dr_jojo
|
A 67-year-old woman has been intubated for 1 week after undergoing a left lobectomy for lung cancer. She has chronic obstructive pulmonary disease. Her preoperative functional vital capacity was 40% of predicted. She is awake and alert. Her blood pressure is 130/75 mm Hg, and pulse is 72/min. The ventilator settings are a synchronized intermittent mandatory ventilation of 8/min, FIO2 of 40%, and positive-end expiratory pressure of 5 cm H2O. Arterial blood gas analysis shows:
pH 7.42
PCO2 47 mm Hg
PO2 90 mm Hg
O2 saturation 96%
Which of the following is the most appropriate next step in management?
A
) Antibiotic therapy
B
) Bronchodilator therapy
C
) Chest physiotherapy
D
) Decrease inotropes
E
) Diuretic therapy
F
) Fiberoptic bronchoscopy
G
) Heparin therapy
H
) Incentive spirometry
I
) Increase FIO2
J
) Increase inotropes
K
) Increase respiratory rate
L
) Placement of thoracostomy tube
M
) Tracheostomy
N
) Wean from the ventilator
|
| Aashi
Forum Moderator
Topics: 113
Posts: 1,061
|
N) Wean from the ventilator
___________________
"Obstacles are those frightful things you see when you take your EYES off your goal."
|
| dr_jojo
|
COULD U PLZ EXPLAIN THIS FOR ME AASHI
PLZ IN DETAILS
|
| Aashi
Forum Moderator
Topics: 113
Posts: 1,061
|
she is doing well,with the minimum required setting on the ventilator, she is saturating >90% with fio2 of 40%, AND SHE IS AWAKE AND ALERT----->so start weaning the pt from the ventilator..
GL
___________________
"Obstacles are those frightful things you see when you take your EYES off your goal."
|
| NE
Forum Guru
Topics: 53
Posts: 504
|
One week after intervention he has normal vital signs; his blood gases are normal (pCO2 is increased a little bit but he has COPD so you don't have to decrease CO2 until standard value because the patient could lose respiratory drive). These are criteria for weaning :
1. Alert patient
2. PaO2> 60 with FiO2< 0.4 / PaO2/FiO2 >150
3. hemodinamic stability
If the patient is doing well why you have to keep him intubate?
|
| dr_jojo
|
Thanx
|
| robin082006
Forum Hero
Topics: 471
Posts: 5,125
|
N
___________________
The Key to Succeed is Patience.
|
| dr in trouble
Forum Guru
Topics: 62
Posts: 601
|
itz N
___________________
If u want to do something, do it today as there is no tomorrow.
|
| Ivonne
Find a way or make one
Topics: 57
Posts: 1,624
|
N
___________________
"The question isn't who is going to let me; it's who is going to stop me. " ~ Ayn Rand
|
|
| |
| | | | | | | | | |
