SAQ 3 - resp - Model Answer:
1- Severe Academia - decompensated
Hypercarbia -Type 2 resp failure and probably Chronic Co2 Retainer
Metabolic alkalosis -Metabolic compensation for Chronic Co2 retaining
Hypoxia and high A-a gradient - Type I respiratory failure secondary to
Infective exacerbation of COPD
2- Salbutamol Neb 5 mg repeated doses
IV Bolus 5mcg/kg and infusion 1-20mcg/kg/min
SE: Tachycardia , Tremor hyperlactemia
Iprotropium Bromide Neb 500mcg
SE: tachycardia , tremor
MgSo3 IV bolus 10 mml
SE: Hypotension, Decrease muscle tone
Aminophylline SE: Tachyarrhythmia , Seizure and vomiting
3- Is an advanced Healthcare directive in place advising against NIV
Indications: Acute resp failure with high risk of abolishing his native respiratory drive.
Risk/Complication: Barotrauma , decrease LOC, aspiration
FiO2 settings: Monitor FIO2 to maintain Resp drive.
Ongoing specific treatment treatment : Continue Bronchodilator via the circuit, Steroids
4- Anticipate difficult mechanical ventilation due to auto PEEP
Permissive hypercarbia
Pressure no more thamn35 cm H2O
Slow Insp: Expiratory ratio
Low vent rate < 10
Sedation, paralysis, Continue bronchodilator , tracheal suction, NG tube insertion
Knowledge Required:
COPD Pharmacological Mx and escalation therapy
Ventilation strategies of COPD
Important consideration of NIV
1- Severe Academia - decompensated
Hypercarbia -Type 2 resp failure and probably Chronic Co2 Retainer
Metabolic alkalosis -Metabolic compensation for Chronic Co2 retaining
Hypoxia and high A-a gradient - Type I respiratory failure secondary to
Infective exacerbation of COPD
2- Salbutamol Neb 5 mg repeated doses
IV Bolus 5mcg/kg and infusion 1-20mcg/kg/min
SE: Tachycardia , Tremor hyperlactemia
Iprotropium Bromide Neb 500mcg
SE: tachycardia , tremor
MgSo3 IV bolus 10 mml
SE: Hypotension, Decrease muscle tone
Aminophylline SE: Tachyarrhythmia , Seizure and vomiting
3- Is an advanced Healthcare directive in place advising against NIV
Indications: Acute resp failure with high risk of abolishing his native respiratory drive.
Risk/Complication: Barotrauma , decrease LOC, aspiration
FiO2 settings: Monitor FIO2 to maintain Resp drive.
Ongoing specific treatment treatment : Continue Bronchodilator via the circuit, Steroids
4- Anticipate difficult mechanical ventilation due to auto PEEP
Permissive hypercarbia
Pressure no more thamn35 cm H2O
Slow Insp: Expiratory ratio
Low vent rate < 10
Sedation, paralysis, Continue bronchodilator , tracheal suction, NG tube insertion
Knowledge Required:
COPD Pharmacological Mx and escalation therapy
Ventilation strategies of COPD
Important consideration of NIV