robin082006
Forum Hero
Topics: 471
Posts: 5,125
|
You are called to see a 67-year-old woman with severe COPD who was intubated on the medicine floor 30 minutes earlier because of respiratory distress. Her temperature is 37.0 C (98.6 F), blood pressure is 90/60 mm Hg, pulse is 133/min and regular, and respiratory rate is 24/min. Her ABG reveals the following: pH 7.21, PaCO2 80 mm Hg, PaO2 69 mm Hg, and her oxygen saturation is 91%. Her current ventilator settings are assist control (AC), respiratory rate (RR) of 12/min, tidal volume (TV) of 500 ml, fraction of inspired oxygen (FiO2) is 50%, positive end expiratory pressures (PEEP) of 5 mm/Hg. The most appropriate intervention at this time is to
A. decrease set respiratory rate
B. increase the fraction of inspired oxygen
C. increase PEEP
D. increase tidal volume
E. make no adjustments at this time
Kap q
___________________
The Key to Succeed is Patience.
|
| Aashi
Forum Moderator
Topics: 113
Posts: 1,061
|
D. increase tidal volume
___________________
"Obstacles are those frightful things you see when you take your EYES off your goal."
|
| hanialkhadher
Forum Elite
Topics: 18
Posts: 258
|
I would decrease the respiratory rate
___________________
"أقرأ بأسم ربك الذي خلق,خلق الأنسان من علق,أقرأ و ربك الأكرم, الذي علم بالقلم,علم الأنسان ما لم يعلم"
|
| khorshid
Forum Guru
Topics: 32
Posts: 591
|
By decreasing the RR you'll have even higher PCo2. what about C?
|
| prathapdoctor
Forum Elite
Topics: 12
Posts: 406
|
I would increase the tidal volume.
|
| robin082006
Forum Hero
Topics: 471
Posts: 5,125
|
This patient has very high PCO2--> we should increase minute ventilation to decrease it.
Minute ventilation= RR*tidal volume
so we increase RR or tidal volume.
Answer is D
___________________
The Key to Succeed is Patience.
|
| ssrpk
Forum Fanatic
Topics: 154
Posts: 2,819
|
wht does explanation say about the low blood pressure???
___________________
life is guud
|
| doyoudig
Forum Guru
Topics: 144
Posts: 613
|
robin u seem to have a good undertsanding of this concept. Could you pls explain in which conditions you would do the other things that are given as answer choices
when do you
--> Decr or Incr PEEP (what should be the normal)
--> Decr incr FiO2 (what is normal)
--> Decr incr TV or RR
ur response is greatly appreciated, thx
|
| robin082006
Forum Hero
Topics: 471
Posts: 5,125
|
Decreasing RR--> increase carbon dioxide because we are decreasing minute ventilation, we select increasing RR if there is this option.
Increasing FiO2 if Pao2<60
Decreasing FiO2 if Pa02=100 and Fi02 is high (too much oxygen may cause lung injury). goal of treatment is PaO2>60 and FiO2<60
Increasing PEEP used in ARDS. Decrease PEEP in COPD (avoid barotrauma..tension pneumothorax) edema
___________________
The Key to Succeed is Patience.
|
| prathapdoctor
Forum Elite
Topics: 12
Posts: 406
|
thanks robin, ita a valuable input.
|
|
| |
| | | | | | | | | | |
