Ch. 5: Oxygen Delivery and Mechanical Ventilation Flashcards
1
Q
Safe Apnea Time
A
1) From onset of paralysis until saturation of 90%
- 2.5min obese adult
- 3.5 min 22# child
- 5 min mod ill adult
- 7.5 min normal adult.
2) Recovery from succinylcholine
- 10% at 7 min
- 50% at 8.5 min
- 90% at 10 min.
2
Q
PreOxygenation
A
1) Want 100% of the patients FRC (30cc/kg) filled with oxygen
2) Accomplished with 3-5 min tidal breathing w 100% FIO2
OR 8 maximal breaths.
3) Best sitting up
4) If lung pathology PEEP my expand FRC
3
Q
Oxygen Delivery Methods
Low Flow
A
LOW FLOW
- NC 2-4L 30% FiO2
- 6L 40
- Simple mask 6 45
- 10 55
- Venturi mask 15 50
- NRB 15 70
- BVM w leak 15 <50
- BVM w/o leak 15 90
- w one way valve.
4
Q
Oxygen Delivery Methods
High Flow
A
High Flow
- Anesthesia Machine 30 LPM 100%
- BVM no leak w valve 15 LPM 100%
- NPPV 50 LPM 100%
- HFNC 40-60 100%
- NRB mask >40 LPM 100%
- Simple mask >40 LPM 70-90%
High flow adds some PEEP which can recruit alveoli.
NPPV especially good in pneumonia, HF, ARDS preox
Use Bipap mode or use vent with PS and PEEP.
5
Q
Flow Meters
A
- Flush rate listed on the side. Usually 40 to 60
- Special flowmeters can go to 70 or 90 LPM
6
Q
Delayed Sequence Intubation
A
- A stepped pause in agitated patients.
- Get them calm enough to preoxygenation
- Often Ketamine 1.5 mg/kg
- BE Vigilant and prepared for a crash airway.
7
Q
Apneic Oxygenation
A
- Even in apnea there is passive inspiration due to Aventilatory mass flow.
- During preoxygenation also have a NC on. When paralysis sets in turn to 15LPM or more.
- Show to reduce hypoxia during intubation.
8
Q
Rescue Oxygenation
A
When intubation attempt fails and Sat drops below 93%
- FOCUS on ventilation.
- BVM with good positioning. Monitor ETCO2
- 30s or more delay between adequate ventilation and saturation increase.
- If unable to bag place an EXTRAGlottic Device-LMA
- Consider using an intubating LMA.
