Critical Care Medicine, Year 2000 Edition (Current Clinical by Michael Safani;Matthew Brenner

By Michael Safani;Matthew Brenner

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Extra resources for Critical Care Medicine, Year 2000 Edition (Current Clinical Strategies Series)

Example text

Wheezing, decreased air movement in the chest, hyperinflation, prolonged expiratory time, barrel chest, and supraclavicular retractions are characteristic. C. Pulmonary function testing 1. Significant airway obstruction is present when the forced expiratory volume in 1 sec (FEV1) is less than 80% of predicted, and the FEV1/Forced Vital Capacity ratio is less than 70% of predicted. 2. Hyperinflated lungs are indicated by an increased total lung capacity and residual volume and by loss of alveolar surface area and decreased diffusing capacity.

Keep peak airway pressure <40-50 cm H20 if possible. E. 48 because of respiratory alkalosis/hypocapnia): Reduce rate and/or tidal volume to less. If patient is breathing rapidly above ventilator rate, consider sedation. F. Patient "Fighting Ventilator": Consider IMV or SIMV mode, or add sedation with or without paralysis (exclude complications or other causes of agitation). Paralytic agents should not be used without concurrent amnesia and/or sedation. G. Sedation 1. Diazepam (Valium) 2-5 mg slow IV q2h pm agitation OR 2.

3. Causes of Inability to Wean Patients from Ventilators: Bronchospasm, active pulmonary infection, secretions, small endotracheal tube, weakness of respiratory muscle, low cardiac output. Pulmonary Embolism 43 Pulmonary Embolism Pulmonary embolism should be considered in any patient with acute respiratory symptoms. Nearly three-quarters of a million episodes of pulmonary embolism occur each year. Pulmonary embolism is usually caused by thrombus formation is in the larger veins above the knee. I.

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