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
Adult lab and simulation examples. Individualize using the assigned case, observed values, and device instructions. These references do not automatically set chart values.
| Parameter | Teaching example |
|---|---|
| Low airway pressure / disconnect | 5–10 cmH₂O below observed PIP; verify disconnect detection. |
| High airway pressure | 10–15 cmH₂O above observed PIP after connection; the cited table lists a maximum of 50 cmH₂O. This is not a target or universally safe pressure. |
| Low PEEP / CPAP | 3–5 cmH₂O below set PEEP. |
| Low exhaled VT | The source lists “100 mL or 50% below set VT”; use the assigned protocol to select and clarify the threshold. |
| Low exhaled minute ventilation | The source lists 2–5 L/min or a threshold 50% below minimum SIMV or assist/control backup minute ventilation; confirm the intended option for the case. |
| High minute ventilation | 1.5 times baseline minute ventilation. |
| FiO₂ | 5 percentage points below and above the set oxygen percentage; e.g., 40% → 35–45%. |
| Humidifier temperature alarm | Textbook example: 2°C on either side of set temperature, with a 37°C upper limit. Check probe location and manufacturer instructions; not a universal device alarm prescription. |
| Apnea delay | 20 seconds in the cited initial-setting example; individualize. |
| Apnea backup ventilation | Textbook example: VT 8–10 mL/kg, rate 10–12 breaths/min, FiO₂ 1.0. Follow case-specific orders and lung-protective goals; do not apply this as a default for all patients. |
Reference: Egan’s Fundamentals of Respiratory Care, 12th ed., Chapter 49, Table 49.6. Independently worded teaching summary based on the instructor-provided excerpt.
Additional instructor teaching examples
| Parameter | Teaching example |
|---|---|
| High respiratory rate | Approximately 10–15 breaths/min above baseline. |
| High exhaled VT | Approximately 10–15% above observed exhaled VT. |
| High PEEP | Approximately 2 cmH₂O above set PEEP. |
| Pressure support interaction | Verify how the device’s high-pressure alarm interacts with breath termination. |
Additional examples supplied by Pawlos Okubagzi; not attributed to Egan’s Table 49.6, AARC, or NBRC. Verify against the simulation protocol and ventilator instructions.
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 + 2.3 × (height inches − 60); female 45.5 + 2.3 × (height inches − 60).
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.
VC-CMV / volume assist-control
| Parameter | Teaching example |
|---|---|
| Tidal volume | 6–8 mL/kg PBW; individualize for lung protection, including lower VT when indicated. |
| Backup respiratory rate | 12–14 breaths/min as an initial teaching example; adjust to ventilation needs and the assigned case. |
| Trigger sensitivity | Pressure: −0.5 to −1.5 cmH₂O from baseline OR flow: 1–2 L/min. Adjust to detect effort without autotriggering. |
| Inspiratory flow | 60–80 L/min; higher flow may be needed to meet inspiratory demand. |
| Flow waveform | Decreasing ramp; confirm device controls. |
| Inspiratory time / I:E | Approximately 0.6–1.0 seconds; allow expiration at least twice as long as inspiration when appropriate. |
| PEEP | 5 cmH₂O initial example; individualize. |
| FiO₂ | Follow the assigned order and prescribed oxygenation target. |
| Humidification | Textbook starting example: heated humidification at 35°C at the airway connection, or an appropriate HME. Follow device instructions. |
Reassess: Exhaled VT, minute ventilation, respiratory rate, pressures, oxygenation, effort, comfort, and waveforms; check gas exchange as indicated.
Reference: Egan’s Fundamentals of Respiratory Care, 12th ed., Chapter 49, Table 49.4. Summary based on the instructor-provided excerpt; PBW terminology used for tidal-volume teaching.
PC-CMV / pressure assist-control
| Parameter | Teaching example |
|---|---|
| Pressure control | Adjust pressure above PEEP to achieve the case-specific exhaled VT, initially 6–8 mL/kg PBW. Confirm whether the device displays pressure above PEEP or absolute pressure. |
| Backup respiratory rate | 12–14 breaths/min as an initial teaching example; adjust to ventilation needs and the assigned case. |
| Trigger sensitivity | Pressure: −0.5 to −1.5 cmH₂O from baseline OR flow: 1–2 L/min. Adjust to detect effort without autotriggering. |
| Inspiratory time | 0.6–1.0 seconds; adjust for synchrony and adequate expiration. |
| PEEP | 5 cmH₂O initial example; individualize. |
| FiO₂ | Follow the assigned order and prescribed oxygenation target. |
| Humidification | Textbook starting example: heated humidification at 35°C at the airway connection, or an appropriate HME. Follow device instructions. |
Reassess: Exhaled VT, minute ventilation, respiratory rate, pressures, oxygenation, effort, comfort, and waveforms; check gas exchange as indicated.
Reference: Egan’s Fundamentals of Respiratory Care, 12th ed., Chapter 49, Table 49.4. Summary based on the instructor-provided excerpt; PBW terminology used for tidal-volume teaching.
Pressure support ventilation
| Parameter | Teaching example |
|---|---|
| Patient readiness | Spontaneous triggering and an intact respiratory drive are required. |
| Pressure support | Titrate to the desired exhaled VT, respiratory effort, rate, and gas exchange; no fixed starting pressure is specified in the supplied excerpt. |
| Exhaled tidal volume | 4–8 mL/kg PBW, individualized to the assigned case. |
| Respiratory rate | Patient determined; assess whether ventilation is adequate. |
| Trigger sensitivity | Select flow or pressure triggering; adjust to recognize effort without autotriggering. No numeric trigger range is specified in the supplied PSV excerpt. |
| Ramp / rise time | Adjust how quickly pressure reaches the set support level to meet inspiratory demand and reduce asynchrony; device-specific. |
| Expiratory cycling | Adjust the flow-termination criterion to avoid delayed or premature cycling; device-specific. No fixed percentage is prescribed here. |
| PEEP / FiO₂ | Follow the assigned case and oxygenation target. |
| Apnea backup | Set and verify backup ventilation and alarms. |
Reassess: Exhaled VT, minute ventilation, respiratory rate, pressures, oxygenation, effort, comfort, and waveforms; check gas exchange as indicated.
