Questions and Answers
Which of the following would you now recommend for Mrs. Bazen-Atkins?
What does the graphic indicate?
Based on your initial assessment and the previous ventilator graphic, what would you now recommend?
Which alternative intervention would you now recommend to address the 'Auto PEEP' situation?
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What lung protection strategy would you recommend to move the PIP below 35 cmH2O?
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Study Notes
Clinical Case Overview
- Mrs. Shelly Ann Bazen-Atkins, 37 years old, admitted for severe asthma.
- Current weight: 135 lbs (61 Kg), height: 5' 7" (170 cm).
- Orally intubated with a 7.5 mm ID ENT tube and receiving mechanical ventilation.
- Ventilation settings: VC SIMV, VT 450 ml, f 16 breaths/min, FIO2 45%, PEEP 7 cmH2O.
Evaluation Recommendations
- Key assessments to recommend for clinical status include:
- Appearance: Observe overall condition.
- Arterial Blood Gas (ABG) report: Critical for oxygenation and ventilation status.
- Ventilator graphics: Assess patient-ventilator interactions.
- Chest X-ray report: Rule out lung pathology.
- Vital signs: Monitor hemodynamic stability.
- Breath sounds: Check for abnormal lung sounds.
Ventilator Graphics Analysis
- Graphic evaluation indicates Air Trapping/Auto PEEP:
- Important to recognize in patients with asthma exacerbations.
Recommended Interventions
- Based on assessment findings:
- Perform in-line MDI treatment with a Short-Acting Beta Agonist (SABA) to relieve bronchospasm and improve airflow.
- Increase the expiratory time to address Auto PEEP concerns.
- Utilize a Heliox mixture to reduce PIP below 35 cmH2O, aiding in lung protection strategies.
Intervention Justifications
- Increasing expiratory time helps lower airway resistance and promote better gas exchange.
- Heliox (helium-oxygen mixture) decreases the work of breathing; beneficial in high PIP situations.
Important Clinical Indicators
- Monitor key ventilatory parameters:
- PIP (Peak Inspiratory Pressure): Should be kept below 35 cmH2O for lung protection.
- Static compliance: Assess for changes indicating patient condition.
- Use of manual resuscitator should be verified to ensure readiness for emergencies.
Final Recommendations
- Focus on optimizing respiratory therapy and mechanical ventilation settings.
- Regularly reassess treatment efficacy and patient responses to interventions.
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Description
This quiz evaluates your understanding of asthma management, focusing on clinical assessments, ventilator settings, and interventions for patients experiencing severe asthma exacerbations. You will explore key indicators such as ABG results, ventilator graphics, and chest X-ray reports critical for effective treatment.
