NBRC RRT/CSE, treating pathologies,
according to Kettering. Questions and
Answers.
Emphysema -
\• O2 therapy via nasal cannula at 24-28%. Keep saturations at approx. 88%-93%.
• Bronchodilators
• Bronchial hygiene as indicated.
• NIPPV for acute vent failure (PaCO2>45 torr)
Chronic Bronchitis -
\• O2 therapy via nasal cannula at 24-28%. Keep saturations at approx. 88%-93%.
• Bronchodilators
• Bronchial hygiene as indicated
• Antibiotics as indicated
• NIPPV for acute vent failure (PaCO2>45 torr)
Chest Trauma/Flail Chest/Rib Fractures -
\• Hyperinflation therapy (IS/SMI, IPPB. Prevent atelectasis and pneumonia)
• Analgesics
• Mech Vent w/ PEEP for severe case
• Severe cases may require surgery.
Pneumothorax -
\• Small pneumo (<20% lung collapse): bed rest
• Large pneumo (>20% lung collapse): chest tube
• Needle thoracentesis if pt is unstable (bradycardia, hypotension, cyanosis, etc.)
• Hyperinflation therapy post-chest tube insertion
Hemothorax -
\• Thoracentesis or chest tube
• Hyperinflation therapy post-chest tube insertion
Burns/Smoke Inhalation/CO Poisoning -
\• Immediate assessment of pt's airway: Intubation for marked/severe distress/stridor.
• O2 therapy at 100%.
• Hyperbaric O2 therapy for CO poisoning.
• Monitor for signs of infections.
• Immediate insertion of IV line and monitor basic lab tests + fluid levels
Acute Respiratory Distress Syndrome (ARDS) -
, \• Treat underlying cause
• Increase FiO2 as high as 0.60 and then add PEEP.
• Implement ARDSNet protocol: Vt of 4-6mL/kg; Pplat<30cmH2O
• Consider alternative modes of ventilation (IRV, APRV, HFV, etc.)
• Prone positioning
Myasthenia Gravis -
\• If Vt, VC, and MIP improve with Tensilon: Give "-stigmine" drugs/Mestinon
• If Vt, VC, and MIP worsen with Tensilon: Give atropine
• If Vt drops below 6mL/kg, VC drops below 1000mL, or MIP drops below -20cmH2O,
INTUBATE
• Recommend Hyperinflation therapy and pulmonary hygiene
Guillain-Barre Syndrome -
\• Monitor Vt, VC, and MIP until they reach the criteria for intubation
• Recommend hyperinflation therapy and pulmonary hygiene
• Plasmapheresis: in severe cases.
Chest Pain/MI -
\• Immediate O2 therapy at 100%
• Aspirin
• Anti-arrhythmic agents as indicated: Amiodarone to slow HR, Atropine to speed HR,
etc.
• Nitrates for chest pain
• Maintain BP with fluids or vasopressors (dopamine)
• Defibrillate for PVT or V-fib.
CHF/Pulmonary Edema -
\• Immediate O2 therapy at 100%
• Place pt in Fowler's position
• IPPB/NIPPV with 100% O2
• Diuretics; Lasix
• Positive Inotropic Agents; Digitalis, Digoxin
• Analgesic/Sedative; Morphine
Croup -
\• Mild stridor: Cool aerosol mist, Racemic Epinephrine, Corticosteroids if not effective.
• Severe/marked stridor: Intubation. Extubate when leak can be heard.
Epiglottitis -
\• Immediate intubation
• Antibiotics
• Extubate after leak can be heard
Delivery Room Care/APGAR -
\• APGAR Score 1-3: CPR. 4-6: O2 Therapy, ventilation, etc. 7-10: routine monitoring.
according to Kettering. Questions and
Answers.
Emphysema -
\• O2 therapy via nasal cannula at 24-28%. Keep saturations at approx. 88%-93%.
• Bronchodilators
• Bronchial hygiene as indicated.
• NIPPV for acute vent failure (PaCO2>45 torr)
Chronic Bronchitis -
\• O2 therapy via nasal cannula at 24-28%. Keep saturations at approx. 88%-93%.
• Bronchodilators
• Bronchial hygiene as indicated
• Antibiotics as indicated
• NIPPV for acute vent failure (PaCO2>45 torr)
Chest Trauma/Flail Chest/Rib Fractures -
\• Hyperinflation therapy (IS/SMI, IPPB. Prevent atelectasis and pneumonia)
• Analgesics
• Mech Vent w/ PEEP for severe case
• Severe cases may require surgery.
Pneumothorax -
\• Small pneumo (<20% lung collapse): bed rest
• Large pneumo (>20% lung collapse): chest tube
• Needle thoracentesis if pt is unstable (bradycardia, hypotension, cyanosis, etc.)
• Hyperinflation therapy post-chest tube insertion
Hemothorax -
\• Thoracentesis or chest tube
• Hyperinflation therapy post-chest tube insertion
Burns/Smoke Inhalation/CO Poisoning -
\• Immediate assessment of pt's airway: Intubation for marked/severe distress/stridor.
• O2 therapy at 100%.
• Hyperbaric O2 therapy for CO poisoning.
• Monitor for signs of infections.
• Immediate insertion of IV line and monitor basic lab tests + fluid levels
Acute Respiratory Distress Syndrome (ARDS) -
, \• Treat underlying cause
• Increase FiO2 as high as 0.60 and then add PEEP.
• Implement ARDSNet protocol: Vt of 4-6mL/kg; Pplat<30cmH2O
• Consider alternative modes of ventilation (IRV, APRV, HFV, etc.)
• Prone positioning
Myasthenia Gravis -
\• If Vt, VC, and MIP improve with Tensilon: Give "-stigmine" drugs/Mestinon
• If Vt, VC, and MIP worsen with Tensilon: Give atropine
• If Vt drops below 6mL/kg, VC drops below 1000mL, or MIP drops below -20cmH2O,
INTUBATE
• Recommend Hyperinflation therapy and pulmonary hygiene
Guillain-Barre Syndrome -
\• Monitor Vt, VC, and MIP until they reach the criteria for intubation
• Recommend hyperinflation therapy and pulmonary hygiene
• Plasmapheresis: in severe cases.
Chest Pain/MI -
\• Immediate O2 therapy at 100%
• Aspirin
• Anti-arrhythmic agents as indicated: Amiodarone to slow HR, Atropine to speed HR,
etc.
• Nitrates for chest pain
• Maintain BP with fluids or vasopressors (dopamine)
• Defibrillate for PVT or V-fib.
CHF/Pulmonary Edema -
\• Immediate O2 therapy at 100%
• Place pt in Fowler's position
• IPPB/NIPPV with 100% O2
• Diuretics; Lasix
• Positive Inotropic Agents; Digitalis, Digoxin
• Analgesic/Sedative; Morphine
Croup -
\• Mild stridor: Cool aerosol mist, Racemic Epinephrine, Corticosteroids if not effective.
• Severe/marked stridor: Intubation. Extubate when leak can be heard.
Epiglottitis -
\• Immediate intubation
• Antibiotics
• Extubate after leak can be heard
Delivery Room Care/APGAR -
\• APGAR Score 1-3: CPR. 4-6: O2 Therapy, ventilation, etc. 7-10: routine monitoring.
