Week 14 Semester 3 Flashcards
What Should You Set the Plunger To
1.5 cc
What Should You Say to the Patient to Get Informed Consent
Description of the Procedure
Description of Potential Complications
Do You Understand or Have Any Questions
Do they consent
Optimal Site for ABG
Between styloid process fo radial bone and tendon of flexor carpi radialis
1-2 cm proximal to crease of wrist
Platlets
Normal: 150 000-300 000
Critical Number: <10 000
Thrombolytics
Ends in -ase
Streptase
Retavase
Activase rt-PA
Anticoagulants
Heparin
Fribrinogen
Normal: 1.6-4.1
Critical: <0.6
Veins of the Arm
Superifical veins are basilic and cephalic
The two radial veins lie on either side of the radial artery
The ulnar veins are close to the ulnar artery
Radial and ulnar veins meet to drain into
Transporting the ABG Sample
If the analysis of the sample will take more than 10 min put it in the ice slurry
Activated Partial Thromboplastin Time (aPTT)
Normal: 23-24 seconds
Critical Value: >120 seconds
ABG Hazard for Pt
Hemorrhage-Hold pressure for 5 min
Hematoma
Infection
Arterial Spasm and occulsion
Laceration of vessel
Air or blood emboli
Anaphylaxis
Cant Locate the Artery
Withdraw the needle until bevel is just below skin then redirct
only two redirct allowed
If still can not fin artery choose another site
International Normalized Ratio (INR)
Normal 0.9-1.1
Critical Value >6
Ventilatory Parameters Pediatric
Mode
PRVC
Ventilatory Parameters Pediatric
Vt
Start at 6 mL/kg
6-8 mL/kg
May be as low as 4 ml/kg or as high as 10 ml/kg depending on the size/age of the ped
Ventilatory Parameters Pediatric
PEEP
Start at 5
PEEP in asthma will not hold open a spasm airway so it will add onto air trapping and make it harder fortehptto trigger a breath
start 4-5 cmH2O
Aim for optimal PEEP
Increases typically made in increments of 1-2 cmH2O
Watch for CV compromise with increasing levels
Optimal PEEP
that which achieves the best lung compliance and oxygenation with the fewest CV side effects
Ventilatory Parameters Pediatric
Circuit
< 25 kg neo
> 25 kg adult
Neo circuit always heated, adult circuit dependent on size of ped
Always use a heated circuit in peds
KNOW your circuit for week 14 so when you are selecting a starting ptit is asking you for what circuit you are using in order to compensate for compressible volume
Ventilatory Parameters Pediatric
Inspiratory Time
Use 0.8
RR Infant
30-50
Toddler RR
24-35
Pre School RR
20-35
Child RR
18-30
Teen RR
12-20
Ti and Asthma
Shorten Ti to allow for exhalation
ABG in Pediatric
pH 7.35-7.45
PaCO2 35-45
PaO2 80-100
HCO3 22-25
SpO2 >90%
Oxygenation is bad and FiO2 is >0.6 and PEEP is apprpriate
Consider Ti
Moderate WOB and Decent Sats (>90%)
Asthma Protocol
Use MDI
Once RR is high and WOB is high and stats are low go to SVN
If sats are below 92 give oxygen with MDI
MDI Asthma Medications
Ventolin
- 5 Puffs is <20 kg
- 10 puff if >20 kg
Ipratropium
- 5 puffs
Nebulizer Medications
Ventolin
- 2.5 mg is <20 kg
- 5 mg if >20
Atrovent
- 250 mcg
What should you do before you use an inhaler
Shake the inhaler
When should you use a nebulizer
when they can not talk or when SpO2 is 85% or less
How to use an MDI with a spacer
10 puff of sabutamol
Administer one puff every 30 seconsd follow by 5 puff of ipratropium
Oxygen Therapy with MDI
Want sat > 92%
