00:01
Hi, I'm Professor Lawes.
00:02
And I am really excited
to bring you this series
on Mechanical Ventilation.
00:07
So I'm going to walk you through
all of the most important things
that you'll need to know
as a nurse,
caring for a patient
who's on a ventilator.
00:15
So let's start from
the very beginning.
00:17
Okay, so this is a
mechanical ventilator.
00:20
When you say a
patient's on the vent,
this is what they're referring to.
00:24
And what's got this
microprocessor in it?
It's pretty fancy these days.
And that's what controls the device.
00:30
Now, it delivers a mixture
of air and oxygen
into the patient's lungs.
00:36
Now, this replaces
their natural respiration.
00:38
So, patients who are on a ventilator
are obviously having some type
of respiratory difficulty.
00:43
And I want to introduce you to
who will become your best friend,
If you're smart,
if you're working on a unit
for any patients that
need respiratory support.
00:53
I want to talk about
the difference in
between a respiratory therapist
and a nurse.
00:57
And when I work a unit, these are
the people I count on and rely on.
01:02
They're fabulous
to collaborate with.
01:04
See both of us have a license.
01:06
As a nurse,
I have an RN state license.
01:10
A respiratory therapist has an RRT
or a Registered Respiratory
Therapist state licensed.
01:15
So we're both licensed
healthcare personnel.
01:18
Nursing collaborates
with respiratory therapy
and respiratory therapy
collaborates with nursing.
01:24
Hey, when this all works well,
when you have a positive
and strong relationship
with your respiratory therapy team,
they can spot things
really quickly work together
and help avoid major problems
or danger with your patients.
01:38
Now, technically, the nurse is going
to assess the patient as a whole,
right, from head to toe.
01:43
And we're overseeing
all of the care.
01:45
The respiratory therapist
is going to focus
on the cardiopulmonary system.
01:49
But man, I wish I could tell you
how many times a
respiratory therapist
has noticed a slight change.
01:57
We got put our heads together
and we're able to come
up with a solution
that avoided a really bad outcome.
02:02
So you want to see them
as your equal.
02:04
You collaborate with them.
They know their stuff.
02:08
They have an intuition,
just like nurses have intuition
based on experience.
02:13
So, hopefully, you quickly establish
a really solid relationship
with a respiratory therapy
team where you work.
02:19
Okay, now,
let's talk about breathing.
02:23
Yep, you're doing it all the time.
02:25
But you may not have really
sat down and thought about it.
02:28
In order for you to understand
mechanical ventilators,
you need to understand what
goes on in a natural inhalation.
02:36
So just stop for just a second
and take a deep breath in.
02:43
Okay, that's how it's
supposed to work.
02:45
You wanted to take a breath,
you took a breath,
everything's going well.
02:49
But the patients we take care of
in the hospital,
it's usually not that simple.
02:53
So, it's important
that you understand
how it works naturally,
or normally in your body.
03:00
Now you have the diaphragm, right?
That's that muscle.
03:03
It was right across the center.
It contracts.
03:06
And when I say it contracts,
it pulls down.
03:09
And that's what creates
negative pressure into the lungs.
03:13
Okay, I know that you guys
have heard that term,
negative pressure,
diaphragm involve.
03:18
You've heard it before in
lots of other lectures.
03:21
But I want you to really think
about how it works.
03:24
So this is where I want
you to get the picture.
03:26
That diaphragm flattens out.
03:29
That creates an open space,
and air is able to enter
into the lungs, right?
That's natural inhalation.
03:36
You just took a breath
with us together.
03:38
What we're going to talk about today
is when natural inhalation
doesn't provide enough oxygen
to the patient's body.
03:45
We use a mechanical ventilator.
03:48
Remember, that's that machine
with a microprocessor in it.
03:50
Now, the mechanical
ventilator has to push
oxygenated air in with positive
pressure into a person's lungs.
03:59
Naturally inhalation.
04:01
My diaphragm helps to create
negative pressure
and air goes in gently.
04:06
Mechanical ventilator,
that is pushing oxygenated air
into it with positive pressure.
04:13
So, this, doesn't really
risk damaging my lungs.
04:18
Mechanical ventilator can come
with all kinds of complications
that we'll talk about further
along in this video series.
04:25
So, let's start at the very top.
04:28
You've got a framework,
you know, the people we work with.
04:31
We've talked about
what negative pressure is,
and we'll get
a little bit more into that.
04:35
And we talked about how a
mechanical ventilator is different
because it is pushing air
into those lungs.
04:43
So, let's just do a quick review
of your anatomy.
04:46
We'll start at the top because
that's where the air enters.
04:49
So you've got your nasal cavity.
04:51
Now you can also
take it in and your mouth.
04:53
But let's say you're taking air in.
04:55
In your nasal cavity
where those cilia are
so they can function
like they're intended to do
to protect you
from really nasty things
getting into your respiratory tract.
05:05
Travels down through the pharynx,
down through to the trachea
into the lungs.
05:10
So that airway
is what needs to be complete,
intact, and unobstructed
in order for air to come
from the outside into your lungs.
05:20
And this is a super cool picture.
Look at this.
05:22
The artists have created for you.
05:24
There's the lungs,
or the pink tissue.
