Competency in a ventilated child

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DESCRIBE EVENTS THAT MAY CAUSE SUDDEN CHANGES IN THE STATUS OF A VENTILATED CHILDS If the patient's condition deteriorates suddenly,a useful mnemonic to use is: D displacement of endotracheal tube O obstruction of endotracheal tube P pneumothorax E equipement failure (Davies and Hassell, 2003) A patent airway must be clear and in the correct position in the airway.This can be checked through observation of chest movement,a chest x-ray,auscultation of the lungs and assessing the child's general appearance.If there is inadequate ventilation this can be due to an air leak around the tube,displacement of the tubeor obstruction i.e.secretions . Tube displacement into the pharynx or oeshophagus produces decreased breath sounds and possiblybreath sounds over the stomach.Displacement into a mainstream bronchus will produce unilateral increase in breath sounds and chest expansion-with a decreaseon the effected side. Tube obstruction will result in resistance to hand ventilation,with little or no air movement or chest expansion. Unilateral pneumothorax will produce decreased breath sounds and chest expansion on the involved side.In a tension pneumothorax the mediastinum shifts away from the side of the air leak causing compromise in cardiac output. Checking ventilator functions ,such as tubing connections ,water in the tubing ,the water trap or filter,ventilator settings -mode appropriate to clinical status and size(neonatal,paediatric or adult),trigger,rate,volumes and alarms is useful to exclude causes of changes. (Hazinski,1999) Changes in ventilation can also be induced by increases or decreases in resistance and compliance. Reference: * Davies, J and Hassell,L (2003) : Children in intensive care -A nurse's survival guide London :Churchill Livingstone *Hazinski, M

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