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\usepackage[normalem]{ulem}     % For underlining links
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% Document Info
\author{xkissmekatex (kissmekate)}
\pdfinfo{
  /Title (ventilator.pdf)
  /Creator (Cheatography)
  /Author (xkissmekatex (kissmekate))
  /Subject (Ventilator Cheat Sheet)
}

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\fancyhead[L]{
\noindent
\begin{multicols}{3}
\begin{tabulary}{5.8cm}{C}
    \SetRowColor{DarkBackground}
    \vspace{-7pt}
    {\parbox{\dimexpr\textwidth-2\fboxsep\relax}{\noindent
        \hspace*{-6pt}\includegraphics[width=5.8cm]{/web/www.cheatography.com/public/images/cheatography_logo.pdf}}
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\columnbreak
\begin{tabulary}{11cm}{L}
    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{Ventilator Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{xkissmekatex (kissmekate)} via \textcolor{DarkBackground}{\uline{cheatography.com/33594/cs/10551/}}}
\end{tabulary}
\end{multicols}}

\fancyfoot[L]{ \footnotesize
\noindent
\begin{multicols}{3}
\begin{tabulary}{5.8cm}{LL}
  \SetRowColor{FootBackground}
  \mymulticolumn{2}{p{5.377cm}}{\bf\textcolor{white}{Cheatographer}}  \\
  \vspace{-2pt}xkissmekatex (kissmekate) \\
  \uline{cheatography.com/kissmekate} \\
  \end{tabulary}
\vfill
\columnbreak
\begin{tabulary}{5.8cm}{L}
  \SetRowColor{FootBackground}
  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Not Yet Published.\\
   Updated 16th January, 2017.\\
   Page {\thepage} of \pageref{LastPage}.
\end{tabulary}
\vfill
\columnbreak
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  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Sponsor}}  \\
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  \vspace{-5pt}
  %\includegraphics[width=48px,height=48px]{dave.jpeg}
  Measure your website readability!\\
  www.readability-score.com
\end{tabulary}
\end{multicols}}




\begin{document}
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% www.emerson.emory.edu/services/latex/latex_169.html
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\begin{multicols*}{3}

