\documentclass[10pt,a4paper]{article}

% Packages
\usepackage{fancyhdr}           % For header and footer
\usepackage{multicol}           % Allows multicols in tables
\usepackage{tabularx}           % Intelligent column widths
\usepackage{tabulary}           % Used in header and footer
\usepackage{hhline}             % Border under tables
\usepackage{graphicx}           % For images
\usepackage{xcolor}             % For hex colours
%\usepackage[utf8x]{inputenc}    % For unicode character support
\usepackage[T1]{fontenc}        % Without this we get weird character replacements
\usepackage{colortbl}           % For coloured tables
\usepackage{setspace}           % For line height
\usepackage{lastpage}           % Needed for total page number
\usepackage{seqsplit}           % Splits long words.
%\usepackage{opensans}          % Can't make this work so far. Shame. Would be lovely.
\usepackage[normalem]{ulem}     % For underlining links
% Most of the following are not required for the majority
% of cheat sheets but are needed for some symbol support.
\usepackage{amsmath}            % Symbols
\usepackage{MnSymbol}           % Symbols
\usepackage{wasysym}            % Symbols
%\usepackage[english,german,french,spanish,italian]{babel}              % Languages

% Document Info
\author{Maria K (mkravatz)}
\pdfinfo{
  /Title (acute-respiratory-failure.pdf)
  /Creator (Cheatography)
  /Author (Maria K (mkravatz))
  /Subject (Acute Respiratory Failure Cheat Sheet)
}

% Lengths and widths
\addtolength{\textwidth}{6cm}
\addtolength{\textheight}{-1cm}
\addtolength{\hoffset}{-3cm}
\addtolength{\voffset}{-2cm}
\setlength{\tabcolsep}{0.2cm} % Space between columns
\setlength{\headsep}{-12pt} % Reduce space between header and content
\setlength{\headheight}{85pt} % If less, LaTeX automatically increases it
\renewcommand{\footrulewidth}{0pt} % Remove footer line
\renewcommand{\headrulewidth}{0pt} % Remove header line
\renewcommand{\seqinsert}{\ifmmode\allowbreak\else\-\fi} % Hyphens in seqsplit
% This two commands together give roughly
% the right line height in the tables
\renewcommand{\arraystretch}{1.3}
\onehalfspacing

% Commands
\newcommand{\SetRowColor}[1]{\noalign{\gdef\RowColorName{#1}}\rowcolor{\RowColorName}} % Shortcut for row colour
\newcommand{\mymulticolumn}[3]{\multicolumn{#1}{>{\columncolor{\RowColorName}}#2}{#3}} % For coloured multi-cols
\newcolumntype{x}[1]{>{\raggedright}p{#1}} % New column types for ragged-right paragraph columns
\newcommand{\tn}{\tabularnewline} % Required as custom column type in use

% Font and Colours
\definecolor{HeadBackground}{HTML}{333333}
\definecolor{FootBackground}{HTML}{666666}
\definecolor{TextColor}{HTML}{333333}
\definecolor{DarkBackground}{HTML}{A3A3A3}
\definecolor{LightBackground}{HTML}{F3F3F3}
\renewcommand{\familydefault}{\sfdefault}
\color{TextColor}

% Header and Footer
\pagestyle{fancy}
\fancyhead{} % Set header to blank
\fancyfoot{} % Set footer to blank
\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}}
    }
\end{tabulary}
\columnbreak
\begin{tabulary}{11cm}{L}
    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{Acute Respiratory Failure Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{Maria K (mkravatz)} via \textcolor{DarkBackground}{\uline{cheatography.com/71404/cs/18143/}}}
\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}Maria K (mkravatz) \\
  \uline{cheatography.com/mkravatz} \\
  \end{tabulary}
\vfill
\columnbreak
\begin{tabulary}{5.8cm}{L}
  \SetRowColor{FootBackground}
  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Published 5th December, 2018.\\
   Updated 5th December, 2018.\\
   Page {\thepage} of \pageref{LastPage}.
\end{tabulary}
\vfill
\columnbreak
\begin{tabulary}{5.8cm}{L}
  \SetRowColor{FootBackground}
  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Sponsor}}  \\
  \SetRowColor{white}
  \vspace{-5pt}
  %\includegraphics[width=48px,height=48px]{dave.jpeg}
  Measure your website readability!\\
  www.readability-score.com
\end{tabulary}
\end{multicols}}




