A 28-year-old male has arrived in the emergency department ...

[joesmith1212]

A 28-year-old male has arrived in the emergency department following a motor vehicle accident. He has a Glasgow Coma Score of 14. Chest X-ray reveals five ribs broken anteriorly in two areas each.
 
  Physical assessment reveals paradoxical movement of the chest. Breath sounds are diminished and the trachea is midline. Arterial blood gas on nonrebreather mask is: pH 7.53, partial pressure of carbon dioxide (PaCO2) is 25 mm Hg, partial pressure of oxygen (PaO2) is 59 mm Hg, arterial oxygen saturation (SaO2) 93, bicarbonate (HCO3) 23 mEq/L. The respiratory therapist should recommend which of the following for this patient?
  a. Noninvasive positive pressure ventilation (NIV) with supplemental oxygen
  b. Intubation with volume-controlled con-tinuous mandatory ventilation (VC-CMV) with positive end-expiratory pressure (PEEP)
  c. Mask continuous positive airway pressure (CPAP) with supplemental oxygen
  d. Intubation with CPAP and pressure sup-port

Question 2

What type of breath occurs when the ventilator controls the timing, tidal volume, or inspiratory pressure?
 
  a. Assisted
  b. Mandatory
  c. Spontaneous
  d. Controlled

[jaykayy05]

Answer to Question 1

ANS: C
The arterial blood gas shows that the patient is ventilating, as evidenced by the partial pressure of carbon dioxide (PaCO2) of 25 mm Hg. Therefore, this patient does not need to be intubated and ventilated at this time. This also means that the patient does not require noninvasive positive pressure ventilation (NIV). The patient does have an oxygenation problem, as evidenced by the partial pressure of oxygen (PaO2) of 59 mm Hg while on a nonrebreather mask. This is an indica-tion for continuous positive airway pressure (CPAP).

Answer to Question 2

ANS: B
Mandatory breaths occur when the ventilator is time triggered, volume or pressure targeted. Spontaneous breaths are patient triggered, and the volume or pressure is based on the patient's demand and lung characteristics. Assisted breaths have characteristics of both mandatory and spontaneous, the patient triggers the breath, the ventilator delivers a set pressure or volume, and the airway pressure rises above baseline during inspiration. The term control is not used to de-scribe the type of breath delivery. This term is used to describe the variable that is being manipu-lated as the target for the breaths (e.g., pressure control or volume control).