Instructor-provided case
Patient case scenario
Enter or paste the patient case assigned in Canvas for this lab or Sim session.
Current entry
Student Information
Student and chart-entry details for the current respiratory care check.
Patient / case
Patient / Case Information
Respiratory care orders
Active and new orders
Verify the order before documenting an intervention. New or changed orders remain in the order history.
Add / update order
Save chart entry to show the order in the timeline and print review. If you type an order and tap Save chart entry, it will be added automatically.
Order history
| Date/time | Category | Order / parameters | Status | Verification |
|---|
Mechanical ventilation
Ventilator Flowsheet
Document ventilator settings, measured values, monitoring, and alarms.
Equipment check
Ventilator identification and pre-use test
Patient calculation
Height and predicted body weight
Calculated from sex and height for ventilator tidal-volume selection.
Step 1
Select ventilator mode
Only settings used for the selected mode will appear.
Step 2
Set parameters
Step 3
Measured ventilator values
Document observed values—not ordered settings.
Mode-specific monitored data
Safety
Ventilator alarms
Record the limits verified at this check.
Show lab alarm-setting reference
Use the scenario order and local policy first. The ranges below reproduce the guidance in the supplied lab sheet.
| Alarm | Lab reference |
|---|---|
| High pressure | 10–15 cmH₂O above observed PIP; in PS, keep below the pressure at which the breath is terminated. |
| Low pressure / disconnect | 5–10 cmH₂O below observed PIP. |
| Low / high exhaled Vt | Approximately 10–15% below / above observed Vt. |
| Low / high minute ventilation | Approximately 2–3 L/min below / above observed Ve. |
| High RR | Approximately 10–15 breaths/min above baseline. |
| Apnea interval | 15–20 seconds for the adult lab scenario. |
| PEEP / CPAP | Approximately ±2 cmH₂O around the set level. |
| FiO₂ | Approximately ±5% around the prescribed FiO₂. |
ARDSNet adult lung-protective ventilation reference
Use predicted body weight (PBW), not actual weight. Initial Vt target 6 mL/kg PBW; titrate within 4–8 mL/kg using plateau pressure and protocol. Target Pplat ≤30 cmH₂O, SpO₂ 88–95% or PaO₂ 55–80 mmHg. RR may be adjusted up to 35/min according to pH and protocol. Minimum PEEP 5 cmH₂O. Review ABG, auto-PEEP, hemodynamics and synchrony after changes.
PBW (kg): male 50 + 0.91 × (height cm − 152.4); female 45.5 + 0.91 × (height cm − 152.4).
Lower PEEP / higher FiO₂ table
| FiO₂ (%) | PEEP (cmH₂O) |
|---|---|
| 30 | 5 |
| 40 | 5 or 8 |
| 50 | 8 or 10 |
| 60 | 10 |
| 70 | 10, 12 or 14 |
| 80 | 14 |
| 90 | 14, 16 or 18 |
| 100 | 18–24 |
Teaching summary: use the complete protocol for pH management, plateau-pressure adjustments, higher-PEEP options and weaning. This reference does not change the chart settings.
ARDSNet protocol summary — Appendix A, University of Pennsylvania · NHLBI ARDS Network study and protocolsShow initial ventilator settings cheat sheet
Adult lab and simulation starting examples. Use the scenario order and local policy first; adjust to patient response and device instructions.
| Parameter | Initial number or range | Adjustment reminder |
|---|---|---|
| Tidal volume | 6–8 mL/kg PBW; Pplat <30 cm H₂O | Measure plateau pressure with an inspiratory hold under appropriate conditions. Adjust VT for lung protection; ARDS may need a lower VT. |
| Respiratory rate | 10–20 breaths/min | Adjust using pH/PaCO₂ and adequate expiratory time. |
| Peak flow | 60 L/min; range 40–80 | Use on flow-controlled devices; assess demand and timing. |
| Inspiratory time | 0.8 sec; range 0.6–1.0 | Use when the device controls time instead of peak flow. |
| Pressure trigger | −1 to −3 cm H₂O from baseline | Choose pressure OR flow triggering; avoid missed efforts/autotriggering. |
| Flow trigger | 1–2 L/min | Check device-specific operation. |
| Flow waveform | Decelerating / down ramp | Square flow may shorten inspiratory time on flow-controlled devices. |
| FiO₂ | 1.00 in severe distress; 0.40–0.70 when appropriate | Promptly titrate to the ordered oxygenation target. |
| PEEP | 5 cm H₂O | Adjust to oxygenation, mechanics and hemodynamics. |
Reassess: Exhaled VT, minute ventilation, total RR, airway pressures, PEEP/auto-PEEP, oxygenation, gas exchange, patient effort and waveforms. Plateau pressure requires an inspiratory hold under appropriate conditions.
| Parameter | Initial number or range | Adjustment reminder |
|---|---|---|
| Pressure control | 15–20 cm H₂O above PEEP* | Adjust to target exhaled VT; confirm the device pressure convention. |
| Exhaled VT target | 6–8 mL/kg PBW in source | Use a lower lung-protective target when indicated. |
| Respiratory rate | 10–20 breaths/min | Adjust using pH/PaCO₂ and adequate expiratory time. |
| Inspiratory time | 0.8 sec; range 0.6–1.0 | Some cases use 0.8–1.2 sec; assess synchrony and expiration. |
| Pressure trigger | −1 to −3 cm H₂O from baseline | Choose pressure OR flow triggering. |
| Flow trigger | 1–3 L/min | Avoid missed efforts/autotriggering. |
| Rise time / slope | Device-specific | Meet demand without early pressure overshoot. |
| FiO₂ | 1.00 in severe distress; 0.40–0.70 when appropriate | Promptly titrate to the ordered oxygenation target. |
| PEEP | 5 cm H₂O | Adjust to oxygenation, mechanics and hemodynamics. |
| *Pressure example | PC 15 + PEEP 5 = 20 cm H₂O | Applies when PC is defined as pressure above PEEP. |
Reassess: Exhaled VT, minute ventilation, total RR, airway pressures, PEEP/auto-PEEP, oxygenation, gas exchange, patient effort and waveforms. Plateau pressure requires an inspiratory hold under appropriate conditions.
