CP: PERME LEC 5+6 Flashcards
With higher flow rate devices, you need increased ______
Humidification
If flow rate is more than 3L/m -> needs humidification
Nasal canula can give up to 6L/m what can happen if it is increased more than this?
Potentially damages nose
What kind of mask can deliver the HIGHEST concentration of oxygen
Note: very serious if patient has this!
Nonrebreather mask (75-100%)
What is the advantage of a venturi mask?
Can choose the oxygen percentage delivered based on colored valve
For nonrebreather masks, the flow rate needs to be….
High enough to keep the bag 1/3 to 1/2 full!
8-15L/m
the bag should not be flat!
A __________ mask is typically the last step after intubating OR the first step after a patient got off intubation
nonrebreather mask
A patient will have a tracheostomy mask (T-collar) if they need….
Prolonged mechanical ventilation
What is paradoxiccal breathing
More accessory muscles working/ diaphragm is tired
These patients must be mechanically ventilated
stomach will be sucked in with inspiration
What are 4 mechanical ventilation indications
- Acute respiratory failure
- protection of airway and lung parenchyma
- Relief of upper airway obstructions
- Improvement of pulmonary toilet (basically improved ability to clear secretions)
Before you work with an intubated patient what should you do?
Have nurse or doctor certify that the intubation is in the right location
What are the 5 most important things to look at on a ventilator display
Mode of ventilation
FiO2
PEEP
Minute Ventilation
Respiratory Rate
EACH PARAMETER TELLS YOU ABOUT YOUR PATIENTS LAST BREATH
What is PEEP
Positive end expiratory pressure
pressure applied by ventilator at the end of each breahte
PEEP applies extra pressure to the alveoli at the end of exhalation, keeping them partially inflated and preventing atelectasis (alveolar collapse).
This helps maintain better gas exchange by keeping more alveoli open and improving oxygen delivery to the blood.
Excessive PEEP may cause….
Reduced cardiac output
Impair oxygen delivery system
_____ helps expand collapsed alveoli
PEEP
What is considered normal PEEP? Moderate PEEP? high PEEP?
3-5 is normal physiological PEEP
Moderate 5-15
High > 15
Note: High PEEP is used only for severe lung injury
Assist Control ventilator
Every breathe is the same. Rate and tidal volume is pre-set. Patient can trigger the breathes
Note: not for weaning off ventilator
adaptive pressure ventilation APV
ventilator automatically regulates inspiratory pressure and flow to maintain the target TV
AC ventilation
Synchronized Intermittent Mandatory Ventilation
Pressure support is preset and tidal volume
Patient gets spontaneous breathes by triggering ventilator, these spontaneous breathes do not have a preset tidal volume
Rate of how many times the ventilator will help per minute is pre-set just like Assist-Control
Note: this mode is for weaning
Pressure support ventilation
Additional pressure to assist with oxygen delivery
The patient controls respiratory rate and inspiratory time
Note: this mode is for weaning off ventilator
What is the only method of ventilation where the rate is not preset
Pressure Support PSV/ CPAP
patient controls the RR and inspiratory time
usually set to 10cmH2O
Non-invasive ventilation is only used when….
what types are NIV?
Short term ventilation is needed
-prevent intubation
-failed intubaiton
patient must be able to breathe spontaneously
CPAP or BI-PAP
If patient does not tolerate being removed from Non Invasive Positive Pressure Ventilation then….
They may not tolerate any kind of physical activity
What kind of ventilators can allow patients to take an extra breathe?
A/C and SIMV
PS has no preset rate so no breathes are “extra”
What type of ventilator essentially breathes for the patient
A/C
Difference between Critical Illness myopathy vs clinical illness polyneuropathy?
Sorry this is a lot!
Critical Illness Myopathy (CIM):
CIM primarily affects the muscles.
It is characterized by weakness and dysfunction of the skeletal muscles.
CIM is often associated with muscle wasting and difficulty in weaning patients from mechanical ventilation.
CIM is thought to be caused by a combination of factors including prolonged immobilization, systemic inflammation, and use of** certain medications such as corticosteroids**
CIP primarily affects the peripheral nerves.