\begin{document}
\raggedright
\raggedcolumns

% Set font size to small. Switch to any value
% from this page to resize cheat sheet text:
% www.emerson.emory.edu/services/latex/latex_169.html
\footnotesize % Small font.

\begin{multicols*}{3}

\begin{tabularx}{5.377cm}{x{2.4885 cm} x{2.4885 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Acute Resp. Failure/Acute Lung Injury}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{{\bf{ARF}}: {\emph{sudden deterioration in pulmonary gas exchange = CO`2` retention \& inadequate oxygenation}}} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
{\bf{paO`2` \textless{} 60 mmHg}} & (should be 80-100) \tn 
% Row Count 3 (+ 1)
% Row 2
\SetRowColor{LightBackground}
{\bf{paCO`2` 60 mmHg}} & (should be 35-45) \tn 
% Row Count 4 (+ 1)
% Row 3
\SetRowColor{white}
{\bf{arterial pH \textless{} 7.35}} & (pts usually acidotic) \tn 
% Row Count 6 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{3.08574 cm} x{1.89126 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Causes}}  \tn
% Row 0
\SetRowColor{LightBackground}
\{\{bb\}\} {\bf{Direct}} & \{\{bb\}\} {\bf{Indirect}} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
Aspiration & Sepsis \tn 
% Row Count 3 (+ 1)
% Row 2
\SetRowColor{LightBackground}
Pneumonia & Burns \tn 
% Row Count 4 (+ 1)
% Row 3
\SetRowColor{white}
Contusions/trauma & Truama \tn 
% Row Count 5 (+ 1)
% Row 4
\SetRowColor{LightBackground}
Upper airway \{\{nl\}\} obstruction & TRALI \tn 
% Row Count 7 (+ 2)
% Row 5
\SetRowColor{white}
Toxic inhalation & Drug reaction/OD \tn 
% Row Count 9 (+ 2)
% Row 6
\SetRowColor{LightBackground}
SARS & Cardiopulm. bypass \tn 
% Row Count 11 (+ 2)
% Row 7
\SetRowColor{white}
 & Pancreatitis \tn 
% Row Count 12 (+ 1)
% Row 8
\SetRowColor{LightBackground}
 & Multiple fractures \tn 
% Row Count 14 (+ 2)
% Row 9
\SetRowColor{white}
 & Lung/bone marrow tx \tn 
% Row Count 16 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Stages of ARF}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Stage 1}}: {\emph{inc. SOB, RR, few CXR changes... within 24 hr \{\{fa-arrow-right\}\} signs of ARDS (CXR changes)}} \{\{nl\}\} - Tachypneic, dyspneic} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Stage 2 (Exudative)}}: {\emph{vent. required}} \{\{nl\}\} - Address underlying issues} \tn 
% Row Count 5 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Stage 3 (Proliferative)}}: {\emph{hemodynamically unstable}} \{\{nl\}\} - Can't maintain BP, tachy, compen. mechanisms, inflammation \& cascade of events} \tn 
% Row Count 8 (+ 3)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Stage 4 (Fibrotic)}}: {\emph{lung fibrosis issues; vent. management issues}} \{\{nl\}\} - Dec. compliance, stiffness} \tn 
% Row Count 11 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Types of Respiratory Failure}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Type 1 - Acute Hypoxemic}}: {\emph{abnl. transport of O`2` w/ resultant inadequate oxygenation}}} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Type 2 - Hypercapnic}}: {\emph{inadequate alveolar ventilation; marked elevation in paCO`2`}}} \tn 
% Row Count 4 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Type 3 - Mixed Hypoxemic-Hypercapnic}}: {\emph{inadequate alveolar ventilation \& abnormal O`2` transport}} \{\{nl\}\} - Often most common type} \tn 
% Row Count 7 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Management of ARF}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\emph{Warrants immediate intervention!}}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{GOALS}}: \{\{nl\}\} {\emph{Correct the cause}} \{\{nl\}\} {\emph{Alleviate hypoxemia \& hypercapnia}}} \tn 
% Row Count 3 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Indications for Intubation}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Altered mental status or coma}}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Severe respiratory distress}}} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Extremely low or agonal RR}} (gasping) \{\{nl\}\} - Cerebral issue r/t O`2`} \tn 
