5. Respiratory Care Going to New Heights › sites › default › files... · Respiratory Care:...
Transcript of 5. Respiratory Care Going to New Heights › sites › default › files... · Respiratory Care:...
![Page 1: 5. Respiratory Care Going to New Heights › sites › default › files... · Respiratory Care: Going to New Heights Suzanne Iniguez BSN, RN, RRT-NPS-ACCS, AE-C, C-NPT, CHSE. Respiratory](https://reader033.fdocuments.us/reader033/viewer/2022060210/5f04a3eb7e708231d40ef965/html5/thumbnails/1.jpg)
Respiratory Care: Going to New Heights
Suzanne Iniguez BSN, RN, RRT-NPS-ACCS, AE-C, C-NPT, CHSE
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Respiratory Care
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Oxygen
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Thanks for Playing
Bubble CPAP
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Ventilation
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Scenarios
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stion
Premature infants who exhibit good respiratory effort at birth should be placed on what immediately?
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CPAP (Continuous Positive Airway Pressure)
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Why do we use BCPAP?
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Ans
wer CPAP increases FRC (Functional
Residual Capacity) and decreases WOB (Work of Breathing)
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stion
What is the time frame in which to receive early surfactant?
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Within the first 2 hours of life?
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How do we deliver surfactant?
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Que
stion § 5F MAC needed to administer Curosurf.
§ Pt. can be given Curosurf while on ventilator or while manually bagging.
§ MAC can be saved for repeat dosing if needed.
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stion
What is the dose for surfactant?
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Ans
wer Depends on the brand that you use –
Curosurf Dosing
Initial Dose 2.5ml/kg
Second dose in 12 hours1.25ml/kg
Third dose 12 hours later 1.25ml/kg
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When intubated what is the preferred mode of ventilation?
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wer
Volume Guarantee (VG) VentilationAssist Control – Volume Guarantee (AC-VG)SIMV – Volume Guarantee (SIMV-VG)
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stion
How many mls do we target for Vt ?
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Vt Target 4.5 – 6.0 mls/Kg
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What is the volume of an infant manual resuscitator?
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wer
250mls
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stion
If a patient fails conventional ventilation what ventilator do they go to next?
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stion - High Frequency Oscillator Ventilation
(HFOV)
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Que
stion What is different about the
oscillator when compared to other ventilators?
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stion
The oscillator has active inspiration and exhalation.
Conventional ventilation has passive exhalation.
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stion
If you want to increase oxygenation on the oscillator what are 2 parameters that you can change?
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stion
1. FiO22. MAP (Mean Airway Pressure)
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stion
If you want to decrease CO2 on the oscillator what are 2 parameters that you can change?
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stion
1. Amplitude (Delta pressure)2. Hz (the rate)
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stion
To decrease the CO2 do I turn the Hz up or down?
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Ans
wer You turn the Hz down to blow off more
CO2
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What is the Targeted Oxygen Saturation Range in your NICU?
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wer
Your NICU?
My NICU is 90 to 95%With alarms set at 88 – 96%
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stion
What is the easiest way to provide low flow supplemental oxygen?
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Ans
wer A simple Nasal Cannula
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stion
Where do you measure a Pre-Ductal Oxygen saturation?
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stion
On the right wrist/hand
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stion
A difference between the pre-ductal and the post-ductal saturation may be indicative of?
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wer
Pulmonary Hypertension
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stion
What gas can we deliver to the patient to treat pulmonary hypertension?
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wer
Inhaled Nitric Oxide (iNO)
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stion
What are the 3 components of BCPAP?
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Ans
wer What are the 3 components of BCPAP
- Circuit
- Interface
- Pressure Generator
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stion
When checking BCPAP what do you look at?
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Que
stion When checking BCPAP
- Look for appropriate sized prongs/mask- Ensure a cushion of air with prongs/barrier with
mask- Assess the skin- Is a chin strap needed- Is there bubbling (Suzanne’s 5 Types of Bubbling)- Check flowrate- Check FiO2- Check CPAP pressure- Does the infant need suctioning
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Ans
wer What, What!!
Suzanne’s 5 Rules of Bubbling!
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What do you use to suction an infant on BCPAP; and how far do you go?
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Ans
wer 8Fr suction catheter
Measure from the nose to the ear X 1.5
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stion
What can you tell me about this CPAP set up?
