Case 5 - Jacob - ICU

Question 1

Suction process

Answer 1

Preoxygenate 100% (2 mins), check suction pressure (60-150mmHg), insert 1cm back from carina and support ETT tube, withdraw (15 secs max), post oxygenate (2 mins), use 3ml saline to clean catheter make sure valve is shut.

Question 2

What should you do before and after the suction process?

Answer 2

Auscultation! (and oxygenation..)

Question 3

Weaning process from mechanical ventilation

Answer 3

• PEEP = reduced to 5cm water.
• RR = turned down, CO2 increase stimulated drive to breathe.
• FiO2 = dropped.
• Pressure support = switched to SIMV, turn on to ASB mode.
• Gradually turn down ventilator OR drop settings during day and return to normal at night.

Question 4

What is CMV/IMV?

Answer 4

Controlled/intermittent mandatory ventilation

Question 5

What is SIMV?

Answer 5

Synchronised intermittent mandatory ventilation.

Question 6

Why closed suctioning?

Answer 6

B/c ventilator will retain PEEP to prevent absorption atelectasis – less PC (important b/c Jacob will already have atelectasis; therefore, don’t want to make it worse).

Question 7

Why is early mobilisation/exercise important?

Answer 7

(1) strengthening the diaphragm and accessory muscles, and (2) preventing general deconditioning and reducing muscle wasting, aiding in the physical effort required for spontaneous breathing

Question 8

How does early mobilisation/exercise work?

Answer 8

Help reverse muscle atrophy caused by prolonged ventilation as well as increase lung volumes, improve lung compliance, and help clear secretions, making breathing easier; they also support neuromuscular coordination and reduce ICU delirium, lowering anxiety and promoting pt engagement (all of which contributes to a smoother weaning process)

Question 9

How does Wasserman’s gears diagram work?

Answer 9

Exercise = turning the gears.
As the gears function more effectively, there’s less strain on each system, meaning breathing becomes easier, the heart doesn’t have to work as hard, and everyday activities require less effort

Question 10

Physiology of wasserman’s gears diagram

Answer 10

Increased muscle work leads to increased cardiac output, increased redistribution of blood flow, and increased ventilation in response to both the (1) increased metabolism, and (2) evolution of CO2 from the blood b/c of lactic acid buffering

Question 11

What would Jacob’s CXR show?

Answer 11

Rib #’s, lungs may appear more opaque, diaphragm, fissures, hili, or mediastinum may be displaced.