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Unit 5 > Critical Care > Flashcards

Critical Care Flashcards

1
Q

What is hemodynamic monitoring?

A

Measurement of pressure, flow and oxygenation in CV system

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2
Q

What is cardiac output?
Formula?
What is cardiac index?

A

Volume of blood pumped in 1 minute

Stroke volume x HR = CO

Cardiac index=CO adjusted for body surface area (BSA). It is more accurate.

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3
Q

What is stroke volume index?

A

Stroke volume adjusted for body surface area (BSA)

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4
Q

What is a normal cardiac index? (CI)

A

2.8—-4.2 LPM/per meter squared

Hearts efficiency as a pump per BSA

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5
Q

What 3 factors determine Stroke volume?

A

Preload
Afterload
Contractility

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6
Q

What is systemic vascular resistance? (SVR)
Pulmonary vascular resistance? (PVR)

A

Resistance LV encounters, systemic vascular bed resistance, increased leads to LV hypertrophy

Resistance RV encounters, Pulmonary vascular bed resistance, increased lead to RV hypertrophy

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7
Q

What is preload?

A

Volume in ventricle at end of diastole
—Think of this as stretch–

It is also called LV end-diastolic-pressure.
In a normal healthy heart, preload=PAWP (pulmonary artery wedge pressure).

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8
Q

What factors increase and decrease preload?

A

Remember this is STRETCH
Increase=Fluids, HF, regurgitation
Decrease=Diuresis and vasodilation

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9
Q

What is after load?
Why factors increase and decrease after load?

A

The force opposing ejection
This of this as SQUEEZE

Increase: HTN, vasoconstriction, valve stenosis, high viscosity of blood (thick)
Decrease: Hypotension, vasodilation, low viscosity of blood (thin)

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10
Q

What is contractility?

What do inotropic meds do to contractility?

A

Strength of contraction

Positive inotropes strengthen (epi, dobutamine, dopamine, dig)
Negative inotropes calm (beta blockers, calcium channel blockers)

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11
Q

What is normal range of PAWP?

A

6—12 mm Hg

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12
Q

What is normal range of MAP?

A

70—105 mm Hg

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13
Q

What is normal range of PVR?

A

<250

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14
Q

What is normal range of SVR?

A

800—-1200
Systemic Vascular Resistance

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15
Q

What is normal range of CO?

A

4—8 LPM

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16
Q

What is normal range of stroke volume?

A

60—150 ml/beat

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17
Q

What is normal range of stroke volume index? (SVI)

A

30—65 mL/beat/meters squared

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18
Q

Normal arterial hemoglobin O2 Sat?

A

95—100%

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19
Q

Normal mixed venous hemoglobin O2 Sat?

A

60—80%

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20
Q

Normal venous hemoglobin O2 Sat?

A

70%

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21
Q

What is a normal range for central venous pressure (also called right atrial pressure)?

A

2—8 mm Hg

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22
Q

What is also called left atrial pressure?

A

PAWP
Also same as preload in healthy heart.
Pulmonary artery wedge pressure
PAWP same as PCWP (pulm capillary)

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23
Q

What is the phlebostatic axis?

A

The level of atria. This is location you will level the stopcock on the arterial monitoring system in ICU.

To find it:
1. Lay patient supine and flat
2. Draw 2 imaginary horizontal line on top and bottom on patient’s body. Find the midline between the two.
3. Draw 1 line vertically through the 4th intercostal space.
4. The intersection is the phlebostatic axis.

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24
Q

What is referencing the arterial pressure monitor?

