CH3 TroubleShoot Flashcards
Problem: High Peak Airway (P AW ) Pressures
Your first step should be to perform what?
pressure (PPLAT ). T
perform an inspiratory pause and measure the plateau pressure (PPLAT)
What does the plateau pressure represents?
The alveolar pressure
What does the peak pressure represents?
combination of the alveolar pressure and airway resistance.
This pressure represents the Equilibration of all pressure when flow is stopped
Plateau pressure
What is the best assessment of alveolar pressure?
Plateau pressure
What represents the resistance of conducting airway
The Difference between peak airway pressure and plateau pressure
High airway resistance is characterized by what gradient?
Increase in the gradient between the Peak airway pressure and plateau pressure.
High PAW , Low PPLAT —this means the problem is
high airway resistance.
Causes of high airway resistance with low PPLAT
Mucus plugging, kinked tube, bronchospasm , tube too small (may have to changed out tube or accept high PAW)
High PAW , HIGH PPLAT this means the problem is
Problem is in the lungs
Causes of high airway resistance with High PPLAT
Mainstem intubation, atelectasis, ARDS< pulmonary edema, pneumothorax
Problem: Dynamic Hyperinflation (Auto-PEEP)
(bronchospasm, COPD, mucus plugging) makes it worse.
This is usually due to inadequate time for exhalation. High airway resistance
With Hyperinflation , what do you see on the ventilator screen?
The ventilator’s expiratory flow waveform will not return to the baseline of zero flow.
Absent breath sounds on one side—
pull the endotracheal tube back a
few centimeters
3 top diagnoses to consider when there is a sudden drop in SpO2
Mainstem intubation
tension pneumothorax
mucus plugging
Absent breath sounds on one side, even with the tube in the right place—think
pneumothorax, or mucus plugging with complete atelectasis of the lung
Tension pneumothorax should be suspected if breath sounds are ______and if the patient is _____
are absent on one side and if the patient is hypotensive.
Suspected tension pneumothorax: The treatment is
immediate needle decompression and placement of a chest tube
Falling ETCO2 with unchanged or rising PaCO2 —the widening gradient between the two suggests an _______ in what ?
increase in dead space ventilation.
Falling ETCO2 with unchanged or rising PaCO2 : 3 main causes
Pulmonary embolism
Falling cardiac output (cardiogenic or hypovolemic shock)
Dynamic hyperinflation with autoPEEP
Falling ET CO2 and falling PaCO2 —indicates
an increase in alveolar ventilation.
Falling ET CO2 and falling PaCO2 : 3 main causes
Pain, agitation, FEVER, SEPSIS.
