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  <head>
    <title>062-02 Oxygen transport, ventilator mechanics, haemodynamic support, and intensive-care recovery</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Oxygen, ventilation, circulation, and recovery">
      <outline text="Support has a cost">
        <outline text="Temporary substitute while recovery occurs"/>
        <outline text="Oxygen injures lung, pressure lowers output"/>
        <outline text="Sedation prolongs ventilation, devices infect"/>
        <outline text="Define target, least harmful support, remove early"/>
      </outline>
      <outline text="Oxygen transport and monitoring">
        <outline text="Delivery is cardiac output times content">
          <outline text="Haemoglobin times saturation dominates"/>
          <outline text="Dissolved oxygen contributes little"/>
        </outline>
        <outline text="Full saturation cannot offset anaemia or low output"/>
        <outline text="Venous saturation and lactate are indirect clues"/>
        <outline text="Oximetry biased by perfusion, pigment, probe"/>
        <outline text="Oxygen can conceal hypoventilation">
          <outline text="Saturation stays high while carbon dioxide rises"/>
        </outline>
        <outline text="Co-oximetry detects abnormal haemoglobins"/>
        <outline text="Persistent hypoxaemia: five mechanisms">
          <outline text="Low inspired oxygen, hypoventilation, diffusion"/>
          <outline text="Ventilation-perfusion mismatch or shunt"/>
        </outline>
      </outline>
      <outline text="Non-invasive support">
        <outline text="High flow meets demand, washes dead space"/>
        <outline text="Continuous pressure recruits, lowers afterload"/>
        <outline text="Bilevel adds inspiratory assistance"/>
        <outline text="Needs cooperation, mask fit, rapid improvement"/>
        <outline text="Failure triggers intubation, not mask escalation">
          <outline text="Rising rate, acidosis, falling consciousness"/>
          <outline text="Delay until collapse is harmful"/>
        </outline>
      </outline>
      <outline text="Intubation physiology">
        <outline text="Induction lowers sympathetic tone and resistance"/>
        <outline text="Paralysis removes respiratory muscle pump"/>
        <outline text="Positive pressure cuts right-heart venous return"/>
        <outline text="High arrest risk in hypovolaemia, right failure"/>
        <outline text="Prepare vasopressor, minimise apnoea"/>
        <outline text="Confirm with waveform carbon dioxide"/>
      </outline>
      <outline text="Ventilator mechanics">
        <outline text="Alveolar ventilation is minute minus dead space">
          <outline text="Rises with less alveolar ventilation or more production"/>
        </outline>
        <outline text="Oxygenation follows oxygen, end-expiratory pressure, shunt"/>
        <outline text="Peak includes resistive and elastic load"/>
        <outline text="Plateau approximates alveolar pressure"/>
        <outline text="Rising peak, stable plateau: resistance">
          <outline text="Secretions, kink, biting, bronchospasm"/>
        </outline>
        <outline text="Rising peak and plateau: lower compliance">
          <outline text="Oedema, pneumothorax, atelectasis, abdomen"/>
        </outline>
        <outline text="Driving pressure: plateau minus end-expiratory pressure">
          <outline text="Tidal strain relative to aerated lung"/>
        </outline>
      </outline>
      <outline text="Lung injury and distress syndrome">
        <outline text="Overdistension, pressure, cyclic opening, oxygen"/>
        <outline text="Tidal volume from height-based predicted weight">
          <outline text="Aerated lung does not scale with fat"/>
        </outline>
        <outline text="Sudden deterioration: disconnect, assess manually"/>
        <outline text="Inflammatory permeability oedema">
          <outline text="Dependent collapse, small lung takes tidal volume"/>
        </outline>
        <outline text="Prone positioning redistributes stress">
          <outline text="Reduces mortality if early and prolonged"/>
        </outline>
        <outline text="Conservative fluid after shock reduces lung water"/>
      </outline>
      <outline text="Synchrony and liberation">
        <outline text="Dyssynchrony is a sign, not a sedation order"/>
        <outline text="Pain, acidosis, intrinsic pressure, trigger mismatch"/>
        <outline text="Waveforms show missed and double triggers"/>
        <outline text="Liberation tests integrated reserve"/>
        <outline text="Trial fails from load, diaphragm, heart, fluid"/>
        <outline text="Laryngeal oedema can defeat extubation"/>
      </outline>
      <outline text="Shock and vasoactive support">
        <outline text="Blood pressure is a means, not the target"/>
        <outline text="Fluid challenge has endpoint and stopping rule">
          <outline text="Responsiveness does not mean benefit"/>
        </outline>
        <outline text="Sepsis needs source control and narrowing"/>
        <outline text="Slow lactate fall: adrenergic, liver, seizure"/>
        <outline text="Norepinephrine for distributive shock"/>
        <outline text="Epinephrine adds inotropy, arrhythmia, lactate"/>
        <outline text="Right-heart failure worsened by excess fluid">
          <outline text="Septal shift reduces left filling"/>
        </outline>
      </outline>
      <outline text="Kidney, nutrition, and brain">
        <outline text="Creatinine lags injury and is diluted"/>
        <outline text="Replacement for complications, not a number"/>
        <outline text="Overfeeding raises carbon dioxide and liver fat"/>
        <outline text="Early mobilisation is organ support"/>
        <outline text="Prevent secondary brain injury"/>
        <outline text="Hyperosmolar therapy and hyperventilation are bridges"/>
      </outline>
      <outline text="Devices, delirium, and recovery">
        <outline text="Devices must justify risk daily"/>
        <outline text="Pneumonia prevention: head up, oral care"/>
        <outline text="Fever and opacity alone are not pneumonia"/>
        <outline text="Iatrogenic withdrawal mimics delirium or sepsis">
          <outline text="Taper by exposure and half-life"/>
        </outline>
        <outline text="Time-limited trials specify review date"/>
        <outline text="Recovery planning starts before discharge"/>
        <outline text="Handover states indication for new medicines"/>
      </outline>
    </outline>
  </body>
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