critical care and ventilation Flashcards
assessment
no different to previously learnt- PC, HPC, PMH etc.
charts and monitors- ABGs, trends, fluid balance, drugs, how patient has reacted to different treatments
ventilator, X-rays, auscultation, the patient- intubated, lines, colour, extra equipment
methods of monitoring- ECG
measures HR and rhythm
normal values- 50-100 BPM
methods of monitoring- CVP
central venous pressure, placed in subclavian or jugular vein- measures fluid and is an indicator of the hearts ability to cope with this volume.
normal values- 3-15cmH20, low levels indicate dehydration
normally a BLUE line
methods of monitoring- A line
atrial line, sits in an artery (radial, femoral, brachial, dorsalis, pedis), gives constant measure of blood pressure, give access for arterial blood sampling- ABG’s, normally line is RED
methods of monitoring- saturation probes
measures oxygen levels from a patient’s finger, toe or ear
normal values >95%
methods of monitoring- Swan Ganz catheter
inserted via a central vein through the right side of the heart into the PA, measures CO, SV and ventricular load, normally a YELLOW lin e
methods of monitoring- ICP bolts
measures intracranial pressure (ICP) and cerebral perfusion pressure (CPP)
CPP= MAP=ICP, normal MAP= 9mmHg, critical values- brain begins to get damaged
ICP normal- 0-15mmHg, critical >20
CPP normal- >70mmHg, critical <50mmHg
methods of monitoring- intra-aortic balloon pumps (IABP)
placed in aorta- increases pressure during diastole increasing aortic pressure, then deflates- reducing pressure
methods of monitoring- continuous venovenous hemofiltration
short term treatment for renal failure, dialysis catheter- 2. lines- one takes blood from patient to machine and then blood travels back to body when blood components fixed
methods of monitoring- external-ventricualr drain
placed in brain ventricles-reduces amount of fluid and reduces the pressure
ventilator
mode, FiO2- amount of oxygen, PEEP- positive end respiratory pressure, RR, airway pressure, lung compliance
indications for ventilators
respiratory failure, post-op, head injuries, polytrauma, spinal injury, airway obstruction
indications for ventilations- values
RR >25, PCO2 >50mmHg, PO2 <50 mmHg, SpO2 <90%
intubation
endotracheal tube- leads to tracheostomy, tracheostomy- first choice if large amounts of facial injuries, nasal endocatehtal
labelled intubation
murphy’s eye- reduce risk of occlusions and maintain airflow, soft tip- reduces trauma, depth marker lines- allows correct placement, precise calibration- reliably indicating depth of incision, 15mm tube- allows reliable connection, high volume, low pressure cuffs- provide even pressure, valve, radio-opaque line- allowing clear identification of the inTube
complications
CVS instability, barotrauma, V/Q mismatch, discomfort, excess secretions/infections, complications of high O2, gut and bowel dysfunction, weakened respiratory muscles
what is mechanical ventilation
during complete mechanical ventilation and air and oxygen mixtures pushed into the lungs for inspiration, the gas flow is stopped and air is allowed to be passively exhaled, it uses positive pressure
effects of ventilation on V/Q
accentuates the perfusion gradient, reverse the ventilation gradient= diaphragm is passive, positive pressure takes the path of least resistance, lower regions compressed by increased perfusion, absorption atelectasis at higher oxygen concentrations
types of pressure ventilation- pressure controlled
the gas will be delivered and cause inspiration until a certain pre-set pressure is reached, and then expiration is allowed to happen passively- doesn’t guarantee amount of volume, prevents volume trauma
types of ventilation- volume controlled
a pre set volume of gas is delivered during inspiration and once it has all been delivered expiration is allowed to occur
settings for ventilators
inspiratory pressure or tidal volume, RR, PEEP, FiO2, I:E ratio
example ventilator models- synchronised intermittent mandatory ventilation and pressure controlled synchronised intermittent mandatory
SIMV- volume controlled ventilation- TV and RR set, however if patient takes breath the machine synchronises to match patient.
PSIMV- same as previous but pressure set
example ventilator models- adaptive supportive ventilation, controlled mandatory ventilation
ASV- ventilator is given information about patient (height and ideal body weight)- ventilator calculates minute volume
CMV- delivers certain amount of breaths, no options to breathe
example ventilator models- spontaneous ventilation (SPONT), high frequency oscillation ventilation
SPONT- used in patients doing well- patient triggers all breaths, which are supported by pressure support
HFOV- extremely unwell individual, recruits maximum amount of alveoli, delivers small tidal volume
responding to alarms
if alarm sounds, respond immediately by identifying which equipment it is, assess patient, is it that the patient has changed or is it that the equipment is picking up interference
liberation from ventilator
weaning, reduce ventilatory support= consultant preference, protocool lead
induction to ventilator independence, management of artificial airway
what factors cause difficulty in weaning patients- load issues
bronchospasm, LVF, sepsis, pyrexia, fitting, increased secretions, hyperinflation, other cause of increased BMR
what factors cause difficulty in weaning patients- drive and capacity pump
drive- sedation, CNS problems, hypercapnia, motivation, psychological issues
capacity of pump= treat patient or discomfort, treat abdominal discomfort, optimise positioning, have the paralysing agents worn of?, is diaphragm working
what factors cause difficulty in weaning patients- consider and pump capacity
consider- Hb, anxiety, fear, sensory overload/deprivation, communication/ depression
pump- muscle weakness, neuropathy, disuse atrophy, nutrition, sleep, electrolytes
physio in critical care- primary role
Maintenance and improvement of cardiorespiratory status/ MSK function, optimisation of neurological status
physio in critical care- extended role
weaning/ liberating patients from mechanical ventilation, extubating/ decannulation, troubleshooting mechanical ventilation problems
treatments in critical care
ACBT, autogenic drainage, hydration, positioning, mobilisation, mannual techniques, adjuncts, suctioning,
tools for increasing lung volumes
positioning, mobilisation, breathing exercises, incentive spirometry, IPPB, clearways/cough assists, neurophysiological facilitation, CPAP
it’s not all about the chest
patients need early rehabilitation to prevent long term complications, deconditioning/ disuse atrophy secondary to loss of muscle mass, atrophy of postural muscles significantly affecting ability to sit/stand, lack of proprioceptive feedback and movement 2nd to environment and illness, orthostatic intolerance (decrease BP)
