1. RESPIRATORY SUPPORT Case Studies 2009

2. Severity of Respiratory Distress < 90 % 90 %> 95 % Hypoxia / O2 Sat in RA (3- 4 +) OR None > imminent RF Moderate (2-3+)‏Mild (+)‏Wheezing DecreasedMild decreaseNormalAir Entry Affected-Lethargy Mild affected Irritable /Normal -AlertMental Status > 45 / 50 % 50% <75% Norm/>75% PCO2 / PEFR SC-IC-SC Retrac.& nasal flaring ? fatigue SC-IT and Supra- clav Retrac- Mild SC retractions Work of Breathing 2 x standard -Severe dyspnea. - Can barely speaks - Weak cry 1 ½ x standard – Mod dyspnea - Speaks with pauses, normal cry Normal / Mild Dysp - Speaks in full sentences - Normal cry Tachypnea/ Dyspnea Severe Moderate Mild

3. Patient # 2: 3 mo old, 6 kg, in severe respiratory distress 2nd to RSV + Bronchiolitis. ____________________________________________ ABG’s on 100 % FiO2: Ph 7.15 PCO2 60 PO2 85 Sat90 % Bic15 BE-5.

4. ASSESSMENT ABG assessment: __________________________________ __________________________________ __________________________________ Physiological Assessment and __________________________________ Initial therapies: _____________________ __________________________________

5. MECHANICAL VENTILATION 1.- SELECT VENTILATOR: – Bear Cub750 (Neonatal < 10 Kg)‏ – BP 840 Adult Ventilator > large infant 2.- SE;ECT MODE OF VENTILATION: –CPAP - BI-PAP –CPAP with SIMV –SIMV –SIMV with Pressure Support –Others

6. ORDERS 1. Mode ________ 2. Rate _________ 3. PIP / TV _________ 4. I: Time _________ 5. Flow __________ 6. PEEP/CPAP __________ 7. FiO2 __________ 8. IPAP / EPAP __________

7. Patient # 3: 15 months old, 12 kg, with complex febrile Sz., alter mental status and hypo- ventilation. (Vomited milk when being ambubag.)‏ ____________________________________________ ABG’s on non rebreathing oxygen mask: Ph7.2 PCO255 PO2250 Sat100% Bic20 BE-1.

8. Patient # 4: 10 years old in severe respiratory distress 2 nd to Status Asthmaticus. ____________________________________________ ABG’S on non rebreathing oxygen mask, Ph7.12 PCO260 PO280 Sat90% Bic16 BE-4.

9. Patient # 5 10 year old, 35 kg with SSD and ACS (Bilateral extensive lung infiltrates) in Severe respiratory distress and hypoxia. O2 Sats 85% on 100 % FiO2 ____________________________________________ ABG’S (on 100 % FiO2) Ph7.35 PCO230 PO255 Sat84% Bic17 BE-4

10. Patient # 6: 15 year old female, 55 kg, with history of multiple drug overdoses, alter Mental status and hypoventilation. ____________________________________________ ABG’S on non rebreathing oxygen mask, Ph 7.2 PCO2 60 PO2480 Sat100 % Bic20 BE-1.