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ASSIGNMENT ON SETTING, USE AND
MAINTENANCE OF BASIC EQUIPMENTS
IN HOSPITAL
SUBJECT: MEDICAL SURGICAL NURSING (II) critical care nursing

1

INDEX
S
...


CONTENT

1
...


5
...


REMARKS

Pulse oximetry:
•
•
•
•
•
•
•

3
...


bedside monitor
Purposes and uses
Cardiac monitors
Types of monitors
Recommendations for cardiac arrhythmia
monitoring in the emergency department
Setting of monitors and maintenance

14- 20

Transducers:
•
•
•

Introduction & definitions
Types of ultrasound transducer
Application of biomedical transducer

20-25

Defibrillators:
•
•
•
•
•
•
•

Cardioversion
Defibrillator
Medical uses
Types of defibrillator
Principle and uses
Types of waveforms
Maintenance of defibrillator
• Role of nurse

25-32

6
...


procedure and maintenance
Conclusion & summary

40

8
...
VENTILATOR:
Definitions:
•

A mechanical ventilator is a positive- or negative-pressure breathing device that can maintain
ventilation and oxygen delivery for a prolonged period

•

Mechanical ventilation is a method to mechanically assist or replace spontaneous breathing
when patients cannot do so on their own
...
PubMed
Mechanical ventilation, or assisted ventilation, sometimes abbreviated as IMV, is the medical
term for artificial ventilation where mechanical means are used to assist or replace spontaneous
breathing
...

Fraction of inspired oxygen: Usually 100% oxygen to start there decreases slowly
...

Ensure adequate sedations, opioids and muscle relaxants
...


Criteria for institution of ventilator support:
PARAMETERS

VENTILATION
INDICATED

Pulmonary function studies:
• Respiratory
rate
(breaths/min)
...
)
<5
• Vital capacity (ml/kg
< 15
body wt
...
25
< 60
> 50

7
...
45
75-100
35-45

Mechanical ventilator settings:
Initial Ventilator Settings—parameters to be clarified

Setting
Fraction of
inspired
oxygen (FiO2)
Tidal Volume

Description
•
•
•
•

Respiratory
rate

Use high FiO2 in the beginning (
...
0)
For infants, and especially in premature infants, avoiding high levels of
FiO2 (>60%) is important
...
Altered if there is difficulty in
optimizing PO2 and PCO2
...
In adults
a rate of 12 is generally used
...
e
...


•

Target range from 2
...
It is the product of tidal volume
and Respiratory rate
...
It is
adjusted according to the target tidal volume required
...
A breath that has a greater volume than the tidal volume
...

Sigh volume: Usual volume is 1
...

Sigh rate/ frequency:-Usual rate is 4 to 8 times per hour
...
Elective: To allow for sedation and paralysis during major surgery
2
...
Inadequate Alveolar Ventilation:
• Apnea
• Respiratory Failure
• Resuscitation
• Neuromuscular Disorders
4
...
Chest Wall Diseases:
• Acute Airway Obstruction
• COPD exacerbation
• Severe Asthma
• Excessive Secretions
• Intra-thorax
• Pleural disease
6
...

Oxygen and air sources (pressurized at 50 pounds per square inch) (psi)
BVM (bag/valve/mask) or “ambu bag”)
Stethoscope
Suction apparatus and suction catheters
Endotracheal tube holder
Crash cart or airway toolbox

PROCEDURE & *POINTS OF EMPHASIS:
A
...

*Ventilation is accomplished through positive pressure and, therefore, cuffed tube is required
...
Selection of ventilator, type, mode, and settings may be done jointly by physician and
Respiratory Therapist
...

*Most frequently used in critical care setting is positive-pressure volume-cycle ventilator
...

Note: The more frequently used modes are:
Assist control (AC): a preset total volume is delivered with each cycle set at a rate, but he patient may
initiate breaths beyond that rate and receive the set tidal volume with each inspiration
...

Synchronized intermittent mandatory ventilation (SIMV): is same as IMV except that ventilator
breaths are synchronized with the patient’s own inspiration effort and the ventilator breath is inhibited;
is used as a weaning mode
...

Pressure support ventilation: patient initiates each breath and the ventilator augments each breath with
set amount of positive pressure; patient determines rate and total volume but machine can augment
volume; used in patient having difficulty with standard weaning methods
...
Ventilator settings to be given by the physician, if the physician is
not available set ventilator at: Tidal volume 6m/kg per body weight
...

C
...

D
...

*This is to prevent hypoxia
...
Obtain order for sedation and administer if necessary
...

