They intubated too early, they shouldn've done a DuoNeb not just Albuterol nebulizer through the Bipap mask. Put the Bipap around 40%, adjust the setting so they he's getting good tidal volumes and encourge deep breathing. Calm the patient down because a lot of SOB is due to anxiety. Definately get an ABG, possibly a chest xray. They should give him a chance to recover before they just shove the tube down.

the blinking is kinda creepy

I love your videos. Please do more simulations.

Yes, I have a two year program near where I live in Texas.

this is a great video. where can i find more like this?

i have a speech impairment, i studder, i can control it at times, but sometimes not so well. but i'm really interested in this career do you think i could do this carrer?

The HP viridias are purely awesome. Can you monitor BIS on this simulator?

No, actually u can do it since different people approach the scenario differently. it's not as hard as they sound either its just a matter of getting use to it.

im thinking about going to school for this

Just like the simulations they are giving us in my 2nd year of school

Increased oxygen would for decrease the patients drive to breathe, however, in this situation the patient is in respiratory distress and impending resp failure. Turning down the flow on the oxygen in theory sounds good, but not the move here. Assistance with ventilation is needed, be it non-invasive or invasive.

pts with COPD are not always CO2 retainers. Get an ABG ASAP that will help you evaluate the situation a lot quicker. A specific saturation number doesnt always work for everyone. I am usually happy with my chronic COPD pts to be in the high 80's if thats where they usually live at. If they are pretty hypoxic than usual I dont get stingy with the oxygen. Once we start going back and forth with hypoxia vs acute respiratory acidosis its time to intubate because you wont win the race.

Critical errors: The patient needs to be placed in high fowlers position along with a 28 % venturi mask at flush.

why didn't they sit him up high flowers position?

Should have raised the head of the bed ...in the beginning, and only lowered the head of the bed when he needed more that oxygen and nebulizer...

2 or 4 year depending on what school you go to

Also COPD SAAC iprotropium bromide should have been recommended

ya but a COPD pt still need an O2 ... give as much as he need tills SAT reach atleast 92%..

OMG..This test is intense......i dont know if could do this.........ಥ_ಥ

i don't know why you would put a COPD pt on high flow oxygen. COPD pts SHOULD NOT be on oxygen over 2 liters. Their stimulus to breathe is high levels CO2, giving them more than 2 Liters of oxygen is taking the pt's away the pt's stimulus to breathe. Obviously, after intubation and getting put on the vent, it's OK to do high flow oxygen because the machine would be breathing for him. but still, the pt should not be on 6 Liters of oxygen in the ER. Pts on COPD already run a low SpO2.

Why were my comments deleted? I was merely illustrating poor patient care by the RTs. They performed incorrectly when instituting certain interventions and did not institute other needed interventions. I sincerely hope that RT students do not use this as a learning tool.

Shouldn't they have brought the flow down on the nasal cannula first and tried a bronchodilator? ^l/min is too much for a COPD patient. His hypoxic drive would be cut off wouldn't it?

why would you put a COPD patient on 100%??? HE WILL PASS OUT! hypoxic drive?

ABG?

what is hypoxic..

That's what school is for! :)

2 and 4

i would put him on 28% venti mask.

I can't do this all on my own, no I know, I'm no superman. I'm no superman.

Also the section of 15 mm tubing in the nebulizer must be used as a holding chamber to increase drug delivery. I sincerely hope that the RTs in this video do not conduct themselves like this in real life.

Should have raised the head of the bed ...