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Critical Care Paramedic > 3-2: Mechanical Ventilation > Flashcards

3-2: Mechanical Ventilation Flashcards

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1
Q

What is the total lung capacity and typical range?

A

the volume of air the lungs can hold after max inhalation

5,500 - 6,000 mL

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2
Q

What is the tidal volume and typical range?

A

volume moved with each breath

~7 mL

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3
Q

What is exhaled tidal volume (Vte)

A

volume of air returned from a vented patient

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4
Q

What is the vital capacity (VC)? What is typical range?

A

the amount of air forced out of the lungs after a maximal respiration.

Average: 4.6-4.8

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5
Q

What is residual volume (RV) and normal range?

A

volume of air remaining in the lungs after maximal expiration

usually about 1 L in adult pts

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6
Q

Functional Residual Capacity = WHAT?

A

OXYGENATION
If you increase the FRC, you increase oxygenation
FRC is the volume of air remaining in the lungs at the end of a standard expiration

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7
Q

Minute ventilation = WHAT? define

A

CO2- capnography
the amount of air expired per minute

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8
Q

What is the difference between anatomical and physiological dead space.

A

anatomical dead space is just the air that remains in the conductive region. physiological dead space is all of anatomical + alveolar dead space. It is air that doesn’t participate in gas exchange

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9
Q

What are the indications for mechanical ventilation?

A
  • acute respiratory failure
  • hypovolemia despite maximum oxygen delivery
  • apnea
  • to increase lung volume (FRC)
  • diffusion disturbances across alveolar/capillary membrane
  • control PaCO2 in pts with head injuries
  • to decrease the myocardial oxygen demand in the presence of acute coronary syndrome or PE
  • when procedures require heavy sedation
  • to facilitate alveolar recruitment and prevent atelectasis
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10
Q

What are the clinical indicators for mechanical ventilation?

A
  • PaCO2 > 50 or pH <7.3
  • PaO2 <60 with inspired O2 concentration >60%
  • RR > 30-35
  • decreased LOC with inability to protect airway
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11
Q

What are the goals of mechanical ventilation?

A
  • maintain adequate PaO2 and PaCO2
  • return ABG to normal for pt
  • improve ventilation to meet demands
  • decrease work of breathing
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12
Q

What measurement is important to keep an eye on when using a volume support ventilator?

A

Plateau pressure

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13
Q

Is CPAP a true mode of ventilation and why?

A

CPAP is not a true mode of ventilation because it does not provide additional pressure during inspiration

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14
Q

Is BIPAP a true mode of ventilation and why?

A

BIPAP is a true mode of ventilation because it provides inspiratory support

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15
Q

Why is CPAP used for treatment of acute COPD and CHF exacerbations?

A

These patients can’t get air OUT, and CPAP helps by keeping the diameter of the bronchi wider, allowing air flow out

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16
Q

What is iPAP?

A

inspiration PAP - similar to pressure support ventilation

it is ventilation, ETCO2

it is the SIZE of the breath

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17
Q

What is ePAP?

A

expiration PAP - provides pressure to maintain open airways during exhalation, enhancing oxygenation

it is oxygenation, SPO2

it is FRC- oxygenation

18
Q

What is the range for PS-ventilation for iPAP in BIPAP?

A

5-20 cmH2O
adjust by 5

19
Q

What is the range for PEEP for ePAP in BIPAP?

A

2-20 cmH2O
adjust by 2.5-5

20
Q

In what conditions might you see “stiff lungs” or high plateau pressures?

A
  • ARDS
  • Pneumonia
  • Pulmonary fibrosis
21
Q

What is the difference between AC and SIMV

A

in AC, the patient receives the full volume or pressure that is set when they take a breath.

In SIMV, the patient takes what they can take and the volume of that breath is dependent on pt effort

22
Q

What types of patients is IRV (inverse ratio ventilation) really good for and REALLY bad for?

A

really good: pneumonia and ARDS

really bad: asthma/COPD

23
Q

What does an FiO2 of 0.4 mean?

A

40% inspired oxygen

24
Q

What is the typical tidal volume for adults?

A

5-8 mL/kg

25
Q

What is the typical I:E ratio?

A

1:1.5-2

26
Q

Inverse I:E can’t be done in patients with a pH of < ____

A

7.2

27
Q

What is the PIP?

A

Peak inspiratory pressure

sets the highest pressure that will be delivered in the vent circuit

28
Q

What is the plateau pressure (P Plat)?

A

the overall pressure it took to overcome the elastic forces resisting inflation of the lungs during the static phase of inhalation

29
Q

What is the goal P Plat

A

< 30

30
Q

What is sigh?

A

an uncommon method used to help prevent atelectasis

volume of air that is 1.5-2x the inspired tidal volume

frequency about 6-10 times per hour

31
Q

What is Paw

A

the current airway pressure

31
Q

What is the equation for oxygen tank life?

A 
               lpm
32
Q

What is the most common dysrhythmia as a complication of mechanical ventilation?

A

PVCs

33
Q

What are the causes of atelectasis in vented patients?

A
  • inadequate tidal volumes
  • infrequent repositioning
  • secretion retention
  • high concentrations of oxygen (absorptive atelectasis)
34
Q

What are the classic signs and symptoms of oxygen toxicity in a vented patient?

A
  • V/Q mismatch
  • diffuse pulmonary infiltrates on x-ray
  • o2 saturations falling despite increases in FiO2
35
Q

What are the early signs of oxygen toxicity in a vented patient?

A

substernal discomfort, malaise, fatigue, nausea

36
Q

What are the late signs of oxygen toxicity in a vented patient?

A

decrease in lung compliance, decreased vital capacity, and increased PIPs

37
Q

How can we prevent O2 toxicity in a vented pt?

A

decrease FiO2 as early as possible without causing hypoxemia

the goal is to wean the pt from 1.0 FiO2 to 0.5 FiO2 within the first 24 hours

38
Q

What is the diagnostic triad for ventilator acquired pneumonia?

A
  1. pulmonary infection signs (purulent secretions, fever, and leukocytosis)
  2. bacteriologic evidence of pulmonary infection
  3. radiologic suggestions of pulmonary infection
39
Q
A

Critical Care Paramedic (20 decks)

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