This episode debuts something I’m really excited about….if you’ve ready my book, Nursing School Thrive Guide, you know that I am a big fan of learning in a variety of ways. So…one of the things I did when I was a student was to record audio quizzes so I could basically quiz myself on topics while I went for a walk, did the laundry, cleaned house….whatever. It freed me from the prison of my desk and used a different part of my brain as well. Win-Win!
In this episode we talk about the basics of ARDS – Acute Respiratory Distress Syndrome. It is the most severe form of acute lung injury and is something we see pretty regularly in the MICU. Learn about the different stages that occur as ARDS develops, what you’re going to assess and how the patient is going to be treated in this episode of the Straight A Nursing Podcast.
ECMO (otherwise known as extracorporeal membraneous oxygenation) is essentially a life support measure used when the lungs or both heart and lungs cannot function adequately with traditional mechanical ventilation support. In ECMO, blood is drained from the body, diverted to an oxygenator where gas exchange takes place, then returned to the patient. There! Now you know everything you need to know about ECMO. Just kidding! Let’s start at the very beginning.
I first encountered Heliox when working in ICU and assuming care of a patient with severe asthma. As the team brought her up from the emergency room, I saw the respiratory therapists pushing a huge cart with what looked like gigantic oxygen tanks. The patient was wearing an oxygen mask hooked up to these tanks via long tubing and working hard to breathe. As I would learn later, she was on Heliox and it made the difference between ending up on ventilator or improving enough to downgrade to telemetry the next day. Which she did. Go us!
Knowing when you need to intubate a patient in respiratory distress is a key skill you will use regularly as a nurse. This skill applies across the board…not just ED or ICU. Nurses in all settings come into contact with patients who decompensate, and knowing when you need to intubate can mean the difference between life and death.
Capnography and ETCO2 monitoring is one of those super cool things that seem so simple at first blush, but that can really provide you with a lot of very useful data. But first, what the heck is it?
Capnography is a way to monitor carbon dioxide levels using waveform technology. See? I told you it was super cool! Why is this important? Think back to your gas exchange physiology…what is it that drives your need to breathe? Is it low oxygen? Nope. Is it high carbon dioxide? Yep! So, it stands to reason that monitoring the MAIN thing that spurs the respiratory drive would tell us loads about how our patient is doing in the ol’ gas exchange department.
ARDS (Acute Respiratory Distress Syndrome) is a lung condition we see a lot in the ICU. It is extremely serious with a mortality rate of 30-50%…actually, I’m always a little bit surprised when someone survives ARDS. Usually they are dealing with a host of other problems such as sepsis, and when you put those two together the results are often poor.
In my last post about ABGs, you learned how to do a basic analysis of uncompensated acid/base disorders. If you need a review, check out that post then come back here. I’ll wait.
Now that you’ve got uncompensated gasses figured out, I’ve got some bad news. Most of the time you won’t be handed a nice clear-cut ABG like that and will, instead, be dealing with compensated and partially compensated acid/base disorders…sorry. The good news is, once you’ve got the basics down you will have no time taking it a level deeper to understand compensation.
I was chatting with some nursing students recently and asked what their most challenging subjects have been so far…someone piped in and said that ABGs were a real pain in the neck… and no wonder! Her professor had suggested they just try to memorize the values. Sorry, but that’s not going to do squat to help you analyze an ABG at the bedside of your critically ill patient in renal failure with COPD and pneumonia.