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  1. #1
    hunteradam07 is offline Permanently Banned 511 points
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    Mechanical ventilation setting issues!

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    Heh guys, I was doing my UW and i got some mechanical ventilation (MV)setting quetions which i didnt understand. I guess i need to do Pulmo elective or something . But I hope someone can explain them to me here. My problem is this:
    1. What are the indications for putting pt on MV?
    2. What are the intial setting?
    3. What/How would you correct the setting after first ABG for optimal pt benefits?
    4. What are the appropriate levels of gas components for pt on MV?

    Like if your ABG came back and everything in is with in range but PaO2=105, then what would u do next?
    Like if your pt is respi alk or acidosis what would u do next? Specific situation post intial ABG.
    Thanks you guys in advance for all ur inputs.

  2. #2
    kalra is offline Newbie 510 points
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    I am also doing UW nowadays.What percent of correct answers are u getting.i have completed 11 blocks till today and getting 60%.

  3. #3
    hunteradam07 is offline Permanently Banned 511 points
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    59% unused with time per subject so far. Do it with time especially is challenging for me since most of the questions are so long and have many lab values to analyze. Do u have a good idea on Mechanical vent?

  4. #4
    kalra is offline Newbie 510 points
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    I donot know the details of MV and its settings.
    Best of luck for ur qbank..

  5. #5
    kalra is offline Newbie 510 points
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    While going through UW QBANK,i came across this question..

    A 72-year-old woman complains of difficulty "finding the right word" when she is speaking. Her daughter notes that she also frequently complains that her neighbour is stealing he newspapers when this is not the case in actuality.Recently the patient has been having difficulty balancing her checkbook as well.On physical examination her BP is 160/100 mm hg and her heart rate is 90/min.The exam of other is unremarkable.Over the course of next three years, the pt develops a severe memory deficit, and suffers from poor sleep , slowness of movement ,shuffling gait and urinary incontinence.
    Which is the most likely diagnosis?

    A. Alzheimer dementia
    B. Dementia with lewy body
    C. Multiinfarct dementia
    D.Vit B12 defeciency
    E. Normal pressure hydrocephalus
    F. Hypothyroidism
    G.Thiamine deficiency
    H. Huntington disease
    I. Pseudodementia
    J.Chronic subdural hematoma
    K.Drug induced dementia

    Can u plzz explain it??

  6. #6
    hunteradam07 is offline Permanently Banned 511 points
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    Quote Originally Posted by kalra View Post
    While going through UW QBANK,i came across this question..

    A 72-year-old woman complains of difficulty "finding the right word" when she is speaking. Her daughter notes that she also frequently complains that her neighbour is stealing he newspapers when this is not the case in actuality.Recently the patient has been having difficulty balancing her checkbook as well.On physical examination her BP is 160/100 mm hg and her heart rate is 90/min.The exam of other is unremarkable.Over the course of next three years, the pt develops a severe memory deficit, and suffers from poor sleep , slowness of movement ,shuffling gait and urinary incontinence.
    Which is the most likely diagnosis?

    A. Alzheimer dementia
    B. Dementia with lewy body
    C. Multiinfarct dementia
    D.Vit B12 defeciency
    E. Normal pressure hydrocephalus
    F. Hypothyroidism
    G.Thiamine deficiency
    H. Huntington disease
    I. Pseudodementia
    J.Chronic subdural hematoma
    K.Drug induced dementia

    Can u plzz explain it??
    I think the answeris E (normal pressure hydrocephalus). I m not sure i will able to explain to you. But my dx base on the fact that she has urinary incontience with excutive function abnormality. This would d/dx from Alzheimer's. And there is no hx of ext weakness so i ruled out multinfract. I hope this help. Sometime it's very frustrate doing UW.

  7. #7
    kalra is offline Newbie 510 points
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    thanx for your reply.i was also thinking the same..

  8. #8
    Statia Graduate is offline Junior Member 510 points
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    MV answers

    The question is very broad, so I will answer some of the basics.

    1. Common indications for MV:
    Hypercapnic respiratory failure, severe hypoxia, airway protection (to include trauma and low GCS)

    2/3/4. Initial settings really depend on the situation.

