Respiratory Therapy Formulas and normal values: 1. Ideal Body Weight (IBW): a. Female: 100 lb for 1st 5ft + 5lbs ea additional inch b. Male: 106 lb for 1st 5 ft + 6lbs ea additional inch 2. Static Compliance: Compliance: (VT/Static (VT/Static pressure – PEEP) PEEP) a. Normal = 60-100 b. <60 = lungs becoming becoming less less compliant compliant c. >25 is acceptable d. <25 is unacceptable 3. Desired FiO2 = Desired PaO2 + Known FiO2 Known PaO2 4. Desired Ve= Known Ve*Known PaCO2 Desired PaCO2 5. RAW: PIP–Plateau/ P IP–Plateau/ Flow, or PIP–plateau 6. French size size sx catheter = ETT size size * 3/2 8. PAO2: PAO2: (713 (713 *Fio2 *Fio2 – PaCO PaCO2)/ 2)/0.8 0.8or or 0.1 0.1 if 100% 100% O2 9. A-a gradient: PAO2 – PaO2 a. Normal Normal on RA = 10-40 10-40 or on 100% 100% = 25 25 – 70 b. Increa Increased sed 66-3 66-300 00 = acute acute lung lung injury injury c. >300 >300 = severe severe shun shuntin ting, g, ARDS ARDS (una (unacce ccepta ptable ble)) 10. Shunt % = A-a gradient/20; normal=20% -- if >20 an increase increase in PEEP is indicated 11. a-A ratio: PaO2-PAO2 a. Normal = 80% (74% elderly) b. 60% = V/Q imbalance imbalance c. 15% = shunting shunting 12. P/F Ratio: PaO2/FiO2 a. Normal = 300 – 500 b. Acute lung injury = 200 – 300 c. <200 = ARDS 13. Expected PaO2 = FiO2 x5 a. Used to determine determine if pt oxygenating oxygenating better b. Actual PaO2/ Expected Expected PaO2 = % of patient expected PaO2 14. PS should be set to= RAW or > if therapy indicated. indicated. 15. e-cylinder time remaining=0.30(P remaining=0.30(PSI) SI) / LPM 16. Oral intubation intubation = 21-25cm @ lip. 17. Nasal intubation intubation = 26-29cm 17. PEEP therapy = >6-8 CWP 18. Humidity should should be set at 37 degrees Celcius. 20. Suction:Adult=100-120,Child=80-100, Suction:Adult=100-120,Child=80-100,Infant=60-80 Infant=60-80 21. Pt.WOB=<0.8=normal, Pt.WOB=<0.8=normal, measures measures effectiveness of rise time and sensitivity. sensitivity. Measured in spont. mode. Acute Lung Injury or ARDS Ventilator Strategy: Lung Protective Ventilation 1. Idea Ideall VT VT = 6 ml/ ml/kg kg IBW IBW 2. Oxygenat Oxygenation ion target: target: a. PaO2 PaO2 55-80 b. SpO2 88-95% 88-95% 3. pH Goal: 7.45-7.30 a. >7.45: Decrease Rate b. <7.30: Increase Rate Rate (maximum (maximum rate = 35) c. If rate >35, or CO2 <25, <25, consider HCO3 d. < 7.15?, increase VT 1ml/kg (may exceed Static Pressure) 4. Plateau pressure: Dr. to select target pressure a. If >30? & due to VT, decrease decrease VT by 50cc Q1 until p-plat < 30, but do not let VT get <4cc/kg b. If <25? & VT < ideal VT, increase VT by 50cc Q1 until ideal VT is reached, so long as p-plat remains < 30. 5. Pts usually tachypneic, tachypneic, may be uncomfortable, uncomfortable, & may fight the ventilator. Increased sedation may may be indicated.
Guidelines to adjusting Ventilator settings: 1. PaCo PaCo2 2 > 45 4. SpO2 SpO2 >95% >95% a. increase RR a. reduce Fio2 –60% b. increase VT b. reduce PEEP to 5 2. PaCo2 <35 c. reduce FiO2 a. decrease ra rate b. decrease VT 3. PCO2 <90% <90% or SaO2<60 a. increase FiO2 FiO2 to 60% b. increase PEEP c. increase FiO2 FiO2 to 100%
EKG and rhythm strip interpretations: interpretations: 1. Pulmonary Embolism: a. S wave in in le lead I b. b. ST depr depres essi sion on in lead lead II c. Larg Largee Q wave wave in lead lead III III d. T wav wavee inve invers rsio ion n in lead lead III III 2. Basics: a. ST dep depre ress ssio ion n = acut acutee bloo blood d loss loss b. Q Wave Wave makes makes diag diagnos nosis is of of infa infarc rctt c. Q wav wavee one one smal smalll squ squar aree is is MI MI d. Inve Invert rted ed T-w T-wav avee is isc ische hemi miaa 3. Posterior wall Infarct: Infarct: a. ST depr depres essi sion on in in V1 & V2 V2 if acut acutee b. b. Larg Largee R in V1 and and V2 V2 c. Maybe Q in V6 d. Inve Invert rted ed mir mirro rorr test test V1 V1 & V2 V2 4. Lateral wall Infarct: Infarct: a. Q in in lea leads ds I and and AVL AVL (V5, (V5, V6) V6) 5. Inferior wall Infarct: a. Q in in lea leads ds II, II, III III,, & AVF AVF b. b. ST elev elevat ated ed if if acu acute te 6. Anterior wall Infarct: Infarct: a. ST elev elevat atio ion n V1 V1 & V2 b. b. Q in in V1, V1, V2, V2, V3 V3 or or V4 V4 c. V1 & V2 V2 = Ant Anter erio iose sept ptal al d. V3 & V4 V4 = Ante Anteri riol olat ater eral al 7. SVT: Narrow QRS QRS & rate of 150-250 8. LBBB: 2 R waves in V5 & V6 9. RBBB: a. 2 R waves in V1 & V2 b. QRS wide and looks like an M 10. Acidosis: Smaller amplitude 11. COPD: Small amplitude, amplitude, Right axis deviation deviation 12. 2nd degree block block type I: a. PR interval interval becomes progressively longer until 1 QRS skipped. b. blocked QRS QRS after every 2-5 QRSs c. QRS may be normal or wide if BBB 13. 2nd degree type II: a. p waves for ea. QRS at ratio of 2:1, 3:1 or 4:1. b. Often wide w/RBBB w/RBBB
Level of Consciousness: 1. Lethargic/ Lethargic/ somnolence: somnolence: sleepy 2. Stuporious/confused: responds inappropriately, OD, intoxication 3. Semi-comatose: responds only to painful stimuli 4. Comatose: does not respond to painful stimuli 5. Obtunded: drowsy, maybe decreased cough/gag reflex
Res irator thera
cave.blo s ot.co .com 09/07/2009
