Step T - Treatment Flashcards
What are the two kinds of treatment?
- corrective
- supportive
What does corrective treatment do?
reverses the underlying problem
What does supportive treatment do?
treats the symptom and preserves acceptable pH
What do you give a person when s/he is acidotic?
bicarb
If the pH is normal, you should not treat ___ or ___
bicarbonate or CO2
How should you treat respiratory acidosis?
- bronchial hygiene if possible
- initial CMV if in resp failure and pH <7.25
What may be a greater indicator of the need for CMV than an isolated pH measurement?
respiratory acidemia
How should you treat a patient with COPD?
- low-flow oxygen may be effective despite high CO2 levels
- noninvasive ventilation
- hypercarbia
- CMV
What must you do to lower CO2?
- increase alveolar ventilation
- increase VT
- increase RR
- decrease deadspace
What are the CMV goals for chronic CO2 retention?
- return CO2 to chronic normal level
- 10mmHg per hour
What can abrupt changes in CO2 lead to?
- cerebral alkalosis
- vasoconstriction
If a patient has been on a vent with lowered CO2, they may require a ____ time to wait for renal compensation
longer
What is the most common cause of respiratory alkalosis?
hypoxemia
How should you treat respiratory alkalosis?
- O2 (supportive treatment)
- breathing exercises to alleviate panic
- drugs
If respiratory alkalosis is not due to hypoxemia, how should you treat it?
try breathing in a bag or tubing
With sustained hypocapnia, CO2 is lowered to ___ ICP. It should not go below ___ and should only be used short term
lower; 30
How would you reduce alveolar ventilation?
- decrease VT
- decrease RR
- increase VD
For metabolic acidemia, how should you treat a pH greater than 7.10?
leave alone, better to treat the underlying cause
For metabolic acidemia, how should you treat a pH lower than 7.10?
sodium bicarbonate
What are some NaHCO3 complications?
- arterial hypercapnia
- intracellular hypercapnia
- CSF acidosis (CSF does not receive extra HCO3)
- decreased potassium can occur
- fluid overload
When is THAM used?
it is no longer used but was once used to treat metabolic acidemia
What is THAM?
a superior alkalizing agent that is a good buffer due to its lack of sodium and is superior to HCO3 in CSF. it comes in a powder form and must be mixed prior to administration
What are the THAM hazards?
- spasms
- phlebitis
- thrombosis at site of administration
How many ABGs are classified as metabolic alkalemia?
1/3
What can cause metabolic alkalemia?
- IVs
- NG tubes
How would you treat mild to moderate (pH 7.45-7.55) metabolic alkalemia?
- potassium replacement therapy
- KCl
- fluid replacement
- foods: bananas, beans, potatoes, fish, poultry
How would you treat severe (pH >7.55) metabolic alkalemia?
dilute IV with HCl, ammonium chloride, or arginine monohydrochloride
