Chest Tube Oxygen.pdf

Chest Tubes Oxygen Delivery Vents Final  Chest Tubes * Pneumothoax (popped Lung · Defined as the presence of air within pleural space · secondary to...

Chest Tubes Oxygen Delivery Vents Final  Chest Tubes * Pneumothoax (popped Lung · Defined as the presence of air within pleural space · secondary to Trauma (blunt or penetrating) - breaking ribs , gun shot T ! Lif open penetrating injury DO NOT REMOVE OBJECT bleb rupture. - emphysema - - spontaneous (peds patients) -line insertionliatrogenic) thoracentesis Sesssmall · Mild : tachycardia dyspnea , -large ; resp distressairhunger desaturationa affected area in DX · - CXR S - & Tension Pneumothorax # Large amount of air accumulatesinthea · pressure forces the mediastinal Highstructures to the opposite side exitracheal deviation ; JUD , cyanosis, ↓ CO This is an EMERGENTY the superior pressure collapses High and inferior vena cava Rinigh thready RirThigh  Water-Seal Drainage System - Most important chamber · WATER SEAL normal note intermittent bubbling : c continuous bubbling = AIR LEAK in thesuctionchamber,continuousbubblin is What if... 2 wat The tube becomes disconnected ? - put the end in Sterile saline bottle after hand immediate glove Lact like a water seal The chest tube is pulled ? out - ocquavedressingovertheInsertionsite pneumothic des fallows escape air to and prevent tension NOTIFY PROVIDER The pluravac leaks or breaks ? treat like disconnection -  Oxygen Delivery  Masal Cannula · Advantages - comfortable for patient - Ideal for claustrophobic patients Ideal foroxygendependent patientsrequirin as a - a Disadvantages · - Maximum estimated FiO 240 - Notappropriate for patients respiratory in distress 2-6L/min -24 42 % 02 - % Mon-Rebreather air 21 room Advantages · - Fast and easy to set up Disadvantages · FiO2 : 100 /FiO2;fraction of inspired ony/ Delivers only one - variable While - Fitz is extremely - FiOz of 1 00 , theoretically capable of delivering an 60 and 80 due to. realistically it is more likely btw around the mask - air entrainment Isuffication risk if bag becomes detached from the wall Don't have both values on 15 liters /min Oxygen Delivery P+ 2. Simple Face Mask Advantages quick and to set up and easy apply - - often found at the head of the bed in emergency areas (eg Emergency Dialysis PACK). , , Disadvantages - Nonspecific FiO2 (Dependant on patients (maximum Fide estimated at Sanspiratory flows). not intended for long term use - bliters/minute Venturi Mask Advantages Quiet - Administers a specific FiO2 I Determined by air entrainment adaptor on end Disadvantages to mask adapters. fiO2 only · available according · 24· 201 31 ,. 35,. 40 and 60 - Oxygen Delivery Pt3. Nebulizer Airways  Non-Invasive Positive Pressure Ventilation CPAP-BiPAP A CPAP-ContinuousPositive Air Pressure BiPAP-Two levels of Positive Airway Pressure IPAP-Inspiratory Positive Airway Pressure EPAP-Expiratory Positive Airway Pressure  ↑ CPAP -Continuous Positive Pressure Ainay Continuous pressure delivered throughout the · respiratory cycle · Helps vol hypoxia - Increases 02 Decrease the work of breathing - - Increases intrathoracic pressure-preload >↓ - cardiac orgest used for sleep workload' appea and CHF exacerbation Patient must have spontaneous respiration · setting Usually 6 to 15 cmH0-Highest 25 cH20 · BiPAP Two levels of Positive Airway Pressure Delivers Expiratory Pressures inspiratory and · works to remove CO2 D Copp exacerbation - Two · setting :. Ex: 10/s - 10cmHz0Inspiratory ; SamH20 expiratory = The difference between inspiratory and - called expiratory pressure is pressure support 10-15 cm+ usual Settings Inspiratory : 20 · Expiratory 2- TcmH20  da For kidsa  CO2 Detector A To check tube