% Row Count 4 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Obvious respiratory muscle fatigue}} - r/t inc. work of breathing = mechanical vent.} \tn 
% Row Count 6 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Peripheral cyanosis}} - fingers, lips dusky} \tn 
% Row Count 7 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Impending cardiopulm. arrest}} - heart starts to compensate (tachy, arrythmias) \{\{fa-arrow-right\}\} cardiac arrest} \tn 
% Row Count 10 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\emph{Better to intubate electively rather than emergently!}}  \newline Mechanical vent. - helps to breathe, protects airway}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Systemic Inflammatory Response Syndrome (SIRS)}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{2+ of...} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Temp. \textgreater{} 100.4\textasciicircum{}o\textasciicircum{}F (38\textasciicircum{}o\textasciicircum{}C) or 98.6\textasciicircum{}o\textasciicircum{}F (36\textasciicircum{}o\textasciicircum{}C)}}} \tn 
% Row Count 3 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{HR \textgreater{} 90 bpm}}} \tn 
% Row Count 4 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{RR \textgreater{} 20 breaths/min}} or {\bf{paCO`2` \textless{} 32}}} \tn 
% Row Count 5 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{WBC \textgreater{} 12,000 or \textless{} 4,000 or/ \textgreater{}10\% bands}}} \tn 
% Row Count 6 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\emph{Older adults - inc. risk for MODS w/ less chance of recovery from ARDS}}}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Acute Respiratory Distress Syndrome (ARDS)}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Severe end of continuum} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Complex syndrome w/ high mortality risk} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Precipitated by {\emph{direct}} or {\emph{indirect}} lung injury} \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{\{\{bt\}\} Pathophysiology: \{\{nl\}\} {\bf{Lung injury}} \{\{fa-arrow-right\}\} {\bf{Dec. blood flow to lungs}} {\emph{(inflamm. mediators thin lung lining)}} \{\{fa-arrow-right\}\} {\bf{Alveolar membrane damage}} {\emph{(membranes thicken, gases can't exchange)}} \{\{fa-arrow-right\}\} \{\{nl\}\} {\bf{Inc. membrane protein permeability}} {\emph{("Leak syndrome"; changes osmotic pressure)}} \{\{fa-arrow-right\}\} {\bf{Interstitial \& intra-alveolar edema}} {\emph{(alveolar area flooded = pulm. edema)}} \{\{fa-arrow-right\}\} {\bf{Further impaired oxygenation}} \{\{fa-arrow-right\}\} {\bf{Pulm. edema}} \{\{fa-arrow-right\}\} {\bf{Inflamm. changes can lead to fibrosis}} {\emph{(may cause permanent lung change)}}} \tn 
% Row Count 16 (+ 13)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Surfactant gets lost \& makes process worse...  \newline - Dec. gas exchange \newline - Dec. lung compliance (resistance, pressure)}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{ARDS (cont.)}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Symptoms can develop very quickly after lung insult} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{\{\{bt\}\} {\bf{Assessment}}:} \tn 
% Row Count 3 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{- Accessory muscle use} \tn 
% Row Count 4 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{- {\bf{Tachypneic}}} \tn 
% Row Count 5 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{- {\bf{Tachycardia}}} \tn 
% Row Count 6 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{- Restless, air hunger = change in O`2`\{\{nl\}\} - Confusion} \tn 
% Row Count 8 (+ 2)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{- New/worsening lung sounds (crackles, wheezes) \{\{fa-arrow-right\}\} steroids} \tn 
