Airway Pressure Release Simulation

* Practicum Goal: * Prevent further complications in respiratory distress by educating the nurse on the use of CPAP and BiPAP to support the patient population with acute respiratory distress and other chronic respiratory illness.

Inspiratory muscles relax (diaphragm rises; rib cage descends)  Thoracic cavity volume decreases  Elastic lungs recoil and intrapulmonary volume decreases  pressure increases  Air flows out of lungs down its pressure gradient until Ppul = 0. (Marieb & Hoehn, 2013, p. 817-819)

Another important intervention was to maintain the head of the bed at 30-45 degrees and position L.M.’s left lung into a dependent position to improve ventilation and perfusion. L.M.’s O2 was decreased to 63 and her CO2 was increased to 50. According to the IHI, it is recommended to elevate the bed to 30- 45 degrees to improve ventilation. Patients that lay in the supine position have lower spontaneous tidal volumes on pressure support ventilation compared to those laying at more of an angle (Institute for Healthcare Improvement, 2012). In regards to positioning, when the least damaged portion of the lung is placed in a dependent position it receives preferential blood flow. This redistribution of blood flow helps match ventilation and perfusion, therefore, improving gas exchange (Lough, Stacy & Urden, 2010). Implementing these interventions combined with respiratory therapy, significantly improved the blood gas values for oxygen and carbon dioxide levels.

The rates are as following: newborns, 40-60 bpm; infants, 22-36 bpm; children, 18-24 bpm; adults, 12-20 bpm. The lung capacity is estimated 6000 mL of air. The tidal volume is estimated 500 mL at rest, with dead space taking up an estimated 150 mL, and alveolar air another 350 mL. The minute volume, the total air moved per minute, is calculated by the rate of breathing multiplied by the volume. While this calculation in particular is not used by EMTs, it is an important assessment item in general and should be known by EMTs. Consequences of inadequate breathing rate or depth includes cyanosis, or the skin taking on a bluish color due to poor oxygenation. It is the job of the EMT to keep the patient at a stable oxygen saturation of 94 percent or

Both rapid, shallow breathing patterns and hypoventilation effect gas exchange. Arterial blood gases will be monitored and changes discussed with provider. Alteration in PaCO2 and PaO2 levels are signs of respiratory failure. Patient’s body position will be properly aligned for optimum respiratory excursion, this promotes lung expansion and improved air exchange. Patient will be suctioned as needed to clear secretions and maintain patent airways. The expected outcome is that the patient’s airway and gas exchange will be maintained as evidence by normal arterial blood gases (Herdman,

The Ventilatory threshold was reached at 5 minutes or stage 3 for patient 92 C. The ventilatory threshold is important because it indicates the point at which the blood lactate acid increases non-linearly. It indicates that there is an increase in the lactate acid level in the blood as well as the excess carbon dioxide (Kenny et al., 2015). The increase in carbon dioxide will stimulate chemoreceptors to increase ventilation. The ventilatory threshold is related to the anaerobic threshold which refers to the increase in carbon dioxide and indicates that the body has shifted towards anaerobic metabolism (Kenny et al., 2015).

Due to the mechanical ventilator, it is able to assist in oxygen perfusion to all of her tissue. Thus, the lungs will be able to expand appropriately.

Another follow up ABG at 0100 shows a small improvement on the Ph to 7.18, the Pco2 became more acidotic moved to 53, the Po2 improved to 77 which shows he is oxygenating better but still hypoxic, his Hco3 acidosis is improving at a change to 19.8, and sating 91% now. The Pt is now breathing at a rate has come down to 10 BPM on his own above and beyond the vent. After consulting with the physician we changed the Vt to 600 and the pressure support to 20 and Cpap to 15. The Pt continued on these settings till 0415. The physician then made the change to Bi-level with the settings of a rate of 14 pressure support of 25, and an H/L pressure of 35/15. The Pt at this time is pulling a Vt of 745 and a spontaneous rate of 17 and still at 100% Fio2 and sating 92%. This is the point when the Pt makes the turn. The Bi-level or APRV was the proper setting for this Pt. He continued to improve over the next several days with his peek pressure climbing to 40. The Pt continues these settings and slowly improves and eventually weaned from the ventilator till the Pt no longer needs support.

The patient will be able to tolerate ambulation to the bathroom and to the shower with minimal shortness of breath

Upon arriving at the scene, the advanced care paramedic would begin the primary survey. All dangers would be assessed, including environmental dangers, animals, agitated bystanders and any other alarming cues. Once all dangers have been assessed the ACPs begin investigating the patient’s responsiveness using the acronym AVPU (QLD.gov.au, 2016). An assessment of their alertness, verbal response, response to painful stimuli or unconsciousness is completed. Once assessed, the patient’s airway is then checked to be clear of any obstructions to ensure proper respiration can occur, at this point, the triple airway manoeuvre would be adjusted to only the opening of the mouth and the jaw thrust (QLD.gov.au, 2015). If the patient complains of neck and back tenderness, neurological deficit, evidence of intoxication or a distracting injury (QLD.gov.au, 2016. 2) spinal immobilisation is required to ensure no further damage to the spinal cord occurs or an aid to keep the patient as calm as possible if a distracting injury (Hodegetts et al., 2011). The patient's breathing should then be assessed now that the spine in immobilised to ensure the depth, rate and rhythm of the breaths are adequate. If needed an oropharyngeal airway may need to be inserted into the mouth to keep the tongue from blocking the airway if it is tolerated (Higginson et al,. 2013). Lastly, in the primary survey, the

The observation of both animal and humans has revealed that mechanical ventilation can cause severe lung injury if over-distention occurs (Roupie et al., 1995). To make the matter even worse, the very patients that need mechanical ventilation the most, patients with the acute respiratory distress syndrome for example, are especially susceptible to over-distention and therefore, lung injury (Stewart et al., 1998). The main reason that patients with acute respiratory distress syndrome or respiratory distress syndrome are in higher risk of lung injury is due to over-distention, caused by reduced numbers of alveoli as result of fluid buildup, consolidation, and atelectasis (Roupie et al., 1995).

Sometimes when a patient is on the more common form of mechanical ventilation for an extended time or if the patient has undergone respiratory failure, their respiratory muscles have a tendency to become weak. With the use of this biphasic cuirass ventilation method they can have the opportunity to build and strengthen those muscles which, in return, can allow them to be weaned from the ventilator

Continuous Positive Airway Pressure or CPAP as it is known, uses forced air to keep a patients airway open. It has common uses that most people are familiar with such as sleep apnea. But it also used in emergency and hospitals routinely to treat sicknesses such as congestive heart failure. In this essay I will give a brief history on CPAP, a basic overview of its anatomy and the some of the many uses of CPAP and health benefits.

There are several important physiological changes occur with proning such as increased ventilation-perfusion matching, optimized chest walls mechanics, decreased pleural

Nurse Vincent M. Vacca, Jr. aptly described in this issue of the Nursing Journal the significance of early detection and health management of people who are or are maybe suffering from Pulmonary Arterial Hypertension. He described PAH as a condition wherein a patient is having a mean pulmonary arterial (PA) pressure of greater than 25 mm