placement , listen to stomach first Be if then hear air come in , lungs you then you know the tube is in the wrong place * · Nellor Easy Cap from ETT Measures CO2 exhaled - · Gold is Good - Detects ETT placement Purple in Stomach ·  Mechanical Ventilator Ventilator ; breaths for you - a machine used to assist or replace the work by the generated ventilatory muscles Mechanical Ventilator use of a ventilator to into and - more gas out of pulmonary system Ventilator needed ? When is a Arrest/Distress Respiratory · floceabsent reflexe unable to Protect gag · · Severe Metabolic Acidosis Airway · Respiratory muscle fatigue Hypoxemia-PaOzkTOmmHg) · Hypercaphia-PaCOz( 50mmHg) · > Resp Acidosis (ph < T 2 w/ Hypercapnia ·.  Ventilator Setting Respiratory Rate number of breaths per minute · I 4-20 breaths/min · Tidal Volume volume of gas delivered per ventilated breath · · 5-15 m//kg 1500 - 800mr) Middle Ventilation oRRXVt achieve normal (for the patient)PaCO2 · Goal is to Concentration (FiO2) Oxygenofraction (Higher-more severe of inspired oxygen delivered (% ) 0021-1 0 (21-100 ) ·. % · Maintain RaOzhOmmHg pulse oX > 90% InspiratoryExpiratorytexpirin ~ Normal 1 :2 Ventilator p+2 Inspiration · settings spontaneous Pressure Support (PS) - · Pressure that is delivered when the patient initiates their own breath-best when breathing - makes inspiration easier for the Patient Ldecreases the work of breathing wearing from rent Expiration - used when Positive End Expiratory Pressure (PEEP) · Pressure maintained end of expiration at the - keeps alveoli open-prevents atelectasis 2-10 anH20-above 20cm 10 lead to may - Barotrauma & conscious or unconscious pt  Ventilator Modes Full control of - breathing Assist Control (A/c) Continuous or Mandatory (mv) Ventilation - Preset tidal volume (Ut) Preset (f) ofpatient's rate regardless - L own breathing pattern set rate and breath-best for gives who are unable to breath people on own ↳ if patient initiates the breath ,the vent will give the entire It Preset - FiOz Ex A/CarCMV A/cqU+=700m/j Fitz = 50 initiates breath ivent will finish it for If patient - them ventilat Synchronized Intermittent stepping awayI from Mandatory Ventilation (simr) full control - Preset tidal volume (Vt) - Preset rate(f) but synchronizes to patient's , I patient can initiate their own breath breathing who the vent (the vent will givingot give a preset (f) - Preset FiOz - Good for Ventilation support Wearing mode - ex f = 12; V +: 800m/ ; FiOz. 50 if breathing on own the simo will give the rate no matter what ver Constant Positive Airway Pressure (CPAP) mode weaning · - no set rate oftidal volume - patient is breathing spontaneously still receives oxygen - Positive · pressure is applied during spontaneous - 5-20 cmH20 breathing - PEEP is added  Adjunctive Settings Positive End-Expiratory (PEEP): preset positive pressure applied · at the end of expiration of ventilated - breaths only - Sto15cm + 0 ↳ 20 cmH20 can lead to Barotrauma · keeps alveoli open Used with A/C or SIMU · not CPAP - 0 80 PEEP = EX : A/Cif =10 ; V+ 800 ; FiOz O =. ; Adjuctiveings Pressure Support (Ps) · Positive pressure used to augment -bontaneous breathing breathing (inspiration) make work of S-20cmH20 · easies Ex : SIMU ; fIziVt 650 ; FiO, 40 %ps10  Complications Barotrauma · CardiovascularCompromise · Increased Thoracic Pressure>Decreased HR - and BP Ventilator Acquired Pneumonia (UAP) · - Elevator HOB - Good oral care suction canisters - Change -turn  Alarms VentilatorHighBlockage (DE Pneumothorax) ( , High Pressure (Biting zkinks tube in tube Lexcessive airway) Secretions blocking the ventilation - something is blockage Low Pressureofconnectioa n - ventilation is too easy Beware of Alarm Fatigue