% Row Count 10 (+ 2)
% Row 7
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{- Change in SpO`2`} \tn 
% Row Count 11 (+ 1)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{- Lethargy (lose ability to protect airway)} \tn 
% Row Count 12 (+ 1)
% Row 9
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{- {\bf{Dyspnea}}} \tn 
% Row Count 13 (+ 1)
% Row 10
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{- At risk for arrythmias} \tn 
% Row Count 14 (+ 1)
% Row 11
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{- Change in renal status} \tn 
% Row Count 15 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\emph{Bolded are the earliest signs}}}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{ARDS Diagnostic Criteria}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{paO`2`-FiO`2` ratio \textless{} 200}} - {\emph{shunt formula; normally \textgreater{} 300}}} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{B/L infiltrates on CXR}} - {\emph{white out}}} \tn 
% Row Count 3 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Elevated serum lactate levels}} - {\emph{indicates anaerobic metabolism, tissue hypoxia}}} \tn 
% Row Count 5 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{No cariac etiology for pulm. edema}}} \tn 
% Row Count 6 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Deterioration of ABG's despite intervention}} - {\emph{resistant to O`2`}}} \tn 
% Row Count 8 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{ARDS Management}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{GOALS}}: \{\{nl\}\} - {\emph{Correct the cause}} \{\{nl\}\} - {\emph{Prevent further damage}} \{\{nl\}\} - {\emph{Supportive care}}} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Care bundles to improve outcomes} \tn 
% Row Count 3 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{5 P's of ARDS: \{\{nl\}\} - {\bf{Perfusion}} (max O`2` transport) \{\{nl\}\} - {\bf{Position}} \{\{nl\}\} - {\bf{Protective}} lung vent. \{\{nl\}\} - {\bf{Protocol}} weaning \{\{nl\}\} - {\bf{Prevent}} complications} \tn 
% Row Count 7 (+ 4)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Mechanical ventilation} \tn 
% Row Count 8 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Fluid status: {\emph{RA/CVP, JVD, {\bf{BP}}, urinary output}}}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Mechanical Ventilation}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\emph{Improves O`2`, figures out CO`2`, buys time}}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Lowest FiO`2` possible, smallest TV possible} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{\{\{bt\}\} {\bf{Modes of MV}}:} \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{- {\bf{Volume cycled}}: {\emph{pushes air in until preset volume delivered}}} \tn 
% Row Count 5 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{- {\bf{Time cycled}}: {\emph{pushes air in until preset time reached}}} \tn 
% Row Count 7 (+ 2)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{- {\bf{Assist modes}}: {\emph{pt can assist but vent can take over work of breathing}}} \tn 
% Row Count 9 (+ 2)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{- {\bf{Pressure support}}: {\emph{weaning mode; depends on pt's breathing (used for weaning)}}} \tn 
% Row Count 11 (+ 2)
% Row 7
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{- {\bf{Pressure control}}: {\emph{preset volume (based on age, sex, height)}}} \tn 
% Row Count 13 (+ 2)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{- {\bf{Airway Pressure-Release Ventilation (APRV)}}} \tn 
% Row Count 14 (+ 1)
% Row 9
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{\{\{bt\}\} {\bf{Weaning ASAP!}} \{\{nl\}\} - Infection \{\{nl\}\} - Dependent on machine \{\{nl\}\} - Muscles dependent \{\{nl\}\} - Vent may cause trauma (barotrauma, pressure trauma)} \tn 
% Row Count 18 (+ 4)
% Row 10