F
...

Patient is intubated by anesthetist or M
...

Bag patient until connected to ventilator
...

*Use sterile technique
...
Secure endotube with endotracheal tube holder
...
Recheck ventilator settings
I
...
Obtain stat CXR
...
If breath sounds are only
heard on the right side, then the tube is probably in the right bronchus
...

J
...

*Intubation causes transient cardiac arrhythmias
...

K
...

L
...

*Alarms are never turned off
...

M
...

*Check all connections and make sure they are secure
...
Stay with the patient until calm and stable
...

O
...

*To facilitate lung expansion and to prevent ventilator acquired pneumonia
...
Perform routine assessment of patient by checking breath sounds, respiratory rate; measuring while
on ventilator the tidal volume and vital capacity, negative inspiratory pressure and effective or static
compliance
...

B
...

*These measures help prevent atelectasis
...
Provide good, routine mouth care
...

*Helps ensure patient comfort and lessens chance of iatrogenic infection
...
Suction airway as needed following sterile technique
...

E
...

*The last two complications are more likely to occur if trauma has occurred to airway or visceral pleura
that allows leak with the positive pressure ventilation
...

F
...

*Suppression of respiratory drive will reduce the exhalation of CO2
...

G
...
Drugs to suppress the respiratory drive and frequent reassurance and explanations need to be
given to patient
...
e
...

*Medication can be given to the patient in either of these instances, allowing the ventilator to deliver
the oxygen and preventing fatigue and other complications from occurring
...
Neuromuscular blocking agents paralyze the respiratory muscles but
do nothing for the patient’s anxiety
...
Both groups of drugs can also
have effects on the cardiovascular system
...

H
...
g
...

*This is probably the most difficult aspect of intubation for the patient and family
...

*The artificially ventilated patient is a compromised host and is at risk for development of an iatrogenic
infection
...
Evaluate the ventilator regularly for proper function:
*This will be done routinely by the respiratory therapist
...
Check settings to make sure they are correct
...

8

2
...

*Never allow water to drain back into humidifier reservoir, always drain it in the direction of the air
flow, i
...
, disconnect tube and drain it into a container
...
If the pressure alarm is activated, troubleshoot for cause and correct situation
...
If
situation is not corrected immediately, manually ventilate patient with 100$ oxygen
...

*Potential causes of high pressure limit alarm
...
Fluid or kink in tubing
...
Mucous plug or increased secretions in airway requiring suction
...
Restlessness, agitation requiring sedation
...
Pneumothorax
5
...
External source of tube compression, e
...
, patient biting tube
...
Airway disconnection from ventilation
...
Cuff leak with air loss
...
Disconnection of tubing
...
Provide reassurance for patient, always explain what you are going to do beforehand,
e
...
, suctioning airway or disconnecting tubing
...

*Patient will be very sensitive to changes and frightened if not prepared beforehand for airway suction
...

DOCUMENTATION:
Electronic Medical Records

2
...
It is
transported throughout the body as arterial blood
...
The percentage is called blood
oxygen saturation, or SpO2
...


Oxygen saturation?
Hemoglobin bound to oxygen is called oxygenated hemoglobin (HbO2)
...

The oxygen saturation is the ratio of the oxygenated hemoglobin to the hemoglobin in the blood, as
defined by the following equation
...
However, hemoglobin is stable only when bound to 4 molecules of oxygen or when not
bound to any oxygen
...
Therefore, as
shown in the above figure, hemoglobin exists in the body in the form of deoxygenated hemoglobin
(Hb) with no oxygen bound, or as oxygenated hemoglobin with 4 molecules of oxygen
...
SaO2 is oxygen saturation of arterial blood, while SpO2
is oxygen saturation as detected by the pulse oximetry
...


Relation of PaO2 to SpO2
The amount of oxygen dissolved in the blood is proportional to the partial pressure of oxygen
...
The
partial pressure of oxygen is expressed as PO2, and the partial pressure of arterial blood is expressed
as PaO2
...


Purpose/ uses of the pulse oximetry:
•
•

Determining the severity of a disease
Deciding whether to perform blood gas analysis in order to better understand the patient’s
condition
...

• Screening for sleep apnea syndrome
• The pulse oximetry is used as a part of monitoring of patients with dysphagia when they are
observed while eating
...
In these cases, the bone marrow is stimulated to produce more red blood cells and
consequently polycythemia (secondary polycythemia)
...

