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First test

tomorrow is the first test of the new semester. The first month or so we are finishing up mechanical ventilation and tomorrow's test is on weaning. One of the most important things that you need to look at with a patient on the ventilator is when are they coming off. There are 19 things to look at when deciding if a patient comes off. I know RT's in the hospitals do not always look at 19 things when weaning but for this test I need to know them. I think I have them down mostly, including some new formula's (yuck).

  1. original reason for ventilation has improved or resolved
  2. ABG is good
  3. hemodynamic stability (good HR and BP without use of vasopressors)
  4. able to initiate inspiration
  5. P(a-A)DO2 <300>
  6. VD/VT <60%
  7. QS/QT <30%
  8. PaO2/PAO2 >0.35
  9. static compliance >30 mL/cmH2O
  10. PaO2/FIO2 ratio >200
  11. SWI <>
  12. Normal temperature
  13. Hgb >8-10 g/dl
  14. vt >5mL/kg
  15. vc >10 ml/kg
  16. RR 8-20 bpm
  17. ve <10>
  18. MIP > -20
  19. RSBI <>
Wow, thats a lot of stuff and apparently I don't know them like I should because I had to look at my notes to type this list. I've made some of them bold and those are the ones that you need formulas for. I'm gonna see if I can add the formulas below.

6. VD/VT = PetCO2-PaCO2/PaCO2

7. QS/QT = P(a-A)O2 x 0.003/3.5 + P(a-A)O2 x 0.003

9. st cl= VT/plateau pressure-PEEP

11. SWI = vent RR(PIP-total PEEP)/MIP X PaCO2/40

19. RSBI = spontaneous RR/VT in Liters

There. I pretty much got those out without looking at a card for the most part. Another formula that I'll need tomorrow is one that I know. It's the one for PAO2 = (PB-PH2O)FiO2-PaCO2 x 1.25. I doubt any of this will help any of you out there but I just thought I would share what's spinning around in my head. Good night.



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3 comments:
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Heidi said...
August 22, 2008 at 12:10 AM  

I cringe just seeing that....thank goodness it is actually a little easier in the clinical setting...

Damn that NBRC ;)

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N said...
August 22, 2008 at 6:02 PM  

It really helps.I hate alveolar air equation and QS/QT equation. I can see that things doesn't get easier as we move forward. How was your test?

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Freadom said...
August 24, 2008 at 3:42 PM  

I wrote a similar post a while ago to amuse myself. Click here you might find something to add to your list.

I see you have a few things I don't have on mine, only because they are formulas we have never use here at Shoreline. They are QS/QT, VD/VT. I suppose this might be worth re-looking into, because I'm not quite sure why we don't do them. Probably because RTs don't like complicated formulas.

You have one formula I'm not familiar with. Could you expound on SWI. Thanks. Great post.

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