It is characterized by weakness, sensory deficits, and loss of reflexes in a symmetric pattern affecting multiple limbs.
CIP often presents as difficulty in weaning patients from mechanical ventilation and may also involve dysfunction of other organ systems such as the gastrointestinal tract.
CIP is believed to be caused by systemic inflammation, microvascular dysfunction, and metabolic disturbances.
True or false: NO specific treatment has been shown to reduce the incidence of critical illness myopathy and critical illness polyneuropathy
TRUE
major feature of CIM is
diffuse flaccid weakness in all limbs
critical illness polyneuropathy and myopathy (together) show evidence of what?
acute and chronic denervation and primary muscle change
what is a major risk factor for ICU acquired weakness?
hyperglycemia!
contributes to nerve damage and muscle damage
how does critical illness lead to CIM/CIP?
any illness = body releases cytokines in response, causing systemic inflammation which damages nerves and muscles
On average, patients lose nearly __% of muscle per day in the first week of ICU admission
2%
how do we as PTs manage muscle weakness in the ICU?
early mobility and walking
Phase 1 of early mobility and walking program:
acutely critical, restricted to bedrest
Phase 2 of early mobility and walking program:
able to stand but not ambulate
Phase 3 of early mobility and walking program:
able to ambulate
-focus on orthostatic tolerance and endurance
Phase 4 of early mobility and walking program:
higher levels of physical activity, preparing for discharge
Out of the 4 phases of the early mobility and walking program, which phase is it most important for PT to see the patient in?
Phase 2 when they can stand but not walk
What does Perme score measure
mobility status of patients in ICU
takes into account ICU support, mental status, gait, endurance, functinal strength, bedmobility….
What is special about the perme ICU score? what does a higher score indicate?
able to capture very low levels of function
higher score means higher mobility and less ICU support needed
a minimum clinically important difference of ____ points is set for the PERME score
6.5
IMPORANT: ______ is the main contributor to presistent disability whereas ______ can be associated with a full recovery
Critical illness polyneuropathy
Critical illness myopathy
Out of critical illness myopathy and critical illness polyneuropathy, which is associated with severe septic shock, and organ failrue
critical illness polyneuropathy
When a ventilator alarm goes off what do you want to do?
-Rest patient
-Check vent connection? “disconnected on patient’s side”
Reconnect.
Can’t figure it out?
-Call RT or RN to assist ASAP
What is continous positive airway pressure usually used for?
Sleep apnea
Consequences of bed rest include ____ total blood volume, hemoglobin concentration, VO2max and ventilation, and _____ resting HR
decreased
increased
an example of immobility is a pt who is
sedated, fixed, immovable, casting
muscle strength may decline at a faster rate for someone is on bed rest or who is immobile?
immobile (think casting)
what % of oxygen concentration is considered a drug?
21%
A resevoir nasal cannula is not as common, and is designed to do what?
conserve and reduce O2 use by collecting the O2 exhaled that didn’t make it to the aveoli and provide 100% on next inhlation
Does a reservoir nasal cannula need humidification?
no since it retains the vapor (and its lower flow rates)
A high flow nasal cannula delivers flow rates of 1-15 L/m. What helps prevent mucosal damage with this flow rate?
star shape inside the cannula that changes th eflow of air so delivery is not straight on
O2 concentration of 24-75%
a simple oxygen mask (delivers 30-70%) requires a minimum flow rate of 6 L/m to prevent what?
rebreathing the exhaled CO2
A face tent is a variation of a face mask for patients such as
mouth breathers or pts with facial trauma
What is the most important thing to monitor with an aerosol mask?
this mask turns liquid meds into mist to deliver to the lungs
you should see the mist from the exhalation ports to ensure adequate flow rates
A high flow humidification system can deliver ___& of O2 at____ L/m.
100% at 60L/m
may be used to wean patient off mechanical ventilation
an endotracheal tube (oral or nasal) is used ____ term while a tracheostomy is used ____ term.
short
long
A doctor can order ventilator settings in two variations
pressure of volume
FiO2
amount of O2
PEEP
