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PHTH 564 - ICU > Chest treatment in Critical Care > Flashcards

Chest treatment in Critical Care Flashcards

1
Q

Donning PPE order?

A
  1. hand hygiene
  2. gown
  3. mask / respirator
  4. eye protection
  5. gloves
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2
Q

Doffing PPE order?

A
  1. ensure you are 2 m away from pt before beginning
  2. gloves
  3. hand hygiene
  4. gown
  5. hand hygiene
  6. eye protection
  7. hand hygiene
  8. mask / respirator
  9. hand hygiene
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3
Q

3 components of resp ax?

A
  1. pt history
  2. physical examination
  3. lab tests and investigations
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4
Q

In normal lung, ventilation is best is _______ region

A

dependent

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5
Q

For pt on mechanical ventilation, ventilation is best in ________ region of lungs

A

non-dependent (air follows path of least resistance)

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6
Q

Perfusion in normal lung is a _____ pressure system and therefore responds more to _____

A

low; gravity

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7
Q

________ is our best position for V/Q match as it improves overall ventilation

A

upright

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8
Q

Mechanical ventilation can limit _______ due to high pressures in thorax

A

perfusion

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9
Q

______ zone of lung has best V/Q matching

A

middle

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10
Q

Generally place bad lung ___

A

up (non-dependent position)

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11
Q

When someone has and epidural, be aware of ___ changes

A

BP

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12
Q

Who do we prone ?

A

ARDS or ALI pts

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13
Q

Why we prone: 75% of ARDS pt’s have decrease in ____ and increase in PaO2

A

shunt

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14
Q

Why we prone: generally allows for decrease in ___ and ______ levels

A

FiO2; PEEP

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15
Q

Why we prone: generally allows for decrease in ______

A

PaCO2

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16
Q

4 precautions to proning?

A
  1. hemodynamic instability
  2. active intra abdominal process
  3. facial or ocular injuries
  4. recent sternotomy or abdominal incisions
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17
Q

3 CI’s to proning?

A
  1. unstable spina injury
  2. uncontrolled cerebral hypertension
  3. facial trauma / burns / open chest or abdomen
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18
Q

When proning, head and arm position change every ___ hours, and pt is prone for __-___ hours

A

2; 2-18

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19
Q

Lung volume recruitment techniques produce an ____ breath that is larger than the pt or ventilator delivered TV

A

inspiritory

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20
Q

3 indications to perform lung volume recruitment technique?

A
  1. acute lobar collapse
  2. sputum clearance
  3. maintenance lung compliance and thoracic mobility
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21
Q

Lung volume recruitment techniques can be performed only with non-ventilated pts (T/F)

A

FALSE; ventilated and non ventilated

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22
Q

4 lung volume recruitment technique examples ?

A
  1. breath stacking with an ambu bag +/- a one way valve
  2. manual hyperinflation
  3. mechanical insufflation / exsufflation machine
  4. ventilator hyperinflation
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23
Q

5 CI’s to lung volume recruitment techniques?

A
  1. undrained pneumothorax
  2. proximal tumor / obstruction
  3. unstable head injury
  4. HFOV
  5. recent thoracic sx (unless you have surgeons permission)
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24
Q

Manual hyperinflation is also known as ______

A

bagging

25
Q

_____ ______ is usually performed on an intubated / ventilated pt to improve lung volumes and assist with secretion clearance

A

manual hyperinflation

26
Q

Manual hyperinflation consists of slow _____ phase and a week release stimulating a ____/___

A

inspiration; cough/huff

27
Q

With MHI, O2 flow rate of __-__ L/min is required to prevent rebreathing of CO2

A

14-15

28
Q

When doing MHI, pt’s PEEP on the ventilator should be at __ or below, otherwise opening the circuit could cause excessive de-recruitment

A

10

29
Q

4 pieces of equipment needed for MHI?

A
  1. ambu-bag
  2. O2 tubing
  3. PEEP value
  4. Pressure manometer in the circuit for safety
30
Q

Pressure during MHI in circuit should be __-__cmH2O

A

30-40

31
Q

MHI technique: using both hands, slowly and steadily squeeze bag until it is half empty, hold __-__ s then release, give __-__ breaths

A

2-3;4-5

32
Q

MHI technique: attach bag to O2 flow meter, at __L/min

A

15

33
Q

Breath stacking with ambu bag is used when pt does not have the ability to take full, deep breath and follows same principals as breath stacking (T/F)

A

TRUE

34
Q

Breath stacking with ambu bag and 1 way valve: coordinate movement with inspiration and squeeze
LVR bad until pt signals that ____ has been reached

A

MIC

35
Q

Breath stacking with ambu bag and 1 way valve: one pt’s lungs are full, have pt hold MIC for __-__ s then gently exhale OR produce strong ____ when at MIC

A

3-5; cough

36
Q

How many times should breath stacking with ambu bag be repeated ?

A

3-5 x

37
Q

Breath stacking with ambu bag and 1 way valve: it is best to ___ the tracheostomy and introduce the technique by ____

A

cork; mouth

38
Q

The LVR bag may be introduced directly through the cuff less or cuff deflated tracheostomy tube if the ___ _____ are functional and pt is able to hold the augmented lung ____

A

vocal cords; volume

39
Q

Pressure is dependent on the ____/____ with which the volume is delivered, as well as _____ of the lungs

A

speed/force; compliance

40
Q

In a closed circuit (ie trach with cuff up) you have to monitor ______

A

pressure

41
Q

If you are performing breath stacking with a one way valve (and not monitoring pressure) there must be an alternate way for the air to _______

A

escape

42
Q

An __-__ is used to assist pts who are unable to effectively clear neurological impairment and/or muscle weakness

A

MI-E

43
Q

MI-E is often used in conjunction with a manual ______ ______

A

assisted cough

44
Q

__-__ is only appropriate when a persons peak cough slow is less than ____L/mind

A

270

45
Q

MI-E can be used on ventilated and non-ventilated pts, with or without tracheostomies (T/F)

A

TRUE

46
Q

4 CIs to MI-E?

A
  1. history of bullous emphysema
  2. unresolved barotrauma or pneumothorax
  3. unstable artificial airway
47
Q

MI-E: remove pt from ventilator, if applicable (T/F)

A

TRUE

48
Q

MI-E: do not remove mask during _______ phase, even if pt is coughing

A

exsufflation

49
Q

MI-E: if using manual assisted cough, when should pressure be applied?

A

as machine switches from inhale to exhale mode

50
Q

MI-E: if pt is coughing but it is not synchronized with the _______ phase, disconnect MI-E machining until they finish coughing

A

exsufflation

51
Q

MI-E: perform __-__ sets of __-__ breaths with rests of at least ___ s between sets

A

3-5;3-5; 30

52
Q

_____ = pressure remaining at end of expiration

A

PEEP

53
Q

Physiological PEEP value?

A

5cm H20

54
Q

___ = measures of pressure at end of inspiration; sum of pressure when the lung is full

A

PIP

55
Q

PIP should not be above __ cmH2O and is usually around __-__ at the end of regular breath in via ventilator

A

40; 20-25

56
Q

____ ____ ____ = highest pressure in airway (at any time)

A

peak airway pressure

57
Q

Peak airway pressure should not be above __ cmH2O

A

40

58
Q

_____ ____ = amount of pressure given by ventilator when it assists in a breath triggered by the pt

A

pressure support

PHTH 564 - ICU (15 decks)

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