| Parameter | Initial number or range | Adjustment reminder |
|---|---|---|
| Pressure support | Titrate; no fixed start in your excerpt | Adjust to effort, RR and exhaled VT; the stated 15 is not a universal maximum. |
| Exhaled VT | 4–7 mL/kg in source augmentation example | Source full-support example: 8 mL/kg; use the case-specific protective target. |
| Respiratory rate | Patient determined | Adequate spontaneous drive is required; verify apnea backup. |
| Pressure trigger | −1 to −2 cm H₂O from baseline | Choose pressure OR flow triggering. |
| Flow trigger | 1–3 L/min | Assess triggering and leaks. |
| Flow cycling | 25% of peak inspiratory flow in source | Confirm device default; tune using waveforms. |
| Cycling examples | COPD 35–40%; restrictive 10–20% | Instructor examples, not fixed disease prescriptions. Higher % ends inspiration earlier. |
| Rise time | Device-specific | Adjust to comfort, flow demand and pressure waveform. |
| PEEP | Retain effective PEEP; 5 cm H₂O basic example | Adjust if case orders require it. |
| FiO₂ | Retain effective FiO₂; titrate | Use the ordered oxygenation target. |
Reassess: Spontaneous exhaled VT, minute ventilation, total RR, PIP, mean airway pressure, oxygenation, gas exchange, comfort, effort and waveforms. Verify appropriate apnea backup using the existing alarm reference.
APRV — airway pressure release ventilation
| Set parameter | Meaning / review |
|---|---|
| P high | Upper pressure level; document absolute pressure in cmH₂O. |
| P low | Lower pressure level during release. |
| T high | Seconds at P high. |
| T low | Seconds at P low; review expiratory flow and release volume. |
| FiO₂, rise time, trigger | Verify device controls and prescribed settings. |
Monitor: Release / mandatory exhaled Vt and Ve, spontaneous exhaled Vt and Ve, total Ve, total RR, mean airway pressure, oxygenation, ABG, effort and hemodynamics.
APRV settings depend on the patient, ventilator and institutional protocol. Use the verified simulation order. Release frequency = 60 ÷ (T high + T low); total RR can include spontaneous breaths.
Hamilton Medical: APRV controls and operationAdapted from the supplied course excerpts on initial VC-CMV, PC-CMV and PSV settings. The VC/PC respiratory rate range is 10–20 breaths/min per instructor. PBW terminology is used for tidal-volume guidance.
Weaning readiness
Spontaneous breathing trial (SBT)
Document daily readiness, current support, one SBT trial, tolerance, and outcome. Educational structure informed by the provided HMC SBT protocol; use current course/facility criteria.
Oxygen support
O₂ therapy
Record the device, flow or FiO₂, humidification, and patient response.
Airway
Airway device and care
Tube-specific fields appear after the airway is selected.
Airway device
Device details
Patient assessment
Patient assessment
Record the patient response and clinical assessment.
Vital signs
Mental status
Breathing
Cough and secretions
Laboratory values
ABG, oxygenation, and EtCO₂
Breath sounds by lung field
Adult chest X-ray teaching references
Select a topic to open real teaching images on the source website. “Add reference to chart” records the topic and source; it does not import the image.
Open teaching imagesETT distance refers to the carina. Document neck position and measured distance; 3 cm above the carina is a measured position, not a “high ETT” label. For a combined ARDS + ETT case, review both references or use your instructor's case image.
Chest X-ray documentation
Attach your adult teaching case image. It is stored with saved entries on this device and included in print review. The Canvas case link carries the case text only.
Respiratory therapy
Airway Clearance & Therapy
Document therapy, secretion clearance, tolerance, and response.
Suction and secretions
Therapy performed
Therapy measurements and response
Medication record
Respiratory and critical care medications
Select a medication group, then a subcategory and drug. Record the dose, route, administration or observation, and response according to the Sim case order.
Time-stamped event
Procedures and patient transport
Select one event. Only the corresponding documentation fields will open.
Procedure answers are saved with this time entry and will not carry into the next entry.
Airway procedure
Intubation procedure
Procedure and airway placement
Placement verification — select all used
Assessment, cuff, and outcome
Airway procedure
Extubation procedure
Readiness and procedure
Post-extubation assessment
Post-extubation interventions — select all used
Patient movement
Patient transport
Transport details
Monitoring used — select all used
Response and outcome
Procedure / diagnostic
Procedure documentation
Neurologic death evaluation support
Apnea test documentation
Educational documentation only. Follow supervising physician and institutional protocol.
Prerequisite verification
Pre-test ABG
Trial and monitoring
Post-test ABG and result
Narrative
RT progress note
Summarize assessment, interventions, patient response, and plan. To revise a saved note, open its entry from the charting timeline.
Learning reflection
Hands-on Sim/Lab reflection
Reflect on the activity and save this separately from patient chart entries. You can return to edit your answers before printing.
Student work on this device
Saved chart entries
Edit or delete a single entry using its row below.
| Date/time | Scenario | Charted sections | Mode | FiO₂ | PEEP | RR total | Vt exhaled |
|---|