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RT-131A > Chapter 4 - Establishing the Need for Establishing Mechanical Ventilation > Flashcards

Chapter 4 - Establishing the Need for Establishing Mechanical Ventilation Flashcards

1
Q

What are the 3 definitions of ARF?

A
  • Inability to maintain adequate O2 uptake (PaO2 or CaO2)
  • Inability to adequately eliminate CO2
  • Inability to maintain acceptable ABG’s
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2
Q

What are the 2 types of ARF?

A

Type 1 - Hypoxemic

Type 2 - Hypercarbic w/ some Hypoxemia

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3
Q

Causes of Hypoxic Lung Failure

A
  • Serious V/Q mismatching
  • Diffusion defects
  • R to L shunt
  • Alveolar Hypoventilation
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4
Q

Hypoxic Lung Failure Treatments

A
  • Oxgen Therapy and/or CPAP

- Intubation

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5
Q

What is a “Regular” Shunt?

A

Some blood is going to areas that are under ventilated

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6
Q

What is a “True” Shunt?

A

NO ventilation where blood is going near a ventilator unit

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7
Q

What is Refractory Hypoxemia?

A

When there is no response to an increase of oxygen

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8
Q

Causes of Hypercapnic Respiratory Failure

A
  • Ventilator Pump Failure (Resp. Muscles, Thoracic Cage, Nerves)
  • Disorders (CNS, NMD, Disorders that increase WOB)
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9
Q

Hypercapnic Respiratory Failure Treatments

A
  • NIPPV

- Intubation

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10
Q

In which type does Diaphoresis occurs?

A

Type II

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11
Q

What occurs during Hypoxia?

A

-Tachycardia and Tachypnea

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12
Q

What occurs during Hypercapnia

A
  • Increased CO2
  • Increased cerebral blood flow
  • High levels of CO2 leading to CO2 narcosis
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13
Q

What does a Traumatic Brain Injury cause within the first 24 hours?

A

Reduction of blood flow to the brain by 50%

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14
Q

If patient is hyperventilating with a brain injury, what occurs?

A

Blood flow is reduced by another 50%.

75% total blood flow is cut off.

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15
Q

What is our target CO2 range for TBI patients?

A

35-45 but no less than 30 mmhg

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16
Q

What is given to reduce ICP for head injuries?

A

Osmotic diuretic (Mannitol)

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17
Q

Why do we not hyperventilate patients with TBI for more than 24 hours?

A

Reflex will go away and the ICP will go back up

18
Q

If an ICP > 20 is sustained for 5 min, what can we do?

A

We can temporarily hyperventilate a patient between 30-35

19
Q

What drugs impair neuromuscular function?

A

All Narcotics

20
Q

What is a normal MIF and what is considered bad?

A
  • Normal: -80 cmH20

- Bad: > -20 cm h20

21
Q

What is a normal VC?

A

60-80 mL/kg

22
Q

What is the VO2 percentage with normal WOB?

A

~1-4%

23
Q

What are evidences of increased WOB?

A
  • Increased RR and/or depth of respirations

- VO2 increases to 35-40%

24
Q

What is the Normal and Critical values for MIF?

A

Normal: -100 to -50 cmH20
Critical: -20 to 0 cmH20

25
Q

What is the Normal and Critical values for VC?

A

Normal: 65-75 mL/Kg
Critical: > 10ml per kg

26
Q

What is the Normal and Critical values for Vt?

A

Normal: 4-8 mL/Kg
Critical:

27
Q

What is the Normal and Critical values for RR?

A

Normal: 12-20/min
Critical: >35/min

28
Q

What is the Normal and Critical values for PEFR?

A

Normal: 350-600L/min
Critical: 75-100L/min

29
Q

What is the Normal and Critical values for VD/Vt?

A

Normal: .3-.4
Critical: .6

30
Q

What are the standard criteria for Invasive Ventilation?

A

Normal Criteria: Support of pulmonary system until return to normal state, Reduce WOB, Restore Acid-Base balance, Improve O2 delivery.

31
Q

What are the alternatives to Invasive Ventilation/

A

Supplemental O2: High Flow
Treatment of underlying cause
NIPPV
CPAP via T-piece

32
Q

What are the Absolute contraindications for NIPPV?

A 
Absolute: Cardio-Resp. Arrest, 
Acute instability of other organs, 
Upper airway obstruction, 
Inability to protect airway, 
Inability to clear secretions, 
Facial/Head trauma
33
Q

What are the Relative contraindications for NIPPV?

A 
Relative: 
Cardio-Pulmonary Instability, 
Inability to cooperate, 
copious secretions, 
Extreme obesity
34
Q

What ABG values are associated with respiratory failure?

A

pH less than 7.25

paC02 50 mmhg and rising

PaO2 less than 90% of predicted.

35
Q

How do you assess if a patient has an oxygenation problem?

A

Calculate the predicted PaO2.
Pa02 = 104.2 - (0.27 x age)

After that, if the Patient’s ABG is less than 90% of predicted. Its an oxygenation problem.

36
Q

What are causes of Hypoxemic (Type I) respiratory failure?

5 causes

A

Serious V/Q Mismatching
Diffusion Defects
Right to Left Shunt (Not a true shunt because some blood goes through the pulmonary arteries)
Alveolar Hypoventilation

37
Q

What are causes of Hypercapnic (Type II) Respiratory Failure?
2 main causes

A

Ventilatory Pump Failure
(Respiratory Muscles, Thoracic Cage, Nerves and Nerve Centers That Control Ventilation)

Disorders Leading To Ventilatory Pump Failure
(CNS Disorders, Neuromuscular Disorders, Disorders That Increase WOB)

38
Q

What are signs and symptoms of Hypercapnia?

A

Increased CO2 levels - Hypercapnia

Increased cerebral blood flow/vasodilation – headaches

High levels of CO2 leading to CO2 narcosis
Untreated could lead to acidosis – arrhythmias – death

39
Q

What is the mantra for spinal cord injuries? why?

A

C 3,4,5 keep your patient alive.
C3 injuries have loss of respiratory muscles
C4 and C5 injuries have the possibility of loss of voluntary muscles for respiration.

40
Q

What is the protocol for patients with a traumatic brain injury in the first 24 hours?

A

Never hyperventilate in the first 24 hours
If patient is becoming hypercapnic,
place patient in a Phentobarbitol coma and paralytics to decrease o2 comsumption

41
Q

what is the ABSOLUTE criteria for invasive ventilation?

A

Apnea,

Acute Vent. Failure,

Impending Vent. Failure,

Refractory Hypoxemia

42
Q

What is the formula for Mean Arterial Pressure?

What value are you looking for?

A

(2 diastolic + 1 Systolic)/3 = MAP

You want Map above 60 (low is deceased blood supply to organs)
High MAP is increased Cardiac Work Load

RT-131A (13 decks)

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