• Monitoring during examinations such as endoscopy

How does the pulse oximetry work?
Pulse oximetry measure the absorption of specific wavelengths of light in oxygenated hemoglobin as
compared with that of reduced hemoglobin
...
The oximetry probe has
two light-emitting diodes (LEDs), one red and one infrared, located on one side of the probe
...
Infrared
light is absorbed by the oxyhaemoglobin; red light by the reduced hemoglobin
...
The oxygen saturation of the blood determines the
degree of light absorption
...


PRACTICAL USE OF THE PULSE OXIMETER
• Turn the pulse oximeter on: it will go through internal calibration and checks
...
If used on a finger or toe, make sure the area is clean
...

• Connect the probe to the pulse oximeter
...

• If possible, avoid the arm being used for blood pressure monitoring as cuff inflation will interrupt the
pulse oximeter signal
...

• Look for the displayed pulse indicator that shows that the machine has detected a pulse
...

• Once the unit has detected a good pulse, the oxygen saturation and pulse rate will be displayed
...

• The function of the oximeter probe can be checked by placing it on your own finger
...

• Always make sure the alarms are on
...
Treat each element of the
sequence as you check it
...
WHO has put this into
a chart (below) to help you remember what to look for in a logical sequence
...
You should ask a colleague to read it aloud for you to
make sure that you have not forgotten anything
...

If breathing via a facemask - chin lift, jaw thrust
Consider an oropharyngeal or nasopharyngeal airway
Check for laryngospasm and treat if necessary
Check the tracheal tube/LMA - if any doubt about the position, remove and use a facemask
...

• Consider waking the patient up if you have difficulty maintaining the airway immediately after
induction of anesthesia
...

• If you ‘can’t intubate, can’t ventilate’, an emergency surgical airway is required
...
Airway obstruction is a clinical
diagnosis and must be acted upon swiftly
...
An intubated patient who has been previously well saturated may
become hypoxic if the tracheal tube becomes displaced, kinked or obstructed by secretions
...
Drugs such as opioids,
poorly reversed neuromuscular blocking agents or deep volatile anesthesia may depress breathing
...
In an infant, stomach distension from
facemask ventilation may splint the diaphragm and interfere with breathing
...

Action
• Assist ventilation with adequate tidal volumes to expand both lungs until the problem is diagnosed
and treated appropriately
...

The patient should be ventilated via a facemask, LMA or tracheal tube if respiration is inadequate
...
The lower airway should be suctioned with suction catheters to remove any secretions
...

A pneumothorax may occur following trauma, central line insertion or a supraclavicular brachial
plexus block
...
In thin patients a
hollow note on percussion may also be detected
...
A chest drain should be
inserted to prevent the pneumothorax from worsening
...
A definitive chest drain
should be inserted later
...

C - Is the circulation normal?
• Feel for a pulse and look for signs of life, including active bleeding from the surgical wound
• Check the blood pressure
• Check the peripheral perfusion and capillary refill time
...

Action
• If the blood pressure is low, correct it
• Check for hypovolemia
• Give IV fluids as appropriate (normal saline or blood as indicated)
• Consider head down or leg up position, or in the pregnant mother, left lateral positioning
...

D – Drug effects
Check that all anesthesia drugs are being given correctly
...

• Muscle relaxants will depress the ability to breathe if not reversed adequately at the end of surgery
...

• Anaphylaxis causes cardiovascular collapse, often with bronchospasm and skin flushing (rash)
...
Some patients are allergic to latex rubber
...

• In anaphylaxis, stop administering the causative agent, ventilate with 100% oxygen, give intravenous
saline starting with a bolus of 10ml/kg, administer adrenaline and consider giving steroids,
bronchodilators and an antihistamine
...

• Check that the oxygen cylinder is not empty
• Check that the oxygen concentrator is working properly
• Check that the central hospital oxygen supply is working properly
• Change the probe to another site; check that it is working properly by trying it on your own finger
...
If equipment is missing, mouth to tracheal
tube, or mouth-to-mouth ventilation may be lifesaving
...

Every six months
• Biomedical Technician check require

3
...

• It is a comprehensive patient monitoring systems that can be configured to continuously
measure and display a number of parameters via electrodes and sensors that are connected to
the patient
...

• Each patient bed in an ICU has a physiologic monitor that measure these body activities
...

PURPOSES/ USES:
• The monitor is typically used when the doctor wants to measure functions like the heart rate,
respiratory rate, blood pressure and temperature
...

14

•
•
•
•

The bedside monitor has alarms that signal the nurse if a body function needs attention
...

Most commonly used in emergency rooms and critical care areas, cardiac monitoring allows
for continual observation of several patients
...