A

Zero-ing it out
Will open the stop-cock to room air and zero the pressure

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25
Important assessments of arterial monitoring systems?
Watch for: Bleeding Infection Neurovascular damage distal to insertion Prevent thrombus by continuous slow flush to line
26
What is a pulmonary artery flow directed catheter?
A Swan-Ganz catheter is placed in pulmonary artery to create a "wedge" to allow direct measurements of PAWP (and other things). Also can draw blood, give meds and read core temp. Book says they are not used often? High risk for infections and dysrhythmias.
27
What is an intraaortic balloon pump? (IABP)
Insertion of sausage shaped balloon that inflates and deflates during diastole and systole to increase blood flow to heart and increase CO Also called counter pulsation because the balloon inflation/ventricular contraction are opposite times.
28
How is a patient on IABP weaned?
Starts with 1:1 ratio=every contraction has inflation Then goes to 1:2, then 1:3. Monitored closely while weaning This is a short term device
29
Disadvantages of IABP
Stuck in bed Vascular injuries like dissection or decreased distal circulation Thrombus formation Infection Destroys platelets>>thrombocytopenia
30
What are ventricular assist devices? (VADs)
Can be short or long term Mechanical pump that assists heart Can be internal or external placement Can be for RV/LV or both (BVAD) Allows for more mobility
31
How to teach pursed lip breathing?
Inhale slowly and deeply through nose Exhale slowly through pursed lips (like blowing on candle) No puffed cheeks Do 8--10 times several times daily
32
How to teach huff coughing? Who needs this?
Inhale through mouth deeply and slowly. Hold breath 2-3 seconds Forcefully exhale like they are fogging up mirror. Repeat a couple of times (without coughing) to build up mucous. Cough mucus up. COPD or pts with lots of secretions.
33
What is postural drainage?
Positioning patient in various ways to promote drainage from certain lobes of lungs up to bronchi (so secretions can be cleared) The position will depend on the lobe involved. Usually given bronchodilators and hydration before done. Many times also done with other chest physiotherapy to help loosen secretions.
34
What is advantage of Venturi mask?
Precision of delivery This is especially important in COPD
35
LPM for simple face mask. O2 Concentrations? LP for NRB and partial NRB. O2 Concentrations?
6-12 LPM 35---50% 10---15 LPM 60---90%
36
Most important rule to prevent oxygen toxicity?
Only give enough to maintain an acceptable SpO2 and PaO2
37
S/sx of oxygen toxicity?
Blurred vision Coughing, pulmonary edema Chest pain Dyspnea Seizures
38
What is goal values of SpO2 and PaO2?
SpO2 is >92 PaO2 is >60
39
Differences between oropharyngeal airway and nasopharyngeal?
Oro=must be unconconscious Naso=LOC doesn't matter Oro=Measure from corner of mouth to earlobe Naso=Measure from nares to earlobe
40
What type of dressing over chest tube opening?
Petroleum Then gauze Sterile procedure
41
How much drainage from chest tube is dangerous?
1--1.5 L can cause dangerous hypotension
42
What is subcutaneous emphysema?
Air escaping into tissues and causes crackling when pressed. This can happen around chest tube site. Not dangerous unless large amounts or interfering with breathing
43
What is tidaling in chest tube?
Normal Water fluctuations with movement of breathing
44
If chest tube becomes disconnected, what is the priority action?
Stick exposed end in sterile water. This keeps the water seal and prevents air from entering.
45
Difference between CPAP and Bi-PAP?
CPAP=Pressure stays same through inhalation/exhalation Used mostly for sleep apnea Bi-PAP=Pressure higher on exhalation, this keeps alveoli inflated Pt must be able to remove the mask at any point independently. HOB= 30--45 degrees
46
What is negative pressure ventilation?
Iron lung Never used in hospital setting
47
What is positive pressure ventilation? Two main types?
Type of ventilation used in acute care Pushes air in with inhalation under positive pressure Two types: Volume: Predetermined tidal volume set with each breath is delivered Pressure: Peak inspiratory pressure (PIP) is set to deliver amount
48
What is PIP?
Setting on ventilator Peak inspiratory pressure This is max pressure vent can generate to deliver.
49
What is I/E ratio on vent setting?
Inspiration to expiration ratio
50
What is PEEP on vent setting?
Positive end expiratory pressure This is pressure applied at end of expiration. Usually it is 5-10
51
Position for ET placement?
Supine with sniffing position
52
What is RSI (rapid sequence induction)?
Kit that is used with ET tube to sedate patient Usually have sedative like propofol, opioid like fentanyl, and paralytic like rocuronium Etomidate—sedative, hypnotic, anesthetic Ketamine-anesthetic, NMDA Propafol-Sedative
53
How long is pt oxygenated at 100% with BVM before intubation attempt?
2 min Then allowed 30 seconds to place tube
54
What is a EtCO2 detector?
Placed on ET tube Confirms placement Detects exhaled CO2
55
What are three main modes on vent?
Full Partial Spontaneous
56
What is assist control (AC) mode on vent?
Most common setting for full support in early intubation. Preset rate, tidal volume, PEEP. Pt CAN take a breath on own but tidal volume will be forced in. Rate can't fall below set amount.
57
What is pressure control (PC) mode on vent?
Preset rate, PIP (not tidal volume) and PEEP Tidal volume will vary, no set amount Good for stiff lungs
58
What is SIMV mode on vent?
Synchronized intermittent mandatory ventilation Type of partial mode Preset rate, tidal volume but in sync with spontaneous breathing Pt can breathe spontaneously between set rate too.
59
What is PSV mode on vent? --Pressure support ventilation--
Type of spontaneous setting to allow for weaning Most common type of spontaneous An augmented breath Pt starts inspiration, vent assists by producing positive pressure during inhalation Pt controls rate, tidal volume
60
Cuff pressure on ET tube?
20--30
61
Pressure on suction device should not exceed...
120 mmHg (when tube is occluded)
62
Suction passes should last no longer than...
10 seconds
63
How often is oral care performed on intubated patients? What is used?
Every 2--4 hours for 1--2 min This prevents ventilator assisted pneumonia (VAD) Chlorhexidine (as mouthwash or toothpaste)
64
What is ECMO?
Removes blood from patient through large bore catheters. It goes through ECMO and infused with O2 and CO2 is removed. Then blood returned to patient.
65
What are some complications of mechanical vent?
Aspiration Water/Na+ retention Increased thoracic pressure decreases blood return to heart Alveolar hypo/hyper ventilation (if settings on vent aren't right) Barotrauma and Volutrauma (esp in stiff lungs) Peristalsis VAD
66
What are spontaneous awakening and spontaneous breathing trials? Called SATs or SBTs
Assesses weaning readiness Sedation vacation that allows us to see how their respiratory drive is Done daily on most intubated patients for <30 min

Unit 5 (5 decks)

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