Internal Medicine

0521779407-22 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:23

1520 Vascular Disease of Spinal Cord Ventilator Management in the ICU

follow-up

n/a

complications and prognosis

n/a

VENTILATOR MANAGEMENT IN THE ICU

MARK D. EISNER, MD, MPH

history & physical

History

■Determine etiology of respiratory failure: history of asthma, chronic

obstructive pulmonary disease, underlying malignancy, immuno-

compromise (e.g., HIV infection), cardiac disease

Signs & Symptoms

■Signs indicating respiratory failure include:

➣nasal flaring

➣prominent activity of sternocleidomastoid muscles

➣paradoxical motion of abdomen

➣respiratory rate > 30

➣decreased level of consciousness

➣appearance of “tiring out”

■Wheezing suggests bronchospasm (e.g., asthma or chronic obstruc-

tive pulmonary disease exacerbation)

■Bronchial breath sounds, egophony suggest pneumonia

tests

Basic Blood Tests

■Arterial blood gas to assess hypoxemia, hypercapnea, and pH

■CBC to evaluate for anemia

■Serum potassium, phosphate, calcium, and bicarbonate

Specific Diagnostic Tests

■Chest x-ray to elucidate etiology of acute respiratory failure (e.g.,

pneumonia)

■After intubation, chest x-ray to confirm endotracheal tube place-

ment, evaluate for complications (e.g., pneumothorax, pneumome-

diastinum)

■Continuous pulse oximetry to monitor oxygen saturation