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{\{\{bt\}\} {\bf{Positive End Expiratory Pressure (PEEP)}}: {\emph{back pressure prevents alveolar collapse; helps to keep fluid out of alveoli}}} \tn 
% Row Count 21 (+ 3)
% Row 11
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{- Inc. PEEP = inc. intrathoracic pressure \{\{fa-arrow-right\}\} dec. perfusion = dec. CO \{\{nl\}\} - Affected intrathoracic pressure = organ failure} \tn 
% Row Count 24 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Management of Ventilated Patients}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{3 Priorities:} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{1) Monitor \& evaluate pt response}} \{\{nl\}\} - Vent setting, trach appropriately \{\{nl\}\} - Assess s/s of distress {\emph{(lung sounds, chest expansion, ABC \& disynchrony r/t proper setting {[}change vent settings{]})}}} \tn 
% Row Count 6 (+ 5)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{2) Manage vent safely}} \{\{nl\}\} - Not alone, daily CXR for placement} \tn 
% Row Count 8 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{3) Prevent complications}} \{\{nl\}\} - Oral care {\emph{(dec. bacteria)}}, turn \& repo. {\emph{(changes lung perfusion)}}, VAP protocol {\emph{(elevate HOB \textgreater{}30\textasciicircum{}o\textasciicircum{}, aspiration precautions)}}, DVT prophylaxis, skin care} \tn 
% Row Count 12 (+ 4)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Note: \{\{nl\}\} - Breath sounds should be equal \& symm. \{\{nl\}\} - Document safety, measurement} \tn 
% Row Count 14 (+ 2)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{\{\{bt\}\} {\bf{Proning}}: {\emph{no shock, inc. ICP, unstable spine}}} \tn 
% Row Count 16 (+ 2)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{\{\{bt\}\} Pharmacotherapy: \{\{nl\}\} - {\bf{Antibiotics}} {\emph{(if known microorganism)}} \{\{nl\}\} - {\bf{Bronchodilators}} {\emph{(airway patency)}} \{\{nl\}\} - {\bf{Surfactant?}} {\emph{(not really used, expensive)}} \{\{nl\}\} - {\bf{Corticosteroids?}} {\emph{(immunosuppressed, glycemic control)}} \{\{nl\}\} - {\bf{Diuretics}} {\emph{(dec. lung/general edema, watch electrolytes)}} \{\{nl\}\} - {\bf{Neuromuscular blocking agents}} {\emph{(paralytic agents, sedatives = dec. work of breathing)}} \{\{nl\}\} - {\bf{Flolan?}} {\emph{(new; inc. flow, V/Q mismatch)}} \{\{nl\}\} - {\bf{Epinephrine}} \{\{nl\}\} - {\bf{Low dose dopamine}}} \tn 
% Row Count 27 (+ 11)
% Row 7
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\emph{Ex. Neuromuscular Blocking Agents - propophol, Nimbex, + inotropes \{\{nl\}\} + Inotropes: dilate vascular bed = inc. CO (dibutamine, watch for dec. BP - r/t dose; vasopressors)}}} \tn 
% Row Count 31 (+ 4)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Management of Ventilated Patients (cont)}}  \tn
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{\{\{bt\}\} {\bf{Nutrition}}: \{\{nl\}\} - Dec. mortality, days of not eating \{\{fa-arrow-right\}\} prophylactic enzyme release \{\{nl\}\} - Avoid inc. carb feeds} \tn 
% Row Count 3 (+ 3)
% Row 9
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{\{\{bt\}\} {\bf{Prevent complications}} - VAP, SIRS, MODS, DVT, infection, skin breakdown} \tn 
% Row Count 5 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{1.9908 cm} x{2.9862 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Nursing Diagnoses}}  \tn
% Row 0
\SetRowColor{LightBackground}
\{\{bb\}\} {\bf{ARDS}} & \{\{bb\}\} {\bf{Mechanical Vent}} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
Impaired gas exchange & Risk for infection \tn 
% Row Count 4 (+ 2)
% Row 2
\SetRowColor{LightBackground}
Dec. tissue perfusion & Risk for injury - r/t airway \tn 
% Row Count 6 (+ 2)
% Row 3
\SetRowColor{white}
Airway clearance & Risk for injury - r/t immobility \tn 
% Row Count 8 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{{\bf{NO ineffective breathing pattern}}}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}


% That's all folks
\end{multicols*}

\end{document}