Chest treatment in Critical Care Flashcards
Donning PPE order?
- hand hygiene
- gown
- mask / respirator
- eye protection
- gloves
Doffing PPE order?
- ensure you are 2 m away from pt before beginning
- gloves
- hand hygiene
- gown
- hand hygiene
- eye protection
- hand hygiene
- mask / respirator
- hand hygiene
3 components of resp ax?
- pt history
- physical examination
- lab tests and investigations
In normal lung, ventilation is best is _______ region
dependent
For pt on mechanical ventilation, ventilation is best in ________ region of lungs
non-dependent (air follows path of least resistance)
Perfusion in normal lung is a _____ pressure system and therefore responds more to _____
low; gravity
________ is our best position for V/Q match as it improves overall ventilation
upright
Mechanical ventilation can limit _______ due to high pressures in thorax
perfusion
______ zone of lung has best V/Q matching
middle
Generally place bad lung ___
up (non-dependent position)
When someone has and epidural, be aware of ___ changes
BP
Who do we prone ?
ARDS or ALI pts
Why we prone: 75% of ARDS pt’s have decrease in ____ and increase in PaO2
shunt
Why we prone: generally allows for decrease in ___ and ______ levels
FiO2; PEEP
Why we prone: generally allows for decrease in ______
PaCO2
4 precautions to proning?
- hemodynamic instability
- active intra abdominal process
- facial or ocular injuries
- recent sternotomy or abdominal incisions
3 CI’s to proning?
- unstable spina injury
- uncontrolled cerebral hypertension
- facial trauma / burns / open chest or abdomen
When proning, head and arm position change every ___ hours, and pt is prone for __-___ hours
2; 2-18
Lung volume recruitment techniques produce an ____ breath that is larger than the pt or ventilator delivered TV
inspiritory
3 indications to perform lung volume recruitment technique?
- acute lobar collapse
- sputum clearance
- maintenance lung compliance and thoracic mobility
Lung volume recruitment techniques can be performed only with non-ventilated pts (T/F)
FALSE; ventilated and non ventilated
4 lung volume recruitment technique examples ?
- breath stacking with an ambu bag +/- a one way valve
- manual hyperinflation
- mechanical insufflation / exsufflation machine
- ventilator hyperinflation
5 CI’s to lung volume recruitment techniques?
- undrained pneumothorax
- proximal tumor / obstruction
- unstable head injury
- HFOV
- recent thoracic sx (unless you have surgeons permission)
Manual hyperinflation is also known as ______
bagging
_____ ______ is usually performed on an intubated / ventilated pt to improve lung volumes and assist with secretion clearance
manual hyperinflation
Manual hyperinflation consists of slow _____ phase and a week release stimulating a ____/___
inspiration; cough/huff
With MHI, O2 flow rate of __-__ L/min is required to prevent rebreathing of CO2
14-15
When doing MHI, pt’s PEEP on the ventilator should be at __ or below, otherwise opening the circuit could cause excessive de-recruitment
10
4 pieces of equipment needed for MHI?
- ambu-bag
- O2 tubing
- PEEP value
- Pressure manometer in the circuit for safety
Pressure during MHI in circuit should be __-__cmH2O
30-40
MHI technique: using both hands, slowly and steadily squeeze bag until it is half empty, hold __-__ s then release, give __-__ breaths
2-3;4-5
MHI technique: attach bag to O2 flow meter, at __L/min
15
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)
TRUE
Breath stacking with ambu bag and 1 way valve: coordinate movement with inspiration and squeeze
LVR bad until pt signals that ____ has been reached
MIC
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
3-5; cough
How many times should breath stacking with ambu bag be repeated ?
3-5 x
Breath stacking with ambu bag and 1 way valve: it is best to ___ the tracheostomy and introduce the technique by ____
cork; mouth
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 ____
vocal cords; volume
Pressure is dependent on the ____/____ with which the volume is delivered, as well as _____ of the lungs
speed/force; compliance
In a closed circuit (ie trach with cuff up) you have to monitor ______
pressure
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 _______
escape
An __-__ is used to assist pts who are unable to effectively clear neurological impairment and/or muscle weakness
MI-E
MI-E is often used in conjunction with a manual ______ ______
assisted cough
__-__ is only appropriate when a persons peak cough slow is less than ____L/mind
270
MI-E can be used on ventilated and non-ventilated pts, with or without tracheostomies (T/F)
TRUE
4 CIs to MI-E?
- history of bullous emphysema
- unresolved barotrauma or pneumothorax
- unstable artificial airway
MI-E: remove pt from ventilator, if applicable (T/F)
TRUE
MI-E: do not remove mask during _______ phase, even if pt is coughing
exsufflation
MI-E: if using manual assisted cough, when should pressure be applied?
as machine switches from inhale to exhale mode
MI-E: if pt is coughing but it is not synchronized with the _______ phase, disconnect MI-E machining until they finish coughing
exsufflation
MI-E: perform __-__ sets of __-__ breaths with rests of at least ___ s between sets
3-5;3-5; 30
_____ = pressure remaining at end of expiration
PEEP
Physiological PEEP value?
5cm H20
___ = measures of pressure at end of inspiration; sum of pressure when the lung is full
PIP
PIP should not be above __ cmH2O and is usually around __-__ at the end of regular breath in via ventilator
40; 20-25
____ ____ ____ = highest pressure in airway (at any time)
peak airway pressure
Peak airway pressure should not be above __ cmH2O
40
_____ ____ = amount of pressure given by ventilator when it assists in a breath triggered by the pt
pressure support
