Answer the following questions regarding the patient downbelow.
Triston was a 55 lbs., 6-year-old male in good health until hefell into a fresh water lake while duck hunting with his father.Triston was unaccounted for 15-20 minutes until his body was foundfloating face down in the water. He was immediately pulled out andbasic life support was started.
On arrival to the ED, Triston was cyanotic, pulseless and apneicwith fixed and dilated pupils and a tympanic temperature of 80degrees F. CPR wascontinued.
5. What size ventilator tubing will beused?
6. How does the RCP assure ETTplacement?
6a. How does the RCP know which sizes toselect? Discuss components of the Braslowcart
7. The breath sounds assessment revealscoarse crackles throughout. What is the appropriateaction by the RCP?
8. What size suction catheter will theRCP use to suction?
After establishment of an airway and assessment for otherinjuries, the team begins to warm the patient.
9. Identify methods of warmingnear-drowning clients. How does cold body temperatureaffect the body’s ability to oxygenate itstissues?
10. How can Triston’s ventilation andoxygenation be assessed at this point?
As the initial blood gas is being analyzed the pediatricventilator arrives. The physician requests you to set theventilator on the appropriate settings.
11. What ventilator settings do youchoose?
Mode:
PIP or VT:
Rate:
FiO2:
PEEP:
I-time:
Alarms:
12. How will one assess theappropriateness of these ventilator settings?
Prior to intubation, ABG results are:
pH 7.04
pCO2 84
PaO2 36
HCO3 19
Sat 78%
13. What is the cause of the metabolicacidosis?
Renal failure
Keto-Acidosis
Lactic Acidosis
14. How should the metabolic component betreated at this early point of resuscitation?
15. What assessments would be helpfulafter initiating mechanical ventilation?
Airway
Breathing
Circulation
Neurologic
CXR
20 minutes post mechanical ventilation and the return of aspontaneous HR with adequate BP 103/65, and tympanic temp. = 90°F. ABG results are: pH 7.23 / pCO2 43 /PaO2 88 / HCO3 19 / 92%
16. Interpret this ABG.
17. What actions should the RCP take atthis time to fine tune this patient’s oxygenation and ventilatoryneeds?
18. What will the RCP carefully assesswhile increasing the PEEP?
19. How will the RCP assess theappropriateness of the ventilator changes made?
Triston is stable and is moved to the Pediatric ICU (intensivecare unit). Two days later you return to work the unit. The nightshift has reported that Triston is stable, normal temperature,still unresponsive to command but he is moving around in the bedand restrained to prevent loss of ETT and IV access; and he is nolonger being hyperventilated for ICP protection. During your 0800assessment and ventilator check you note the ventilator settingsare PC/CMV/TC, f 25, PIP is set at 22 cm H20 to return Vt 150 ml,FiO2 0.5, PEEP + 8; you notice a harsh late inspiratory noise onauscultation.
20. What is the cause of this noise andhow do you correct it?
Next you notice that Triston’s total RR has been 32-36 bpmthroughout the night and the am ABG results are 7.48 / 30 / 102 /23 / 98%.
21. Interpret the ABG.
How do you react?
ABG results: 7.46 / 32 / 95 / 23 / 97%
22. Interpret this ABG.
How do you respond to this ABG?
Answer as many questions regarding this patient
