wards Flashcards
When to do home oxygen assessment
72 hrs prior to discharge
Funding for oxygen at rest
Pt rested for min 10 minutes on RA and shows ABG PaO2 < 55mmHg OR if they have CHF or pulm HTN + PaO2 < 60mmHg OR if palliative or cannot do ABG, shows SpO2 < 88% for 6 mins continuously
Funding for oxygen with ambulation
SpO2 < 88% for > 1 minute on RA during 6 minute walk test
Funding for nocturnal home O2
OSA must be absent or maximally treated, SpO2 < 88% for >30% of 4hr night sleep OR if CHF or pulm HTN, for >20% of night.
indications tracheostomy suctioning
(open in wards)
- coarse br/s or decreased br/s
- desat/compromised oxygenation
- unable to clear secretions on their own with cough
- seeing secretions at end of T-piece or trach tube
- changing inner cannula
- assessing patency of the tube
- resp distress
complications of trach suctioning
- bleeding/hemorrhage
- vomiting
- bronchospasm
- infection
- hyper or hypotension
- resp arrest
- increased ICP
- hypoxemia
- dysrhythmias/bradycardia
- mechanical trauma
safety equipment for tracheostomies
(must be at bedside AND transport)
- trach emergency equip bag: syringe, scissors, dilator, lube, 5 cuffed proximal XLT
- spare inner cannula
- obturator
- resusc bag and mask
- OPA
codes
Full: do everything
DNR-5: everything including intubation but no compression
DNR-4: everything but no intubation or compression
DNR-3: everything but no intubation, compression or BiPAP
DNR-1: palliative
**dont do ABGs on DNR-3s bc you can use other oxygenation parameters (e.g. venous samples)
PvO2
35-40mmHg
PvCO2
40-50mmHg
indications for deep suctioning
- unable to clear secretions
- less invasive methods do not work
- retained secretions compromising Pt resp status (increased WOB & O2 requirements)
deep suctioning complications
- mechanical trauma
- mucosal hemorrhage
- hyper/hypotension
- bradycardia
- resp distress
- hypoxemia
- atelectasis
- infection
- increased ICP
- vomit/gag
- dysrhythmia
- laryngospasm
- bronchospasm
deep suctioning contraindications
- INR >1.3 or PTT < 50,000
- epiglottitis, croup
- bleeding around mouth/nares
- laryngospasm
- irritable airway
- gastric surgery with high anastomosis
- head/neck/facial injury (basal skull fracture, battle signs, raccoon eyes)
- occluded nasal passages
- loose teeth
heliox indications
low density gas, short term support to reduce airway resistance and WOB in Pts with airway narrowing secondary to inflammation, bronchoconstriction, or partial mechanical obstruction
what is the lowest helium mixture possible and why
below 50% helium, no benefit due to inadequate difference in density compared to conventional gas mixture