Professional Documents
Culture Documents
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Upper-Lower
Respiratory System
& Alveoli
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Center and
Control of
Respiration
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Pulmonary mechanoreceptors
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Oksigen juga OBAT!
DO2 = CaO2 x CO
1. Anemic hypoxemia
2. Anoxic hypoxemia
3. Stagnant hypoxemia
Klasifikasi PaO2 (role of thumb)
Normal 80-100 mmHg
Hipoksemia ringan 60-80 mmHg
Hipoksemia moderat 40-60 mmHg
Hipoksemia berat <40 mmHg
GAGAL NAPAS
Gutierrez JA & Theodorou AA. Pediatric Critical Care Study Guide 2012 pp 27
Shift to left:
(1) Decreased hydrogen ions
(2) Decreased CO2
(3) Decreased temperature
(4) Decreased DPG
Gutierrez JA & Theodorou AA. Pediatric Critical Care Study Guide 2012 pp 28
VO2 = CO x (CaO2 CvO2)
Condition that increase VO2 % Increase
Minor surgery 7
Fever (each 1oC) 10
Bone fracture 10
Agitation 16
Increase work of breathing 40
Severe infection 60
Chest trauma 60
Multiple organ failure 20-80
Shivering 50-100
Burns 100
Sepsis 50-100
Head injury, sedated 89
Head injury, not sedated 138
Medication that increase VO2 % Increase
Norepinephrine (0.10-0.31 g/kg/min) 10-21
Dopamin (5 g/kg/min) 6
Dopamin (10 g/kg/min) 15
Dobutamine 19
Epinephrine (0.10 g/kg/min) 23-29
Gloria OD, Handbook of Hemodynamic Monitoring, 2nd edition, Saunders, 2004, pp 167
Procedures and Activities that increase VO2 % Increase
Dressing change 10
Nursing assessment 12
ECG 16
Physical exam 20
Visitors 22
Bath 23
Chest radiography 25
Endotracheal suctioning 27
Turn 31
Chest physiotherapy 35
Weight on sling scale 36
Getting out of bed 39
Nasal intubation 25-40
Factors that decrease VO2 % Decrease
Hypothermia (each 1oC) 10
Morphine sulphate iv push (0.5 mg/kg) 9-21
Morphine sulphate ic (0.2-0.5 mg/kg/hr) 21
Anesthesia 25
Anesthesia in burn patients 50
Assist/control ventilation 30
Propanolol in head injury 32
Neuromuscular blockade Abolishes the increase VO2 incurred
by shivering
Gloria OD, Handbook of Hemodynamic Monitoring, 2nd edition, Saunders, 2004, pp 167
O2 ER = SaO2 SvO2
a) VO2/DO2 relationship in normal b) Pathophysiological changes in VO2/DO2
condition relationship
a) Gutierrez JA & Theodorou AA, Pediatric Critical Care Study Guide 2012 pp 30
b) Caille V & Squara P, Crit Care 2006;10(Suppl 3):S4
VO2 = DO2 x O2ER
Gutierrez JA & Theodorou AA, Pediatric Critical Care Study Guide 2012 pp 32
Hipoksia
distress
Reassess
O2 dosis
Cari penyebab
LOC
Resp. effort Monitoring
Chest exam
1. Patients demand
2. Flowmeter
3. O2 device
4. Monitoring
Device Mask Reservoir Total storage
Nasal prongs No 50 ml (DS) 50 ml
Simple mask 100 200 ml 50 ml (DS) 150 250 ml
Mask reservoir 100 200 ml 650 1050 ml 750 1250 ml
Venturi mask 100 200 ml 50 ml (DS) 150 250 ml
DS = dead space = air in the hypopharynx.
Mask reservoir = partial rebreathing & non-rebreathing masks.
Hypoxia
Hypoventilation Hyperventilation
High pCO2 Low pCO2
3 3
2 2
1 1
Objective
Subjective
Mask
Abdomen
Less dead space.
Claustrophobia.
Dyspnic are mouth breather. Can use mouth.
More dead space.
Clustrophobia
Method of NIV CPAP BiPAP
Name Continuous Positive Airway Bilevel Positive Airway
Pressure Pressure