Continuous cardiac monitoring allows for prompt identification and initiation of treatment for
cardiac arrhythmias and other conditions
...
It is different from hemodynamic monitoring, which monitors the pressure and
flow of blood within the cardiovascular system
...
Cardiac monitoring with
a small device worn by an ambulatory patient (one well enough to walk around) is known as
ambulatory electrocardiography (such as with a Holter monitor, wireless ambulatory ECG, or
an implantable loop recorder)
...

• Cardiac monitoring in the ED setting has a primary focus on the monitoring of arrhythmia,
myocardial infarction, and QT-interval monitoring
...

The different classes are as follows:
Class I: Cardiac monitoring is indicated in all or most patients
...

Class III: Cardiac monitoring is not indicated because the patient's serious event risk is low
...


Types:
Type of monitor

Picture

Monitor/Defibrillators
These monitor/defibrillators usually have the
normal capabilities of an ICU monitor, but have
manual (and usually semi-automatic AED)
defibrillation capability
...
Most
monitor defibrillators also have transcutaneous
pacing capability via large AED like adhesive
pads (which often can be used for monitoring,
defibrillation and pacing) that are applied to the
patient in an anterior-posterior configuration
...

Examples of monitor defibrillators are the
Lifepak 12, 15 and 20 made by Physio Control,
the Philips Heartstart MRx, and the E, R, and X
Series by ZOLL Medical
...


Manual ECG recorders:
Manual ECG event recorders require the patient
to be symptomatic and to activate the device to
record an event; this makes these devices useless
whilst, for example, the patient is sleeping
...
The trans
telephonic cardiac event monitor can normally
store approximately five "cardiac events" usually
lasting 30–60 seconds
Holter monitor:
Holter monitor is an external monitor which uses
wires with patches that attach to the skin to
continuously measure and record heart activity
for 1–2 days
...


16

Mobile Cardiac Telemetry:
A Mobile Cardiac Telemetry unit is a wearable
monitor that detects, records, and transmits heart
rhythms for up to 30 days
...

Fetal Heart Rate Monitoring
Monitoring the fetal heart rate is becoming
increasingly prevalent in the standard care of
antepartum pregnant patients
...

Electronic fetal monitoring uses Doppler
ultrasound technology to provide real-time
feedback on the fetus’s cardiac activity during
both gestation and labor
...
The monitor illuminates the
skin tissue with light emitting diode (LED) and
detects the intensity of light reflected with the
photo detector
...
Skin tone and motion artifacts
contributes to this error
...
It
continuously measures and records the heart’s
activity for 1-2 days
...
It
typically requires activation by pushing a button
to record the heart’s activity
...


17

Recommendations for cardiac arrhythmia monitoring in the emergency
department
Class I conditions
• Patients resuscitated from cardiac arrest
...

• Patients with newly diagnosed high-risk coronary lesions
...

• Patients after implantation of automatic defibrillator or pacemaker lead who are pacemaker
dependent
...

• Patients with AV block (Wenckebach, Mobitz II, complete block, new-onset bundle branch
block in the setting of myocardial infarction)
...

• Patients with drug-induced long-QT syndrome
...

• Patients with major trauma, acute respiratory failure, sepsis, shock, pulmonary embolus, major
non cardiac surgery, drug overdose, or other indications for intensive care
...

• Patients with any hemodynamically unstable arrhythmia
...

• Pediatric patients diagnosed with any arrhythmia
...

• Patients with do not resuscitate orders
...

• Obstetric patients, unless heart disease is present
...
The monitor
sounds an alarm if the patient's heart rate goes above or below a predetermined number
...


Equipment required for continuous cardiac monitoring includes:
•
•
•
•
•
•

cardiac monitor
monitor cable
lead wires
electrodes
dry washcloth or gauze pad
alcohol sponges

Preparation
•

All electrical equipment and outlets are grounded to avoid electrical shock and artifact
(electrical activity caused by interference)
...
He or she should connect the lead wires to the proper position and ensure that colorcoded wires match the color-coded cable
...
The nurse should open the
electrode package, and attach an electrode to each lead wire
...

Privacy should be ensured for the patient, and the patient should be clean and dry to prevent
electrical shock
...
Using the
rough patch on the electrode, a dry washcloth, or gauze pad, each site should be rubbed briskly
until it reddens, but care should be taken not to damage or break the skin
...

Patients who are extremely hairy may need to be shaved prior to application of the electrodes
...

