A patient is switched from PRVC to SIMV mode, rate of 10/min, VT 350 ml, fi02 0.40, PEEP 5 cmH20, Pressure Support 8 cmH20,  I-time is 1.0 second in which she had a comfortable work of breathing.  After the switch, here are the ventilator parameters:  PIP 36 cmH20, PPlat 20 cmH20, spon VT 200 ml’s, total RR 35/min, I:E 1:1, Ve 11.5 L.  Patient Assessment:  increased work of breathing with paradoxical respirations noted. Abg’s: pH 7.38, paC02 43 torr, pa02 65 torr,  HC03 22 meq/L, B.E. -What could you attribute this clinical picture to?

The #31 arrow is pointing to which structure? IMG_2820.JPG

The #15 arrow is pointing to which part of the organ? IMG_2808 (2).JPG

The #27 arrow is pointing to which organ? IMG_2816(1).JPG

The #22 sticker is pointing to which part of the organ? IMG_2813.JPG

The black line is located on which part of the organ? (In the second picture, the #20 sticker is located on the same part of the organ) lesser curve physical.png IMG_2812.JPG

The #28 arrow is pointing to which structure? IMG_2817.JPG

The #30 arrow is pointing to which part of the organ? IMG_2819.JPG

The #3 arrow is pointing to which structure? IMG_2801.JPG

The #18 arrow is pointing to which muscle? IMG_2810.JPG