EMERGENCY AND CRITICAL CARE

Ask the student(s) to review a patient on the intensive care unit requiring respiratory support. Encourage them to use an ABCDEFG or similar structured approach.

Following their assessment, ensure they have reviewed all of the relevant vital signs, ventilator settings and similar.

Ask students to consider the patients' oxygenation/gas exchange. Discuss:

• What factors are contributing to the patient's gas exchange? Consider acute and chronic causes e.g. effects of infection, fluid, background lung disease.

Allow them to review the patient's ABG results (ideally from before ventilation). Encourage them to discuss the key abnormalities.

Encourage students to focus on the ventilator machine. Ask them to identify and define key terminology including:

• minute volume
• tidal volume
• inspiratory pressure
• expiratory pressure
• positive end expiratory pressure

Demonstrate these on the ventilator and discuss relevance to the patient. If students have a good understanding consider showing pressure and volume curves.

To apply knowledge and further understanding discuss with students how they would adjust the ventilator in the following scenarios:

1. Controlled hypercapnia post-cardiorespiratory arrest
2. Reduce CO2 and improve oxygenation in type two respiratory failure
3. Management of acute asthma including the effect of airway constriction on pressures needed to support breathing

It may be useful to find patients who have been difficult to ventilate to guide discussion, using blood gases to demonstrate.

1. https://litfl.com/clinical-management-template/
2. https://litfl.com/intubation-and-mechanical-ventilation/