How to Survive the Surgical ICU - AP_Respiratory Status
AssessmentPlan
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PLAN:
  1. Pulmonary Hygiene:
    1. Pulmonary Toilet.
      Early mobilization of patient
      Albuterol nebulizer
      Incentive Spirometry
      Chest Physical Therapy
      Upright posture
    2. Weaning Measures:
      Back off sedatives
      Infections combated
      Nutritional support, magnesium & phosphorus-Helps with diaphragm function
      Weaning parameters met (see ICU guidelines)
    3. Optimize oxygen/ventilator therapy
      Keep PaO2 >60 mm Hg
      Keep FiO2 < 50%
      Lowest PEEP and avoid hyperinflation
      Early discontinuation of pulmonary artery catheters
      Aspiration precautions

  2. Assess the need to Intubate
    Patient airway is first assessed by ABCs
    1. Use head tilt/chin thrust/ jaw thrust to open airway
    2. Oral or nasal airways help
    3. Face mask and bag valve (AMBU-BAG)
      Next step is INTUBATION if:
      1. Airway Obstruction
      2. Inadequate Oxygenation- O2Sat: <90% on Hi-flow oxygen face mask
      3. Inadequate Ventilation- Hypoventilation: High PCO2, pH-acidosis
      4. Elevated Work of Breathing
      5. Airway Protection

  3. ARDS: Many interventions attempted:
    • Maximize PEEP to avoid high FiO2s
    • Reverse I:E ratio
    • Permissive hypercapnia (high PaCO2)
    • Pulmonary consult


  4. Pneumothorax:
    Occur more often in the ICU than in any other part of hospital.
    Ventilators can cause alveolar rupture
    Iatrogenic from procedures: lines, pacemakers, thoracentesis.
    Stat chest Xray
    Tx: Chest tube placement / Angiocath in 3rd or 4th intercostals space

  5. Ventilator Problems:
    If problems arise:
    • Unhook the ventilator from the ET tube
    • Use bag and suction
    • Check Cuff pressure
    • Chest Xray and ABG
    • Call respiratory therapist
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