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Home ICU Basics Intensive Care Topics Vasopressors Mechanical Ventilation Procedures + Calcs Core ICU Core CCU P+C Online ICU Guidebook ICU Guidebook | Procedures&Calculators | Supplemental O2 Supplemental Oxygen Nasal Canula > Simple face mask > Venturi-mask > non-rebreathing mask Nasal Canula Venturi mask - 1L ~ 0.24 FiO2 - Each additional liter ~ adds 0.04 FiO2 - Precise administration of O2 - Usual preset values of FiO2 of 24%, 28%, 31%, 35%, 49% and 50% Nonrebreathing mask - 0.80 to 0.90 FiO2 Non-Invasive Positive Pressure Ventilation (NIPPV) --BIPAP/CPAP How does it work? Increases alveolar ventilation Decreases work of breathing Helps rest pt’s resp muscles **Assess pt’s VS including O2sat, ABCs, and stability before deciding to pursue NIPPV** Contraindications of BIPAP/CPAP (using your common sense): severe encephalopathy, inability to cooperate/protect airway, high risk of aspiration, inability to clear secretions, upper airway obstxn, homodynamic instability If stable à 1. Determine mode and delivery device to be used (BIPAP vs. CPAP, nasal vs. facial mask) àBIPAP: IPAP (inspiratory + airway pressure): 6-10 *helps overcome the work of breathing, adjust this will help change pCO2 EPAP (expiratory + airway pressure): 2-4 *similar to PEEP on vent, adjust this will help change pO2 along w/ the amount of O2 supplied **start low at IPAP of 7 and EPAP of 2 (keep AT LEAST 4-5 pressure difference btwn IPAP & EPAP or will just be like CPAP) àCPAP: 5-7pressures 2. Monitor ABG q30-45minutes for the first 2 hours. à if NO improvement in pH or pCO2, consider trial failure and may need to proceed w/ intubation. WEANING TRIAL 1. Can consider if pt on FIO2 of 105 ( failure to wean likely RSI 51-104 = offer CPAP trila RSI
Home ICU Basics Intensive Care Topics Vasopressors Mechanical Ventilation Procedures + Calcs Core ICU Core CCU P+C Online ICU Guidebook ICU Guidebook | Procedures&Calculators | Thoracentesis A thoracentesis is a very useful diagnostic procedure. Fluid analysis can be used to assess the nature of the effusion, and the need for further management such as antimicrobials. Indications: Pleural effusion which needs diagnostic work-up Symptomatic treatment of a large pleural effusion Contraindications: Uncooperative patient Uncorrected bleeding diathesis Chest wall cellulitis at the site of puncture Bullous disease, e.g. emphysema Positive end-expiratory pressure (PEEP) mechanical ventilation Only one functioning lung Small volume of fluid (less than 1 cm thickness on a lateral decubitus film) Supplies: Thoracentesis kit Bedside US Machine Method: Read the following document: NEJM > Thoracentesis Procedure video: NEJM Videos in Clinical Medicine > Thoracentesis Complications: Pneumothroax Hemothorax Arrhythmias Air embolism Introduction of infection PROCEDURE TEMPLATE PROCEDURE: Thoracentesis, U/S guided. INDICATION: Large pleural effusion. PROCEDURE OPERATOR: CONSENT: Consent was obtained from the patient prior to the procedure. Indications, risks, and benefits were explained at length. PROCEDURE SUMMARY: A time out was performed. The patient was prepped and draped in a sterile manner using chlorhexidine scrub after the appropriate level was percussed and confirmed by ultrasound. U/S images were permanently documented. 1% lidocaine was used to numb the region. A finder needle was then used to attempt to locate fluid; however, a 22-gauge, 3 1/2inch spinal needle was required to actually locate fluid. Fluid was aspirated on the second attempt only after completely hubbing the spinal needle. Clear yellow fluid was obtained. A 10-blade scalpel used to make the incision. The thoracentesis catheter was then threaded without difficulty. The patient had 1200 mL of clear yellow fluid removed. No immediate complications were noted during the procedure. Dr. _____ was present during the entire procedure. A postprocedure chest x-ray is pending at the time of this dictation. The fluid will be sent for several studies. ESTIMATED BLOOD LOSS:
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Online ICU Guidebook ICU Basics Intensive Care Topics ...

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