A short summary of music theory. Useful for quickly reviewing the basics, esp. before an exam.Full description
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CCNP Command Guide LIine
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Freight88 Freight Class Cheatsheet
Guidelines for setting up a Neonatal Ventilator: 1. Pt range range:: Neon Neonat atee (Ma (Maxi ximu mum m VT VT = 40cc) 40cc) 2. Mode Mode:: Pres Pressu sure re Cont Contro roll (wor (works ks best best for for un-c un-cuf uffe fed d ETT) ETT) 3 . VT : a. <33 weeks gestation 4 – 6 cc/kg b. b. >33 weeks weeks gesta gestati tion on or chroni chronicc 5 – 7 cc/k cc/kg g 4. PIP: a. Maximum PIP settings: - <27 weeks gestation 24 CWP - 27 – 32 weeks weeks gestat gestation ion 26 CWP CWP - 33 – 40 weeks weeks gestat gestation ion 28 CWP CWP b. Start low (best to err on low side to prevent barotraumas.) c. Increase to obtain target VT and adequate chest rise d. Frequently monitor & adjust PIP PIP to accommodate changes in lung compliance altering tidal volume. 5. PEEP: a. Start at minimum 4 – 5 CWP b. Increase to 6 – 7 CWP if FiO2 needs > 60% c. Adjust to maintain acceptable PaO2 and SpO2 SpO2 d. 8 – 10 CWP PEEP if directed by physician physician e. Remember that PC setting is “above PEEP” 6. Fi F iO2: a. S ta tart low at 40% b. Adjust to maintain target target SpO2 c. If SaO2 SaO2 < targe targett range, range, FiO2 FiO2 may may be incr increas eased ed by 2–5, 2–5, & then allowing 4 minutes for stabilization after each change. (consider adjustment of PIP and PEEP also.) d. Continue assuring AW patent, HR>100 & baby not apneic. e. If SaO2 > target target range, FiO2 may be decreased by 2 – 5, allowing 4 minutes for stabilization after each change. f. Consider increasing PEEP PEEP prior to FiO2 g. Maintain neonate on ROOM AIR whenever possible. 7. Rat Rate: a. 50 – 60 if < 34 weeks eeks gest gestat atio ion n or < 3 kg b. 40 – 50 if >34 weeks gestation or > 3 kg c. 30 – 40 if 40 weeks gestation; gestation; slightly higher if indicated. d. Watch for air trapping at rates > 40 (adjust I-time). 8. I-ti I-time me:: a. Star Startt at at 0.3 0.3 plus plus or minu minuss 0.5 0.5 (pos (postt-te term rm may may nee need d mor more.) e.) b. Neonatal initial initial I-time I-time setting - <1kg 0.25 – 0.30 sec minimum 0.20 seconds - 1-2kg 0.30 – 0.40 sec minimum 0.20 seconds - 2-3kg 0.35 – 0.45 sec minimum 0.25 seconds - 3-4kg 0.40 – 0.60 sec minimum 0.30 seconds c. Ideall Ideally y set set using using Flow Flow-ti -time me graph graphics ics d. This This alter alterss I-tim I-timee and I:E I:E rati ratio o e. Increase Increase & decrease decrease to reach target target settings settings as appropri appropriate ate f. Watch for air trapping at rates >40 in in neonates >3kg; they may need I-time >0.40 to to complete inspiration inspiration & prevent air trapping. g. If neonate using expiratory muscles, try try decreasing decreasing I-time slightly (increasing flow). h. If I-time gets too short, consider switch switch to PRVC. 9. I-Rise time: a. 10 if < 33 weeks gestational gestational age b. >5 if if > >33 33 weeks weeks gest gestati ationa onall age age c. Basically, Basically, the smaller smaller the ETT ETT the higher higher this this should should be be to create laminar flow and a pseudo sign wave. d. Increase for bronchospasm (slow rise time, longer e-time) e-time) 10. PIP PIP limi limit: t: 2 – 3 > PIP PIP (all (all othe otherr alar alarms ms as a ro riat riate. e.))
Indications to intubating neo 1. PaO2 PaO2 < 45m 45mmH mHg g whi while le breathing 80 – 100% FiO2 2. PaCO2 > 65mmHg 3. Intractable metabolic acidosis(B.E. < -10 meq.) 4. Marked retractions on CPAP 5. Frequent episodes episodes of apnea and bradycardia on CPAP. Normal Neo ABGs & Vitals: 1. Target ABG: PH 7.25 – 7.40 PCO2 = 45 – 59 PaO2 = 50 – 70 BE = 0 – -4 2. SpO2: 82–92% if <27 wks 85–93% if <33 wk 88 – 95% if >33 wks 2. RR: RR: Term Term = 30–5 30–50 0 Premie = 40 - 70 3. HR: HR: Term Term =120 =120 – 160 160 4. BP: 50 – 90 systolic 25 – 60 diastolic
