ANAESTHETICS AND AIRWAY
VENTILATION
PromptCauses of high airway pressures
ResponseDOPES
Dyssynchrony (Awake patient)
Displacement (Eg: R main bronchus intubation)
Obstruction (blocked ETT)
Pneumothorax
Equipment Failure (Ventilator malfunction)
Stacked breaths, Secretions, bronchoSpasm
Dyssynchrony (Awake patient)
Displacement (Eg: R main bronchus intubation)
Obstruction (blocked ETT)
Pneumothorax
Equipment Failure (Ventilator malfunction)
Stacked breaths, Secretions, bronchoSpasm
PromptInitial management of high airway pressures
ResponseDisconnect patient from ventilator and bag (remove machine as possible source)
Examine for tension ptx
CXR for tube position/Ptx
Pass suction catheter down tube
Sedate and paralyse patient
Examine for tension ptx
CXR for tube position/Ptx
Pass suction catheter down tube
Sedate and paralyse patient
PromptChanges you can make to improve oxygenation
ResponseIncrease PEEP (beware hypotension, may decrease tidal volume)
Increase pressure limits (risks of barotrauma, eg; PTx, ARDS)
Increase I time, decrease I:E ratio - worsen hypercapnoea
Increase pressure limits (risks of barotrauma, eg; PTx, ARDS)
Increase I time, decrease I:E ratio - worsen hypercapnoea
PromptCAPNOGRAPHY
Response
PromptUses for ETCO2 monitoring in ED
ResponseConfirm and monitor ETT placement
Sedation and procedural sedation
Cardiac arrest - Suggests ROSC if ETCO2 has abrupt increase to normal level 35-40
Predicts unsuccessful resusctiation if ETCO2 <10 after 20 mins of CPR
Guide to compression quality
Detect spontaneous breathing in intubated/sedation patient
Sedation and procedural sedation
Cardiac arrest - Suggests ROSC if ETCO2 has abrupt increase to normal level 35-40
Predicts unsuccessful resusctiation if ETCO2 <10 after 20 mins of CPR
Guide to compression quality
Detect spontaneous breathing in intubated/sedation patient
PromptExplain this trace in asthmatic and interventions to fix
ResponseSharktooth pattern indicates obstructive airway disease such as asthma
Optomise asthma therapy - beta agonsits, continuous nebulised salbutamol via circuit/IV salbutamol/Mg bolus
Optomise sedation/paralysis
Ensure asthma specific ventilation - Low TV, permissive hypercapnoea
Optomise asthma therapy - beta agonsits, continuous nebulised salbutamol via circuit/IV salbutamol/Mg bolus
Optomise sedation/paralysis
Ensure asthma specific ventilation - Low TV, permissive hypercapnoea
PromptManagement of this trace
ResponseET tube cuff leak, ET tube in hypopharynx, partial obstruction
Check pulses and ensure not in cardiac arrest
Check circut for disconnect/leak
Disconnect and manually bag and ventilate with 100% FiO2
Check ETT placement - Listen/feel for bilateral chest rise and fall
Check for leak ? tube exchange
Pass suction catheter to clear mucous plugging
If tube disrupted/dislodged remove immediately and replace.
Check pulses and ensure not in cardiac arrest
Check circut for disconnect/leak
Disconnect and manually bag and ventilate with 100% FiO2
Check ETT placement - Listen/feel for bilateral chest rise and fall
Check for leak ? tube exchange
Pass suction catheter to clear mucous plugging
If tube disrupted/dislodged remove immediately and replace.
PromptUseful stuff from a website I forgot to reference:
Response