05:26
You've got the ribcage right there.
05:28
You've got your sternum
in the middle.
05:31
Now, we're gonna take
a little chunk out of that,
because I want to explain
to you more
about negative pressure.
05:37
So you see we've taken
that chunk out of the tissue.
05:39
And now we're
going to pull back even more.
05:42
And I want you to understand
how these things all fit together.
05:45
Now I'm going to start
with the outside
and then go into the very
innermost side just to start with.
05:51
So, on the outside,
you see that flesh colored area,
that would be the skin.
So, that's the skin.
05:59
Now, move all the way through
the different layers,
and that is the lung tissue.
06:04
What I want to talk to you about
is the stuff in between.
06:07
So let's help you get
a little oriented.
06:09
You've got the skin,
which is the outside,
and the lung,
which is all the way on the inside
what we're going to look at.
06:16
Now, let's look for
some big markers.
06:19
Some big landmarks that can
help you know where you are.
06:22
Pretty sure you can pick
out the ribcage, right?
Take a look at where that is.
06:27
All right, so in this picture,
you see two ribs.
06:31
And they're letting us
see there that it's bone,
and they've sliced through it
just to help us get
an idea of what it looks like.
06:38
So, you've got the skin, the lungs.
06:40
We've got the ribcage
right in the middle.
06:43
Now, notice of that top rib,
you've got three vessels.
06:47
One is blue, one is red,
one is kind of a golden color.
06:51
That's a vein, an artery,
and an intercostal nerve.
06:56
Okay, so we've got a blood supply
that's bringing oxygenated blood.
07:01
That's the artery.
You've got the vein
taking deoxygenated blood
back to the heart,
and then you've got the nerve.
07:07
Okay, so we've got our
locations we know where we are.
07:10
The next thing I want you to see
is to take a look at the layers.
07:14
Now, this is what helps
keep as whole system intact.
07:18
I want you to look at the pleura.
07:21
You see closest to the lungs,
we have what's called
a visceral pleura.
07:26
Now, on the other side,
you have a parietal pleura.
07:29
So you've got visceral, parietal.
07:31
See those two?
They have a space in between,
and that's what we call
the pleural cavity.
07:38
Okay, now, these are
pretty tight membranes,
and they need to be
whole and intact.
07:44
So when that diaphragm
flattens down,
that's what allows air to come in.
These pleura have to be intact.
07:53
Now, if I've got
extra fluid in there,
sometimes they do a procedure
called a thoracentesis.
07:58
where you end up pulling out extra
fluid for maybe an infection.
08:02
But it's super important
like impossible
for the lungs to stay inflated,
consistently,
if there's some type
of tear or opening
in either one of these pleura.
08:13
So when we say you need
intact space in here,
those pleura have to be intact
in in good shape and functioning.
08:21
So most important
takeaways from this
would be the lungs cannot
inflate and deflate as they should,
unless those pleura are intact.
08:33
Okay, so we've got
lots of other things in there.
08:37
But that's the most important
point I want you to take away.
08:41
When you're helping someone
support their respiratory
even when you're doing
a normal assessment,
picture what it looks
like what it takes
for your lungs to function normally,
the next time you're
listening to lung sounds.
08:53
So, I want to give you
another perspective here.
08:56
See that diaphragm?
Look how its dome shaped.
09:00
See how we have
the pleura outline there?
When that diaphragm flattens,
that's what, it's like,
almost causes a sucking motion,
or the negative pressure because now
it goes from here to here
causes extra space in your cavity.
09:17
Air will come in passively
because of the negative pressure.
09:21
And that's how you can breathe in.
09:25
So, please do me a favor
and take just a second.
09:28
Think about if I pause here
and I take a deep breath in.
09:32
What's happening to your diaphragm?
Well, it had to flatten, right?
So have that picture in your mind
because when the
diaphragm doesn't work,
that's when a person can't breathe.
09:44
That's when they'll absolutely
have to be supported.
09:47
If they've had nerve damage
or direct damage to the
tissue that is the diaphragm,
they will not be able
to breathe on their own.
09:55
And that's critically important
that you understand that as a nurse
because when we give
a patient a medication
like a neuromuscular blocker,
that muscle will be paralyzed.
10:04
And that's why anyone
who's on a neuromuscular blocker
has to be on a ventilator.
Okay, you're doing really well.
10:12
That's just a quick review.
10:13
I know you guys have had
anatomy and physiology,
but I really wanted to
break it down for you.
10:18
So it makes sense when you're
talking about ventilators.
10:22
So when the diaphragm
flattens, I breathe in.
10:26
Right, my chest wall gets bigger.
10:28
My ribs kind of
stretch out a little bit.
10:30
And then when I exhale,
everything returns to normal.
10:35
Any problems with
any of those areas,
breathing is going
to be a difficult.
10:39
What if that nerve is irritated
that we talked about right
or under the vein and artery?
I'm not going to want to
take big breaths, right?
I'm going to want to...
[breath sound]
take little tiny breaths,
because it's painful for me.
10:52
When the lungs are not inflated
to the adequate volume,
when they're under
inflated or over inflated,
you're going to have problems.
10:59
That's why it matters
that we help the patient
breathe as normally as possible
under really abnormal situations.