A patient is intubated in the ICU for airway management post intracranial hemorrhage.    Ventilator settings are PRVC rate of 18/min, VT 600ml, fi02 .30, PEEP 5 cmH20.  The patient’s IBW is 75 kg.   ΔP is 22 cmH20.   Abg’s on these settings:  sp02 97%, pH 7.58, paC02 22torr, pa02 90 torr, HC03 22 meq/L, Base Excess -2.  What changes would you recommend, if any?

A patient is switched from PRVC to SIMV mode, rate of 10/min, VT 350 ml, fi02 0.40, PEEP 5 cmH20, Pressure Support 8 cmH20,  I-time is 1.0 second in which she had a comfortable work of breathing.  After the switch, here are the ventilator parameters:  PIP 36 cmH20, PPlat 20 cmH20, spon VT 200 ml’s, total RR 35/min, I:E 1:1, Ve 11.5 L.  Patient Assessment:  increased work of breathing with paradoxical respirations noted. Abg’s: pH 7.38, paC02 43 torr, pa02 65 torr,  HC03 22 meq/L, B.E. -What could you attribute this clinical picture to?

Read p.164, Understanding the Structure of the Presentation, in your Textbook.  A well organized presentation has 3 parts: an Introduction, a Body, and a Conclusion.  For your presentations, you will need to use these phrases when introducing information/topics for each of these 3 parts. Match the Useful Phrases for Presenting  on pages 173-174 with the correct part of a presentation.

You suspect a patient is receiving too large of a tidal volume on the ventilator.  What could you check to verify this?

Male patient IBW 70 kg with Guillian Barre Syndrome is trached with a 7.0 mm Trach tube and has been vented for the past 2 weeks.  Current vent settings:  PRVC 12/min, VT 450ml, fi02.28, PEEP 5 cmH20.  PIP 20 cmH20, static pressure is also 20 cmH20.  VE 5.4 L/min.  Total RR 12/min and Abg’s are within normal limits. Weaning parameters were performed with a NIF -15cmH20, VC 500ml, RSBI on CPAP with 5 cmH20 pressure support is 70.  There are no signs of respiratory distress when placed on CPAP:  RR 8/min, VT on pressure support of 5 cmH20 is 350ml.  Abg’s are the following:  pH7.30, paC02 53torr, pa02 78 torr, HC03 24 meq/L. How should you approach liberating this patient from the ventilator?

A patient on a high flow nasal cannula is on a flowrate of 35L/min and an fi02 of 1.0.  The sp02 is 88%.  What changes do you recommend?

This patient needs conventional dosing due to her age. Using the initial dosing table in your protocol what is a starting dose/frequency for this patient and explain your reasoning?  Include loading dose (if needed) and maintenance dose. 

According to the Presentation Skills PowerPoint, which is an example of a Strong Presentation Ending?

When should the next random level be taken? (Give exact date and time) 

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