Areas should dry completely to promote good adhesion
...
In addition to oily skin, diaphoretic
skin can cause interference in the recording
...
The backing of the electrode
should be removed, and the gel inspected
...
The nurse should apply one electrode
to each site, press one side of the electrode against the skin, and pull gently
...
The nurse should
press two fingers on the electrode in a circular pattern to affix the gel and stabilize the electrode,
then repeat for each electrode
...


Setting of monitors:

19

Aftercare:
•
•

•

After placing all electrodes, the nurse should observe the monitor and evaluate the quality of
the tracing, making size and tracing position adjustments as needed
...
The upper and lower alarm limits should be set
according to institutional policy, and the alarm activated
...


Complications:
•

There is a potential for skin breakdown at the electrode placement site
...
The
electrodes should be removed and new electrodes applied, using hypoallergenic electrodes if
necessary
...
Abnormal results may include
bradycardia, or tachycardia, accompanied by the alarm
...

Alarm signals are abnormal and must be investigated
...

The electrodes should be repositioned as needed to ensure that the electrode is not over a major
muscle mass and that QRS complex is larger than the T wave
...
Electrodes should be
reapplied as needed
...
The position of electrodes
should be checked and static-causing bed linen changed
...


4
...

The transducer also receives the echoes and sends them to a computer that uses them to
create an image called sonogram
...

Moreover, it is the fundamental determinant of image quality
...
It serves to generate as well as receive
ultrasound waves
...
Linear Transducers
• the piezoelectric crystal arrangement is linear, the shape of the beam is rectangular, and the
near-field resolution is good
• The footprint, frequency, and applications of the linear transducer depend on whether the
product is for 2D or 3D imaging
...
5
MHz – 12 MHz
Use this transducer for various applications, such as:
• Vascular examination
• Venipuncture, blood vessel visualization
• Breast Thyroid Tendon, arthrogenous image of linear probe
• Rectangular Beam Shape: Intraoperative, laparoscopy the thickness measurement of body fat
and muscles for daily health care check and locomotive syndrome check and Photo acoustic
imaging, ultrasonic velocity change imaging
• The linear transducer for 3D imaging has a wide footprint and a central frequency of 7
...
Convex Transducers
• The convex ultrasound transducer type is also called the curved transducer because the
piezoelectric crystal arrangement is curvilinear
...

• The footprint, frequency, and applications also depend on whether the product is for 2D or 3D
imaging
...
5MHz
– 7
...

• You can use this transducer for various applications, such as:  Abdominal examinations 
Transvaginal and diagnosis of organs  an rectal examinations
• The convex transducer for 3D imaging has a wide field of view and a central frequency of
3
...
5MHz
...
In addition to the convex transducers, there is a
subtype called micro convex
...

3
...
5 MHz)
• The beam point is narrow but it expands depending on the applied frequency
...

• You can use this transducer for various applications, such as:  Cardiac examinations 
Abdominal examinations  Brain examinations
4
...

This probe has a small footprint and uses low frequency (typically 2 MHz– 8 MHz)
...
Endocavitary transducers:
• These probes provide you with the opportunity to perform internal examinations of the patient
...

• The endocavitary transducers include endovaginal, endorectal, and endocavity transducers
...
5 MHz – 11
...
Trans esophageal (TEE) transducers
• It has a small footprint and is used for internal examinations
...
The frequency is middle, in the
range of 3 MHz – 10 MHz
...

• However, 4D ultrasound allows us to add live streaming video of the images, showing the
motion of the fetal heart wall or valves, or blood flow in various vessels
...
It uses either a 2D transducer which rapidly acquires 20-30 volumes or a matrix
array 3D transducer is used
...
Its clinical applications are still being studied
...

Application of Piezoelectric Transducer:
• Crystal microphone measures and records the Heart sounds (Phonocardiography)
...
Sounds from heart chambers are measured with Catheter-tip
piezoelectric sensors
...


•
•

•

A piezoelectric sensor senses Radial pulse
In ultrasonic scanning devices, piezoelectric transducers are used
...
The
received is displayed on Cathode Ray Oscilloscope
...
For this reason the drop – counting is done with a
piezoelectric crystal
...
When each drop of medicine falls on the mesh, the piezoelectric transducer
generates a pulse
...
This change in
resistance is the basis for all Thermo resistive temperature sensors
...
In positive type, resistance raises with temperature and in
negative type resistance decreases with increase in temperature
...

• A thermo resistive transducer measures skin and body temperature
...
On the tip
of the catheter, the heated thermistor is enclosed
...
The cooling
effect of the thermistor is directly proportional to the flow of blood
...