    Then the other questions:

    Initial ABG returns, and PO2 is 105. I would dial down the FiO2 a bit. PO2 close to 80 is just fine. One goal of MV is to use the least amount of FiO2 as possible. Oxygen creates free radials, and hence damage.

    If my patient has resp alkalosis after initiation of MV and say, ABG looks like: 7.48/30/86, then I would decrease the rate (this assumes the patient is compliant with the vent).

    If my patient has resp acidosis after intiation of MV and ABG looks like: 7.32/52/86, then I would increase the rate (again assumes the patient is compliant with the vent).

    Rarely does any ICU patient have a pure resp acidosis/alkalosis. Also, there are situations when you want the patient to have resp alkalosis. For example, a patient with increased ICP should be hyperventilated to increase the minute ventilation and force a resp alkalosis. Usually, in these patients you want their PCO2 around 28-30. Low PCO2 causes vasoconstriction and therefore decreasing ICP.

    Another example ICU situation is a patient with severe metabolic acidosis (say lactic acidosis). You also hyperventilate these patients to decrease the PCO2 and therefore increase the overall blood PH.

    For more specific, give an example situation, and I can address it for you...

  9. #9
    anmatson26 is offline Newbie 510 points
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    To KALRA, the explanation of the answer (why E)
    Normal pressure hydrocephalus (NPH) is a type of hydrocephalus that occurs in adults, usually older adults. The average age of people with NPH is older than 60 years. NPH is different than other types of hydrocephalus in that it develops slowly over time. The drainage of CSF is blocked gradually, and the excess fluid builds up slowly. The slow enlargement of the ventricles means that the fluid pressure in the brain may not be as high as in other types of hydrocephalus. However, the enlarged ventricles still press on the brain and can cause symptoms. (The term “normal pressure” is somewhat misleading.)

    The parts of the brain most often affected in NPH are those that control the legs, the bladder, and the “cognitive” mental processes such as memory, reasoning, problem solving, and speaking. This decline in mental processes, if it is severe enough to interfere with everyday activities, is known as dementia. Other symptoms include abnormal gait (difficulty walking), inability to hold urine (urinary incontinence), and, occasionally, inability to control the bowels.

    The dementia symptoms of NPH can be similar to those of Alzheimer disease. The walking problems are similar to those of Parkinson disease. Experts believe that many cases of NPH are misdiagnosed as one of these diseases. The good news is that, unlike Alzheimer disease and Parkinson disease, NPH can be reversed in many people with appropriate treatment. But first it must be correctly diagnosed.

  10. #10
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    RussianJoo is offline Ultimate Member
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    Quote Originally Posted by anmatson26 View Post
    To KALRA, the explanation of the answer (why E)
    Normal pressure hydrocephalus (NPH) is a type of hydrocephalus that occurs in adults, usually older adults. The average age of people with NPH is older than 60 years. NPH is different than other types of hydrocephalus in that it develops slowly over time. The drainage of CSF is blocked gradually, and the excess fluid builds up slowly. The slow enlargement of the ventricles means that the fluid pressure in the brain may not be as high as in other types of hydrocephalus. However, the enlarged ventricles still press on the brain and can cause symptoms. (The term “normal pressure” is somewhat misleading.)

    The parts of the brain most often affected in NPH are those that control the legs, the bladder, and the “cognitive” mental processes such as memory, reasoning, problem solving, and speaking. This decline in mental processes, if it is severe enough to interfere with everyday activities, is known as dementia. Other symptoms include abnormal gait (difficulty walking), inability to hold urine (urinary incontinence), and, occasionally, inability to control the bowels.

    The dementia symptoms of NPH can be similar to those of Alzheimer disease. The walking problems are similar to those of Parkinson disease. Experts believe that many cases of NPH are misdiagnosed as one of these diseases. The good news is that, unlike Alzheimer disease and Parkinson disease, NPH can be reversed in many people with appropriate treatment. But first it must be correctly diagnosed.

    Too bad USMLE World says the Answer to that question is A) not E).

    NPH starts out with urinary incontinence. and this person clearly had dementia a few years before the incontinence.

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