Chest treatment in Critical Care

Question 1

Donning PPE order?

Answer 1

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

Question 2

Doffing PPE order?

Answer 2

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

Question 3

3 components of resp ax?

Answer 3

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

Question 4

In normal lung, ventilation is best is _______ region

Answer 4

dependent

Question 5

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

Answer 5

non-dependent (air follows path of least resistance)

Question 6

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

Answer 6

low; gravity

Question 7

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

Answer 7

upright

Question 8

Mechanical ventilation can limit _______ due to high pressures in thorax

Answer 8

perfusion

Question 9

______ zone of lung has best V/Q matching

Answer 9

middle

Question 10

Generally place bad lung ___

Answer 10

up (non-dependent position)

Question 11

When someone has and epidural, be aware of ___ changes

Answer 11

BP

Question 12

Who do we prone ?

Answer 12

ARDS or ALI pts

Question 13

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

Answer 13

shunt

Question 14

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

Answer 14

FiO2; PEEP

Question 15

Why we prone: generally allows for decrease in ______

Answer 15

PaCO2

Question 16

4 precautions to proning?

Answer 16

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

Question 17

3 CI’s to proning?

Answer 17

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

Question 18

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

Answer 18

2; 2-18

Question 19

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

Answer 19

inspiritory

Question 20

3 indications to perform lung volume recruitment technique?

Answer 20

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

Question 21

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

Answer 21

FALSE; ventilated and non ventilated

Question 22

4 lung volume recruitment technique examples ?

Answer 22

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

Question 23

5 CI’s to lung volume recruitment techniques?

Answer 23

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

Question 24

Manual hyperinflation is also known as ______

Answer 24

bagging

Question 25

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

Answer 25

manual hyperinflation

Question 26

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

Answer 26

inspiration; cough/huff

Question 27

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

Answer 27

14-15

Question 28

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

Answer 28

10

Question 29

4 pieces of equipment needed for MHI?

Answer 29

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

Question 30

Pressure during MHI in circuit should be __-__cmH2O

Answer 30

30-40

Question 31

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

Answer 31

2-3;4-5

Question 32

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

Answer 32

15

Question 33

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)

Answer 33

TRUE

Question 34

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

Answer 34

MIC

Question 35

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

Answer 35

3-5; cough

Question 36

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

Answer 36

3-5 x

Question 37

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

Answer 37

cork; mouth

Question 38

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 ____

Answer 38

vocal cords; volume

Question 39

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

Answer 39

speed/force; compliance

Question 40

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

Answer 40

pressure

Question 41

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 _______

Answer 41

escape

Question 42

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

Answer 42

MI-E

Question 43

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

Answer 43

assisted cough

Question 44

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

Answer 44

270

Question 45

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

Answer 45

TRUE

Question 46

4 CIs to MI-E?

Answer 46

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

Question 47

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

Answer 47

TRUE

Question 48

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

Answer 48

exsufflation

Question 49

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

Answer 49

as machine switches from inhale to exhale mode

Question 50

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

Answer 50

exsufflation

Question 51

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

Answer 51

3-5;3-5; 30

Question 52

_____ = pressure remaining at end of expiration

Answer 52

PEEP

Question 53

Physiological PEEP value?

Answer 53

5cm H20

Question 54

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

Answer 54

PIP

Question 55

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

Answer 55

40; 20-25

Question 56

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

Answer 56

peak airway pressure

Question 57

Peak airway pressure should not be above __ cmH2O

Answer 57

40

Question 58

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

Answer 58

pressure support