A thermistor measures Respiratory rate
...
Pass an amount of current through the thermistor
...
Cathode Ray
Oscilloscope records the resistance increase
...
Cathode acts as one electrode, and it has a specially coated material around it
...
The release in electron produces a current, which is proportional
to the light intensity
...


23

Photovoltaic Cell
A photovoltaic cell has an outer layer of selenium, coated with a transparent metal film
...
Light with high
intensity illuminates the barrier layer
...
After the occurrence of potential difference, the metal film
turns into positive, and selenium layer turns into negative
...

Applications
• We can measure pulsatile blood volume change with a Photo detector
...
In
transmittance technique, pulsating blood flow modifies the optical density
...
The changes in blood flow are
seen immediately with these methods
...
Wrap the chest with a rubber bellow
...
When the chest expands during breathing, the
amount of light that falls on the photodiode varies due to the metal bar
...


•

Blood pressure can be measured with Photo detectors as shown in the figure below
...
Bourdon tube is filled
using a saline solution
...
As the blood
pressure increases, the pressure inside the tube displaces the shade
...


24

•

To determine the oxygen saturation in the blood (oximetry) photoelectric transducers are used
...
In the human body,
earlobes are rich with vascular beds
...
The
reflected light is detected with two photovoltaic detectors
...
The
output from the red channel is related to the oxygen content in blood and the presence of blood
and tissue along the optical path
...
Finally, the difference between the two outputs is proportional to the
amount of oxygen present in the blood
...
DEFIBRILLATOR:
Cardioversion:
•
•
•
•
•

Involves delivery of a timed electrical current to terminate a tachydysrhythmia
...

If the cardioversion is elective, anticoagulation for a few weeks before cardioversion may be
indicated
...

25

•
•
•
•
•
•
•

The patient is instructed not to eat or drink for at least 8 hours before the procedure
...

Respiration then supported with supplemental oxygen
...

Indications of a successful responses are conversion to sinus rhythm, adequate peripheral
pulses, and adequate blood pressure
...


Defibrillation:
•
•
•

It is used in emergency situations as the treatment of choice for ventricular fibrillation and
pulseless VT
Defibrillation depolarizes a critical mass of myocardial cells at once, when they repolarize, the
sinus node usually recaptures its role as the pacemaker
...
Higher the
amount of energy of shock greater is risk of damage

Medical uses:
•
•
•

Defibrillation is often an important step in cardiopulmonary resuscitation (CPR)
...

Defibrillation is indicated only in certain types of cardiac dysrhythmias, specifically ventricular
fibrillation (VF) and pulseless ventricular tachycardia
...
Defibrillation is also not indicated if the patient is conscious or
has a pulse
...


26

Types:
Types

Presentation

1
...

They are used in conjunction with an
electrocardiogram, which can be separate or
built-in
...

These units are primarily found in hospitals
and on some ambulances
...

In the United States, many advanced EMTs
and all paramedics are trained to recognize
lethal arrhythmias and deliver appropriate
electrical therapy with a manual defibrillator
when appropriate
...
Manual internal defibrillator:
Manual internal defibrillators deliver the shock
through paddles placed directly on the heart
...


3
...

AEDs contain technology for analysis of heart
rhythms
...
By making these
units publicly available, AEDs have improved
outcomes for sudden out-of-hospital cardiac
arrests
...
Recent studies show that AEDs
does not improve outcome in patients with inhospital cardiac arrests
...

A
semi-automatic
AED
automatically diagnoses heart rhythms and
determines if a shock is necessary
...
A fully automated AED
automatically diagnoses the heart rhythm and
advises the user to stand back while the shock
is automatically given
...

4
...
Many
modern devices can distinguish between
ventricular
fibrillation,
ventricular
tachycardia, and more benign arrhythmias like
supraventricular tachycardia and atrial
fibrillation
...

There are cases where the patient's ICD may
fire constantly or inappropriately
...
Some emergency
medical services personnel are now equipped
with a ring magnet to place over the device,
which effectively disables the shock function
of the device while still allowing the
pacemaker to function (if the device is so
equipped)
...

5
...

The garment, worn under clothing, detects
arrhythmias and delivers treatment shocks
...

28

The WCD continuously monitors the patient’s
heart and, if a life-threatening heart rhythm is
detected, it can deliver a treatment shock to
restore normal heart rhythm
...


6
...
The electrodes consist of round metal
plates that come in direct contact with the
myocardium
...
Energy stored in capacitor is
then delivered at a relatively rapid rate to chest of the patient
...