Reference: Egan’s Fundamentals of Respiratory Care, 12th ed., Chapter 49, Pressure Support Ventilation discussion, based on the instructor-provided excerpt. Trigger, PEEP/FiO₂ and backup verification are case/device guidance; no unsupported numeric defaults are attributed to this excerpt.
APRV — airway pressure release ventilation
| Parameter | Teaching example |
|---|---|
| FiO₂ | 1.0 initially in this approach; reduce promptly as oxygenation permits. |
| P high | Use current plateau pressure; usually ≤30 cmH₂O. Higher pressures may be necessary in selected patients, including severe obesity. |
| P low | 0 cmH₂O. The brief release does not imply measured PEEP is zero. |
| T high | 5 seconds as a starting example; the source describes a 3–8-second range. Individualize. |
| T low | Initially 0.5 seconds (source range 0.3–0.8 seconds), then adjust using expiratory flow. |
| Expiratory-flow target | Terminate expiration near 75% of peak expiratory-flow magnitude. Example: peak 60 L/min → termination near 45 L/min. Adjust T low in 0.1-second steps while reassessing. |
| Monitoring | Release and spontaneous VT/Ve, total ventilation, gas exchange, pressures, effort, and hemodynamics. |
Reassess: Exhaled VT, minute ventilation, respiratory rate, pressures, oxygenation, effort, comfort, and waveforms; check gas exchange as indicated.
One published APRV approach; protocols differ. Release rate = 60 ÷ (T high + T low). Sedation, neuromuscular blockade, and permissive hypercapnia require case-specific provider direction.
Reference: Swindin J, Sampson C, Howatson A. Airway pressure release ventilation. BJA Education. 2020;20(3):80–88, Box 1. View article.
AARC Patient-Ventilator Assessment guideline (2024): assessment and lung-protective ventilation. This guideline is not the source of every initial setting above.
Weaning readiness
Spontaneous breathing trial (SBT)
Document daily readiness, trial settings, tolerance, outcome, and reassessment. Follow the assigned simulation protocol.
SBT assessment and documentation guide
Adult lab and simulation teaching summary informed by AARC’s 2024 SBT guideline. The charting fields are RTVentLab documentation prompts, not an official AARC checklist.
| Before | During | After |
|---|---|---|
| Assess improvement in the cause of respiratory failure, oxygenation and pH, hemodynamic stability, and ability to initiate breaths. | Record method, support settings, FiO₂, duration, respiratory pattern, vital signs, effort, and tolerance. | Document the result, reasons for stopping, support resumed, reassessment, and communication. |
AARC recommendations (conditional): RSBI is not required to screen readiness; trials may use pressure support or no pressure support; use a standardized daily approach and complete the trial before noon when appropriate; do not increase FiO₂ during the trial.
Trials commonly last 30–120 minutes. Passing an SBT does not alone establish readiness for extubation: assess cough, secretion management, and airway protection separately. Use the assigned protocol for numerical readiness and stopping criteria.
Reference: Roberts KJ et al. AARC Clinical Practice Guideline: Spontaneous Breathing Trials for Liberation From Adult Mechanical Ventilation. Respiratory Care. 2024;69(7):891–901. doi:10.4187/respcare.11735. View AARC guideline
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.
Image ruler — carina to ETT tip
Tap the carina, then the ETT tip. Without calibration, the ruler reports image pixels. To calculate centimeters, mark a known-length scale on this same image and enter its length. A web image without a known scale cannot provide a reliable cm distance.
Calibrated values are image-plane measurements for simulation. Check the scale and landmarks. The ruler does not determine whether the tip is above or below the carina.
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
Document the simulated patient’s assessment, interventions, response, and plan here. Use SOAP for your progress note, or SBAR when assigned by your instructor. Complete your learning reflection in the separate Sim/Lab reflection tab. To revise a saved note, open its entry from the charting timeline.
SOAP progress note guide
S — Subjective: Patient-reported symptoms and concerns. If the patient cannot report, document that limitation.
O — Objective: Relevant respiratory assessment, vital signs, oxygen or ventilator settings, test results, treatments performed, and observed response.
A — Assessment: Your interpretation of the findings, respiratory problems, and response to therapy.
P — Plan: Monitoring, reassessment, next steps, and recommendations communicated to the provider. Distinguish recommended care from orders received and care performed.
SBAR guide (when assigned)
Situation: Current respiratory concern and reason for communication.
Background: Relevant history and current respiratory support.
Assessment: Key findings, actions taken, and patient response.
Recommendation: Requested orders, next steps, and follow-up.
Chart only findings assessed and care performed in the simulation. Review and personalize any note built from chart values.
Learning reflection
Simulation reflection
Complete this section after your simulation. It is due one week after your session; try to write while the experience is still fresh. Write at least one paragraph for each question. You may add a free-form reflection at the end. Submit the printed reflection in Canvas. Document patient care in the RT progress note tab; you do not need to repeat a SOAP or SBAR note here. This reflection is saved separately from patient chart entries.
Clinical note saved with an earlier reflection (optional)
This previous response is preserved for reference. Write new patient documentation in the RT progress note tab.
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 |
|---|