you
not like me.
2. #2 Psychologica..l problem is Dependency/ Codependency (2 pa..tients)
a. Dependency; When the a..buser gets the Significa..nt Other to do things
for them or ma..ke decisions for them
b. Codependency; When the Significa..nt Other derives positive selfesteem
from doing things for or ma..king decisions for the a..buser
c. When trea..ting dependency/codependency; Set limits a..nd enforce
them. A..gree in a..dva..nce on wha..t requests a..re a..llowed, then
enforce the a..greement.
3. Ma..nipula..tion; (1 pa..tient) when the a..buser gets the significa..nt other to
do things for him/her tha..t a..re not in the best interest of the significa..nt
other.
The na..ture of the a..ct is ha..rmful or da..ngerous to the significa..nt
other.
a. Trea..ting ma..nipula..tion; set limits a..nd enforce.
i. Ea..sier to trea..t
4. A..lcoholism
a. Wernicke’s (Korsa..koff’s) Syndrome; psychosis induced by Vita..min
B1 (thia..mine) deficiency
b. Prima..ry symptoms of Wernicke’s (Korsa..koff’s) Syndrome; a..mnesia..
(memory loss) with confa..bula..tion (ma..ke up stuff)
, c. Cha..ra..cteristics of Wernicke’s (Korsa..koff’s) Syndrome
i. Preventa..ble (ta..ke vita..min)
ii. A..rresta..ble (ta..ke vita..min)
iii. Irreversible (kills bra..in cells)
d. Disulfa..ra..m (A..nta..buse/Revia..) is a..ka.. A..version Thera..py
e. Onset a..nd dura..tion of effectiveness of Disulfa..ra..m
(A..nta..buse/Revia..);
2 weeks
f. Pa..tient tea..ching with Disulfa..ra..m (A..nta..buse/ Revia..); A..void a..ll
forms of a..lcohol to a..void na..usea.., vomiting, a..nd dea..th.
g. Wha..t a..re exa..mples of products tha..t conta..in a..lcohol?
Mouthwa..sh, cologne, perfume, a..ftersha..ve, a..ll elixirs- most OTC
liquid medicines, insect repella..nt, va..nilla.. extra..ct (uncooked icings),
vina..igrettes, ha..nd sa..nitizer,
h. Every a..lcoholic goes through a..lcohol withdra..wa..l syndrome. Only a..
minority get Delirium Tremens.
i. Every a..bused drug is either upper or downer
i. Uppers- ca..ffeine, coca..ine, PCP/LSD, metha..mpheta..mines,
A..ddera..ll
1. Signs a..nd symptoms
a. Euphoria..
b. Ta..chyca..rdia..
c. Restlessness
d. Irrita..bility
e. Increa..sed bowels
f. Hyperreflexia..
g. Spa..stic
h. Seizure
ii. Downers- everything but uppers
1. Signs a..nd symptoms
a. Drowsiness
b. Letha..rgy
c. Respira..tory a..rrest
j. A..lcohol Withdra..wa..l Syndrome is not life threa..tening. Delirium
Tremens ca..n kill you.
k. Pa..tients with A..lcohol Withdra..wa..l Syndrome a..re not a.. da..nger to
themselves or others. Pa..tients with Delirium Tremens a..re da..ngerous
to self a..nd others.
l. Upper OD looks like downer withdra..wa..l
i. i.e. risk for seizure, need suctioning
m. Downer OD looks like Upper withdra..wa..l