•
•

The discharge resistance which the patient represents as purely ohmic resistance of 50 to 100Ω
approximately for a typical electrode size of 80cm2
...
The pulse width of this waveform
is generally 10 ms
...
Defibrillators deliver a
brief electric shock to the heart, which enables the heart's natural pacemaker to regain control and
establish a normal heart rhythm
...
A corrective
shock of 750-800 volts is applied within a tenth of a second
...

Types of Defibrillator electrodes and their placement:
a) Spoon shaped electrode • Applied directly to the heart
...

A monophasic type, give a high-energy shock, up to 360 to 400 joules due to which increased
cardiac injury and in burns the chest around the shock pad sites
...


Maintenance of defibrillator:

31

Role of nurse:
Nursing Care before Defibrillation:
•
•
•
•
•
•
•
•

The blue code alarm is activated
Call for the defibrillator
Assess the client's airway breathing and circulation
Assess the client's circulation, if no pulse is present start CPR
If the client is not breathing, give two slow breaths
Check the ECG to verify the presences of Vfib or pulseless VT
In the, meantime CPR started, the clinician turns on the defibrillator and sets it at 200j
...


Care during defibrillation:
•
•
•

•

The paddles are lubricated with electrode paste to enhance the conduction and prevent burn
injury to the skin
...

Anterolateral position is used for paddle placement
...
The phrase “one
...
Two
...
Three
...

Is recommended
...

If the first counter shock is unsuccessful immediate defibrillation must be performed again at
higher energy level
...
A member of the health care team administers appropriate
medications again before the next defibrillation attempt
...
INFUSION AND SYRINGE PUMP:
Infusion Pump:
•
•
•

Infusion Pump is Bio-medical Device which is capable of delivering fluid in large or small
amounts and use to deliver nutrients or medications to a patient’s body in a controlled manner
...

Some Infusion Pumps are designed mainly for stationary use at the Patient’s bedside
...


A syringe pump is indicated for patients who:
•
•
•
•
•

Are unable to take medications orally as a result of persistent nausea, vomiting, dysphagia,
severe weakness or unconsciousness;
Are unable to absorb oral medications;
Are unwilling or unable to take medicines by mouth;
Have a malignant bowel obstruction where surgery is inappropriate;
Have head and neck lesions or surgery
...


•

ADULT-MICRO Button – These button is use to set the age of the patient
...
e
...


•

SET RATE/SET ml/SET TIME (T) – SET RATE is use for setting the rate of saline i
...
amount
of saline in ml/hr
...
SET T button is used to set the time
...


•

ENTER – ENTER Button is use for access the command
...


•

Button

•

CALL – To call the attendant by alarming
...


Set Rate Factor:
• Formula : ml/hr
...

1
...

For Fluids – 20
• How we use by simplifying it?
• For Blood – ml/hr
...
* 1/3 (20/60) = drops/min

34

Types of Infusion:
Continuous infusion usually consists of small pulses of infusion, usually between 500 nano liters and
10 milliliters, depending on the pump's design, with the rate of these pulses depending on the
programmed infusion speed
...
The timings are programmable
...
To get the entire dose of antibiotics into the
patient, the "volume to be infused" or VTBI must be programmed for at least 30 CCs more than is in
the medication bag
...

Patient-controlled is infusion on-demand, usually with a preprogrammed ceiling to avoid
intoxication
...
It
is the method of choice for patient-controlled analgesia (PCA), in which repeated small doses of opioid
analgesics are delivered, with the device coded to stop administration before a dose that may cause
hazardous respiratory depression is reached
...
Some
pumps offer modes in which the amounts can be scaled or controlled based on the time of day
...

TYPES OF INFUSION PUMPS:
There are two basic types of infusion pump
• Syringe Pumps: Syringe pumps are particularly helpful under such circumstances as they are
programmed to do deliver drug through the vein at a determined rate
...
- The piston is operated by a motor through a drive screw or worm gear which helps in
pushing the plunger of syringe in or out resulting in a smooth flow
...
Most of the syringe pump can work with different syringes of different diameters, but the
diameter has to be entered in beginning to make sure correct volume is dispensed
...
- The user can set the parameters such as flow rate, dispense
volume and syringe diameter
...


•

Working of volumetric pump: Volumetric pumps are designed for and suited to delivery of
larger volumes of fluid at medium to high flow rates
...
It is used to accurately deliver
intravascular drugs, fluids, whole blood, and blood products to the patient
...


