Search results

It most certainly does look like a LDLT. Ha! I didn't even notice it when I was looking for CXR that related to the pathology I was referring to. Good eye there, sir, good eye. Although I do feel silly for not seeing the left bronchus obviously intubated.

Agreed. I think when I posted that number I was trying to get the other to know they had room to increase PEEP...

Admittedly, I didn't do the math on it, just relied on experience with ventilating restrictive lungs. The point isn't necessary the exact numbers but the concept surrounding them. Since the PC is 15 and the Peep is 12, then PIP would be 27. The closer the plateau pressure to the peak, then it...

Yeah I've only seen it once. Although probably a little too aggressive, indenpendent lung Ventilation would be a great option here as well.

So I will go ahead and give you my final vent settings… PCV PEEP 18 cmH2O FIO2 100% I:E 4:1 Of course there were some RR changes that I can't remember as well as maxing out on our pressure control. This is the type of patient where "permissive hypercapnia" is definitely applicable

Retrograde does seem to be the ideal here. Kinda disappointed I didn't think of that... Again, I'm pretty big advocate for NIV BiPAP here. If at all possible, keep the patient on some ketamine and run bipap. Keeps the airway open and provides Ventilation. Then again, mask seal would be...

This is a really good article! Never read this before... lots of things to consider with chest tube placement!

Haha to be honest, I have only seen this once and had to ask a resident what in the world was going on. 1-14% chance it will happen. Put the patient on crazy vent settings though! Was wondering if you would max out to the point I did ;)

Thank you for this... we live and learn everyday. When you work to the best ability and still don't come out completely right, you just learn from it and move on.

I agree. I was miserable doing neb after neb on the floors when I was not assigned ICU. But I loved RT school. Would love to teach formal vent classes one day.

So I definitely agree with paralyzingly. Paralyzingly will decrease metabolism due to the muscles not exerting any energy, allowing for less oxygen consumption. In the above quotes I mentioned that at a PEEP of 12 and a Pressure Control of 15, you probably have a plateau of 25. That's gives you...

No... think "fluffy infiltrates"

Oh nice… I went to RT school in North Carolina. Did not have a wait list and the school that I went to was really good have a great reputation… Seems like a lot of people do not want to be RTs

My dogma has always been that if you maintain your plateau pressures less than 30 cm of water then peep can only do good :)

Hmm if we are at a PEEP of 12 and we probably have a pressure control of probably 15, so our peaks are at 27 cmH2O and I can go ahead and tell you the compliance of the lung is low, so probably looking at a plateau of 25 cmH2O. I'll give y'all a hint. The diagnosis has something to do with a...

Where are you located?

Aww thanks... that's flattering but I've just been subject to less than ideal situations and I learn from them... Vent management is a very very specific skill set. I forgot a lot of stuff because I don't work full time in an ICU anymore. I've had to hit the books again for other critical care...

But keep going! You're on the right track with vent settings... what more can you do...

Something like this after the chest tube... (I just google searched an image...obviously this isn't the actual patient's cxr that I encountered)

1) Hmmm good thought on the pneumonia... but I should have given more info. No signs of a pneumonia (ie previous CXR, afebrile, etc). Just a completely "whited out" left lung. Alright you increased the PEEP. Let's say you increased the PEEP to 12 cmH2O and you switched the patient to PCV with...