\begin{tabularx}{5.377cm}{x{1.09494 cm} x{3.88206 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Lung Physiology}}  \tn
% Row 0
\SetRowColor{LightBackground}
\seqsplit{Ventilation} & • To {\bf{lower PaCO2, one must either }}increase RR or increase tidal volume{\bf{.  \{\{nl\}\}• }}Minute ventilation = RR x VT**. \tn 
% Row Count 4 (+ 4)
% Row 1
\SetRowColor{white}
\seqsplit{Oxygenation} & • Monitored by O2 saturation and PaO2.  \{\{nl\}\}• To increase PaO2 in the ventilated patient, one must either {\bf{increase FiO2 or PEEP}}. \{\{nl\}\}• Can also {\bf{extend inspiratory time}} fraction. \{\{nl\}\}• Can improve oxygen delivery by {\bf{increasing CO or hemoglobin}}. \{\{nl\}\}• Can decrease oxygen requirements by {\bf{decreasing work of breathing, agitation or feve}}r. \{\{nl\}\}• Remove pulmonary vasodilators like nitroprusside. \tn 
% Row Count 18 (+ 14)
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\begin{tabularx}{5.377cm}{x{2.04057 cm} x{2.93643 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Key Terms}}  \tn
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\SetRowColor{LightBackground}
Minute Ventilation & • {\bf{RRxVT}}. Should be {\bf{adjusted to achieve baseline PaCO2}}. \{\{nl\}\}• Initial VT of 8-10mL/kg is appropriate in most cases (lower in ARDS and COPD). \{\{nl\}\}• A {\bf{rate of 10-12 breaths/min}} is appropriate. \tn 
% Row Count 10 (+ 10)
% Row 1
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FiO2 & • Initially should be 100\%. \{\{nl\}\}• Quickly titrate down and use the lowest possible level to {\bf{maintain a PaO2 of 50-60 }}or higher. \{\{nl\}\}• Avoid oxygen toxicity with FiO2\textless{}60\% if possible. \{\{nl\}\}• If FiO2 of 0.5 does not result in adequate PaO2, {\bf{add PEEP or CPAP (allow reduction in FiO2)}}. \tn 
% Row Count 24 (+ 14)
% Row 2
\SetRowColor{LightBackground}
\seqsplit{Inspiratory/expiratory} ratio & • Duration of time allotted to inspiration compared to expiration in one delivered breath. Duarte of each breath is determined by set RR. Increased time in inspiration will proportionally decrease tie-in expiration. {\bf{1:2 is usually used}}. \tn 
% Row Count 35 (+ 11)
\end{tabularx}
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\begin{tabularx}{5.377cm}{x{2.04057 cm} x{2.93643 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Key Terms (cont)}}  \tn
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PEEP & • Positive pressure maintained at the end of passive exhalation to {\bf{keep alveoli open}}.  \{\{nl\}\}• 2.5-10cm H2O is the initial setting. \{\{nl\}\}• Can be added to any mode of ventilation and used mostly in hypoxic respiratory failure. \{\{nl\}\}• Increases lung compliance and oxygenation ({\bf{improves gas exchange}}). \{\{nl\}\}• Prevents alveolar collapse and atelectasis. \{\{nl\}\}• Can cause barotrauma or {\bf{low CO (due to decreased venous return and increased PVR}}, esp. with hypovolemia). \tn 
% Row Count 22 (+ 22)
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\end{tabularx}
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\begin{tabularx}{5.377cm}{x{1.09494 cm} x{3.88206 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Mechanical Ventilation}}  \tn
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\seqsplit{Indications} & • Significant respiratory distress or respiratory arrest. \{\{nl\}\}•  Impaired or reduced level of consciousness with inability to protect the airway {\bf{(absent gag or cough reflex)}}. \{\{nl\}\}• {\bf{Metabolic acidosis}} without adequate compensation. \{\{nl\}\}• {\bf{Respiratory muscle fatigue}}. \{\{nl\}\}• Significant {\bf{hypoxemia (PaO2\textless{}70mmHg)}} or{\bf{ hypercapnia (PaCo2\textgreater{}50mmHg)}}. \{\{nl\}\}• Respiratory acidosis (pH\textless{}7.2) with hypercapnia. \tn 
% Row Count 14 (+ 14)
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\begin{tabularx}{5.377cm}{x{1.24425 cm} x{3.73275 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Complications}}  \tn
% Row 0
\SetRowColor{LightBackground}
\seqsplit{Complications} & • Anxiety and discomfort treated with sedation. \{\{nl\}\}• Tracheal secretions need regular suction. \{\{nl\}\}• Nosocomial pneumonia (if \textgreater{}72 hours), accidental extubation, \{\{nl\}\}• {\bf{Barotrauma (high P)}} \{\{nl\}\}• Oxygen toxicity (if FiO2\textgreater{}60\% for \textgreater{}2 days). \{\{nl\}\}• Hypotension (high intrathoracic pressure decreases VR). \{\{nl\}\}• Tracheomalacia (softening of cartilage) due to prolonged ETT. Prevent with tracheostomy if \textgreater{}2weeks. \{\{nl\}\}• Laryngeal damage, GI effects (stress ulcers, cholestasis). \tn 
% Row Count 17 (+ 17)
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\begin{tabularx}{5.377cm}{x{1.24425 cm} x{3.73275 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Complications}}  \tn
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\seqsplit{Complications} & • Anxiety and discomfort treated with sedation. \{\{nl\}\}• Tracheal secretions need regular suction. \{\{nl\}\}• Nosocomial pneumonia (if \textgreater{}72 hours), accidental extubation, \{\{nl\}\}• {\bf{Barotrauma (high P)}} \{\{nl\}\}• Oxygen toxicity (if FiO2\textgreater{}60\% for \textgreater{}2 days). \{\{nl\}\}• Hypotension (high intrathoracic pressure decreases VR). \{\{nl\}\}• Tracheomalacia (softening of cartilage) due to prolonged ETT. Prevent with tracheostomy if \textgreater{}2weeks. \{\{nl\}\}• Laryngeal damage, GI effects (stress ulcers, cholestasis). \tn 
% Row Count 17 (+ 17)
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\begin{tabularx}{5.377cm}{x{2.4885 cm} x{2.4885 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Modes}}  \tn
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\SetRowColor{LightBackground}
Assisted Controlled Ventilation & • Initial mode used in respiratory failure. \{\{nl\}\}• Guarantees a {\bf{"backup" minute ventilation}}. \{\{nl\}\}• The ventilator delivers a breath of {\bf{predetermined tidal volume}} when the patient initiates a breath. \{\{nl\}\}• If the patient does not initiate a breath, the ventilator takes control and {\bf{delivers a breath at a predetermined rate}}. \{\{nl\}\}• {\bf{All breaths are deviled by the ventilator}}. \{\{nl\}\}• The patient can go over the determined rate but not under, and {\bf{every breath is a determined TV}}. \tn 
% Row Count 26 (+ 26)
% Row 1
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Synchronous Intermittent Mandatory Ventilation & • Patients can breath above the mandatory rate without help from the ventilator. \{\{nl\}\}• The tidal volume of extra breaths is not determined by the ventilator. \{\{nl\}\}• When the patient breathes spontaneously, there is no preset volume, but the {\bf{patient has a guaranteed predetermined rate}}. \{\{nl\}\}• Delivers the mandatory breath in synchrony with patient's initiated spontaneous breath (so they do not overlap). \{\{nl\}\}• Good for support of ventilation and weaning. \tn 
% Row Count 50 (+ 24)
\end{tabularx}
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\begin{tabularx}{5.377cm}{x{2.4885 cm} x{2.4885 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Modes (cont)}}  \tn
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Continuous Positive Airway Pressure (CPAP) & • {\bf{Positive pressure (0-20cm H2O) is delivered}} continuously during expiration and inspiration, but no volume breaths are delivered. \{\{nl\}\}• The patient breaths on their own. \{\{nl\}\}• The only {\bf{parameters to set are PEEP and pressure support}}. \{\{nl\}\}• If the patient is being weaned, CPAP can be used to assess whether they can be extubated. \tn 
% Row Count 18 (+ 18)
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Pressure Support Ventilation & • Mostly during weaning trials. \{\{nl\}\}• Pressure is delivered with an initiated breath to assist breathing. \{\{nl\}\}• Pressure is not continuous and only responds to initiated breaths. \{\{nl\}\}• It {\bf{enhances respiratory efforts made by the patient}}. \{\{nl\}\}• PEEP may be added. \tn 
% Row Count 33 (+ 15)
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% That's all folks
\end{multicols*}

\end{document}