Respiratory Therapy Formulas and normal values: 1. Ideal Body Weight (IBW): a.

Female: 100 lb for 1st 5ft + 5lbs ea additional inch b. Male: 106 lb for 1st 5 ft + 6lbs ea additional inch 2. Static Compliance: (VT/Static pressure PEEP) a. Normal = 60-100 b. <60 = lungs becoming less compliant c. >25 is acceptable d. <25 is unacceptable 3. Desired FiO2 = Desired PaO2 + Known FiO2 Known PaO2 4. Desired Ve= Known Ve*Known PaCO2 Desired PaCO2 5. RAW: PIPPlateau/ Flow, or PIPplateau 6. French size sx catheter = ETT size * 3/2 8. PAO2: (713 *Fio2 PaCO2)/0.8or 0.1 if 100% O2 9. A-a gradient: PAO2 PaO2 a. Normal on RA = 10-40 or on 100% = 25 70 b. Increased 66-300 = acute lung injury c. >300 = severe shunting, ARDS (unacceptable) 10. Shunt % = A-a gradient/20; normal=20% -- if >20 an increase in PEEP is indicated 11. a-A ratio: PaO2-PAO2 a. Normal = 80% (74% elderly) b. 60% = V/Q imbalance c. 15% = shunting 12. P/F Ratio: PaO2/FiO2 a. Normal = 300 500 b. Acute lung injury = 200 300 c. <200 = ARDS 13. Expected PaO2 = FiO2 x5 a. Used to determine if pt oxygenating better b. Actual PaO2/ Expected PaO2 = % of patient expected PaO2 14. PS should be set to= RAW or > if therapy indicated. 15. e-cylinder time remaining=0.30(PSI) / LPM 16. Oral intubation = 21-25cm @ lip. 17. Nasal intubation = 26-29cm 17. PEEP therapy = >6-8 CWP 18. Humidity should be set at 37 degrees Celcius. 20. Suction:Adult=100-120,Child=80-100,Infant=60-80 21. Pt.WOB=<0.8=normal, measures effectiveness of rise time and sensitivity. Measured in spont. mode. Acute Lung Injury or ARDS Ventilator Strategy: Lung Protective Ventilation 1. Ideal VT = 6 ml/kg IBW 2. Oxygenation target: a. PaO2 55-80 b. SpO2 88-95% 3. pH Goal: 7.45-7.30 a. >7.45: Decrease Rate b. <7.30: Increase Rate (maximum rate = 35) c. If rate >35, or CO2 <25, consider HCO3 d. < 7.15?, increase VT 1ml/kg (may exceed Static Pressure) 4. Plateau pressure: Dr. to select target pressure a. If >30? & due to VT, decrease VT by 50cc Q1 until p-plat < 30, but do not let VT get <4cc/kg b. If <25? & VT < ideal VT, increase VT by 50cc Q1 until ideal VT is reached, so long as p-plat remains < 30. 5. Pts usually tachypneic, may be uncomfortable, & may fight the ventilator. Increased sedation may be indicated.

Guidelines to adjusting Ventilator settings: 1. PaCo2 > 45 4. SpO2 >95% a. increase RR a. reduce Fio2 60% b. increase VT b. reduce PEEP to 5 2. PaCo2 <35 c. reduce FiO2 a. decrease rate b. decrease VT 3. PCO2 <90% or SaO2<60 a. increase FiO2 to 60% b. increase PEEP c. increase FiO2 to 100%

EKG and rhythm strip interpretations: 1. Pulmonary Embolism: a. S wave in lead I b. ST depression in lead II c. Large Q wave in lead III d. T wave inversion in lead III 2. Basics: a. ST depression = acute blood loss b. Q Wave makes diagnosis of infarct c. Q wave one small square is MI d. Inverted T-wave is ischemia 3. Posterior wall Infarct: a. ST depression in V1 & V2 if acute b. Large R in V1 and V2 c. Maybe Q in V6 d. Inverted mirror test V1 & V2 4. Lateral wall Infarct: a. Q in leads I and AVL (V5, V6) 5. Inferior wall Infarct: a. Q in leads II, III, & AVF b. ST elevated if acute 6. Anterior wall Infarct: a. ST elevation V1 & V2 b. Q in V1, V2, V3 or V4 c. V1 & V2 = Anterioseptal d. V3 & V4 = Anteriolateral 7. SVT: Narrow QRS & rate of 150-250 8. LBBB: 2 R waves in V5 & V6 9. RBBB: a. 2 R waves in V1 & V2 b. QRS wide and looks like an M 10. Acidosis: Smaller amplitude 11. COPD: Small amplitude, Right axis deviation 12. 2nd degree block type I: a. PR interval becomes progressively longer until 1 QRS skipped. b. blocked QRS after every 2-5 QRSs c. QRS may be normal or wide if BBB 13. 2nd degree type II: a. p waves for ea. QRS at ratio of 2:1, 3:1 or 4:1. b. Often wide w/RBBB

Level of Consciousness: 1. Lethargic/ somnolence: sleepy 2. Stuporious/confused: responds inappropriately, OD, intoxication 3. Semi-comatose: responds only to painful stimuli 4. Comatose: does not respond to painful stimuli 5. Obtunded: drowsy, maybe decreased cough/gag reflex

Respiratorytherapycave.blogspot.com 09/07/2009