35

Type

Picture

Stationary Infusion Pumps

Ambulatory/Portable
Infusion Pumps

Volumetric Pump

Simple infusion pump

Syringe Pumps

Insulin Pumps

36

Enteral Pumps

PCA Pumps

Elastomeric Pumps

Suction Pump

Peristaltic Pumps

Multi-channel
Pumps

Infusion

37

Multi-channel
Pumps

Syringe

Smart Pumps

Procedure:
•
•
•
•
•
•
•
•
•
•
•
•
•
•

Perform patient assessment and record vital signs
Assess patient meets criteria for the protocol
...

Hospital staff will draw up the medication or IV fluid to be infused and ensure the infusion
pump is functioning properly
...

The infusion tubing is properly connected to a three-way stop clock on the patient’s intravenous
line
At some facilities, heparin can be infused via a syringe pump without being piggybacked into
a running intravenous line
The rate of infusion pump delivery has to be checked
The volume of infusion already administered has to be checked
...

If the problem is corrected, the alarm display message will disappear
...


Cautions:
•

Don’t use the Infusion Pump on Anesthetic Patient
...


•

Don’t install or store pump where the chemicals are stored
...

38

•

Don’t store or operate it to the area where the air pressure increases or decreases spontaneously
...


•

Don’t carry it in the area where vibration occurs
...
5%
Repeatability of 0
...


•

Keep food and drinks away from the area around the pump
...


•

Before touching the pump

➢ wash hands
➢ dry with a clean paper towel
➢ change tubing according to pump's instructions
➢ Change batteries or recharge the pump as directed by healthcare provider
...

Pump users, care givers, and others should use caution and keep electromagnetic sources away from
the pump
...
ICU equipment may be used to
monitor the patient and/or help treat their illness
...
The ICU equipment we offer include Defibrillator, Patient Monitor, Ventilator,
CPAP & BPAP systems etc
...


SUMMARY:
This assignment includes the following things:
Ventilator:
•
Definitions
•
Purposes
•
setting up the ventilator
•
Mechanical ventilator settings
•
uses for mechanical ventilation
•
Procedure & *points of emphasis
Pulse oximetry:
•
Definition
•
Oxygen saturation
•
Relation of PaO2 to SpO2
•
Purpose/ uses of the pulse oximetry
•
How does the pulse oximetry work?
•
Practical uses
•
Maintenance Checklist Pulse Oximetry
Monitors:
•
Bedside monitor
•
Purposes and uses
•
Cardiac monitors
•
Types of monitors
•
Recommendations for cardiac arrhythmia monitoring in the emergency department
•
Setting of monitors and maintenance
Transducers:
•
Introduction & definitions
•
Types of ultrasound transducer
•
Application of biomedical transducer
Defibrillators:
•
Cardioversion
•
Defibrillator
•
Medical uses
•
Types of defibrillator
•
Principle and uses
•
Types of waveforms
•
Maintenance of defibrillator
•
Role of nurse
40

Infusion and syringe pumps: types, uses, procedure and maintenance
...

Available
from:
https://www
...
com/mechanical-ventilator-basics-for-nurses/ (Internet- May 30, 2019)
(Accessed- June 02, 2020)
Thoreneol
...

Available
from:
https://www
...
net/Tharanoel/mechanical-ventilation-2-86247955
...

MECHANICAL
VENTILATION:
INITIATION
&
MAINTENANCE
[Internet]
...
com
...

Available
from:
https://www
...
com/employee/pdf_critical_care_manuals/mechanicalvent
...
Pulse Oximetry | Measuring Oxygen Status | Nursing Times [Internet]
...
2021 [cited 14 April 2021]
...
nursingtimes
...
Monitoring & devices used in ICU CCU [Internet]
...
net
...
Available from: https://www
...
net/rsmehta/monitoring-amp-devices-used-in-icuccu
Cardiac monitoring - Wikipedia [Internet]
...
wikipedia
...
2021 [cited 17 April 2021]
...
wikipedia
...
Elsaied M
...
Slideshare
...
2021 [cited
17 April 2021]
...
slideshare
...
Application of Transducers in Biomedical Instrumentation [Internet]
...
Available from: https://www
...
com/application-of-transducersin-biomedical-instrumentation/#google_vignette
Padmavathi V, Kundra P, Vishnu Prasad P, Siva T
...
Indian Journal
of Anesthesia [Internet]
...
Available from:
https://www
...
nlm
...
gov/pmc/articles/PMC4645364/
Defibrillation - Wikipedia [Internet]
...
wikipedia
...
2021 [cited 14 April 2021]
...
wikipedia
...
Webstor
...
edu
...
2021 [cited 11 April 2021]
...
srmist
...
in/web_assets/srm_mainsite/files/downloads/unit_2_infu

41



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