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Ans
wer • The mask is gently
contouring to the infant’s face• Side attachments are
loosely secured• ‘Trunk’ is parallel to the
face• Velcro over the ‘trunk’
is not pulled tight
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stion
What is the most important thing to help prevent a HAPI (Hospital Acquired Pressure Injury) with CPAP?
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stion
YOU!!!!!
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Ans
wer
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stion
What is the calculation that we use to determine approximate ETT depth?
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stion
Weight in Kg + 6 = approximate ETT depth
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What landmark do we use to determine where the ETT is secured?
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stion
The LIP
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stion
What is a great position for the ETT?
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stion
T3 to T4
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stion
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wer
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What are some common modes of ventilation?
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AC VG – Assist Control Volume Guarantee Settings - Rate, Vt, Ti, PEEP, P Max
SIMV VG – Synchronized Intermittent Mandatory Ventilation Volume GuaranteeSettings – Rate, Vt, Ti, PEEP, P Max
AC PC – Assist Control Pressure ControlSettings – Rate, PIP/PEEP, Ti
SIMV PC - Synchronized Intermittent Mandatory Ventilation Pressure ControlSettings – Rate, PIP/PEEP, Ti
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What is a benefit of using VG mode after dosing with surfactant?
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wer Variation in PIP with VG
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stion
What are some of the benefits of Kangaroo Care?
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- Physiologic stability (temperature and blood pressure regulation, heart rate and respiratory stability)- Brain, cognitive and motor development.- Improved immune system function.- Weight gain.- Better, deep sleep.- Greater bonding with decrease in stress and crying.
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Can an intubated infant participate in Kangaroo Care?
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Yes!
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What is the Gold Standard for confirmation of ETT position?
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A Chest X-Ray
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How does the head movement in these three positions effect the depth of the ETT?
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Reference: Donn, SM and Kuhns LR. Mechanism of Endotracheal Tube Movement with Change of Head Position in the Neonate. Pediatric Radiology 9, 37-40, 1980.
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You have been called to a delivery of a term infant there is thick meconium.What do you need to consider for this infant’s delivery?
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All meconium stained infants receive warm, dry and stimulate- Then reassess
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Where do we set the suction pressure?
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Ans
wer Where do we set the suction pressure?
Suction pressure is set at -80 to -100 mmHg
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Que
stion You have been called to a delivery of a
term infant of a diabetic mom, the OB is anticipating a large infant.What do you need to consider for this infant’s delivery?
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stion A consideration for a large infant is shoulder dystocia
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stion Forceps delivery
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stion
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wer
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Que
stion You have been called to a delivery
of a 28 week gestation infant.What do you need to consider for this infant’s delivery?
![Page 81: 5. Respiratory Care Going to New Heights › sites › default › files... · Respiratory Care: Going to New Heights Suzanne Iniguez BSN, RN, RRT-NPS-ACCS, AE-C, C-NPT, CHSE. Respiratory](https://reader033.fdocuments.us/reader033/viewer/2022060210/5f04a3eb7e708231d40ef965/html5/thumbnails/81.jpg)
Que
stion If the infant has good tone and
respiratory effort – consider providing CPAP
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Ans
wer If the infant has poor tone and little
respiratory effort consider –- Intubation- Dosing with surfactant- Evaluate for extubation- Remaining intubated and positive
pressure ventilation
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Que
stion You have been called to a delivery of a
term infant that is experiencing decels.What do you need to consider for this infant’s delivery?
![Page 84: 5. Respiratory Care Going to New Heights › sites › default › files... · Respiratory Care: Going to New Heights Suzanne Iniguez BSN, RN, RRT-NPS-ACCS, AE-C, C-NPT, CHSE. Respiratory](https://reader033.fdocuments.us/reader033/viewer/2022060210/5f04a3eb7e708231d40ef965/html5/thumbnails/84.jpg)
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stion Possible nuchal cord, possibility of
an hypoxic event
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Hypoxic Ischemic Encephalopathy
Perinatal asphyxia, more appropriately known as hypoxic-ischemic encephalopathy (HIE), is characterized by clinical and laboratory evidence of acute or subacute brain injury due to asphyxia.
The primary causes of this condition are systemic hypoxemia and/or reduced cerebral blood flow (CBF).
Consider passive cooling and transfer to a center that can perform cooling.
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Que
stion You have been called to a delivery of
an infant whose mother presented to triage with bright red bleeding.What do you need to consider for this infant’s delivery?
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Ans
wer Anticipate a depressed infant that
may be in need of resuscitation
- Intubation- PPV- Lines placed- Fluid resuscitation