critical care and ventilation

Question 1

assessment

Answer 1

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

Question 2

methods of monitoring- ECG

Answer 2

measures HR and rhythm

normal values- 50-100 BPM

Question 3

methods of monitoring- CVP

Answer 3

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

Question 4

methods of monitoring- A line

Answer 4

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

Question 5

methods of monitoring- saturation probes

Answer 5

measures oxygen levels from a patient’s finger, toe or ear

normal values >95%

Question 6

methods of monitoring- Swan Ganz catheter

Answer 6

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

Question 7

methods of monitoring- ICP bolts

Answer 7

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

Question 8

methods of monitoring- intra-aortic balloon pumps (IABP)

Answer 8

placed in aorta- increases pressure during diastole increasing aortic pressure, then deflates- reducing pressure

Question 9

methods of monitoring- continuous venovenous hemofiltration

Answer 9

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

Question 10

methods of monitoring- external-ventricualr drain

Answer 10

placed in brain ventricles-reduces amount of fluid and reduces the pressure

Question 11

ventilator

Answer 11

mode, FiO2- amount of oxygen, PEEP- positive end respiratory pressure, RR, airway pressure, lung compliance

Question 12

indications for ventilators

Answer 12

respiratory failure, post-op, head injuries, polytrauma, spinal injury, airway obstruction

Question 13

indications for ventilations- values

Answer 13

RR >25, PCO2 >50mmHg, PO2 <50 mmHg, SpO2 <90%

Question 14

intubation

Answer 14

endotracheal tube- leads to tracheostomy, tracheostomy- first choice if large amounts of facial injuries, nasal endocatehtal

Question 15

labelled intubation

Answer 15

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

Question 16

complications

Answer 16

CVS instability, barotrauma, V/Q mismatch, discomfort, excess secretions/infections, complications of high O2, gut and bowel dysfunction, weakened respiratory muscles

Question 17

what is mechanical ventilation

Answer 17

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

Question 18

effects of ventilation on V/Q

Answer 18

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

Question 19

types of pressure ventilation- pressure controlled

Answer 19

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

Question 20

types of ventilation- volume controlled

Answer 20

a pre set volume of gas is delivered during inspiration and once it has all been delivered expiration is allowed to occur

Question 21

settings for ventilators

Answer 21

inspiratory pressure or tidal volume, RR, PEEP, FiO2, I:E ratio

Question 22

example ventilator models- synchronised intermittent mandatory ventilation and pressure controlled synchronised intermittent mandatory

Answer 22

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

Question 23

example ventilator models- adaptive supportive ventilation, controlled mandatory ventilation

Answer 23

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

Question 24

example ventilator models- spontaneous ventilation (SPONT), high frequency oscillation ventilation

Answer 24

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

Question 25

responding to alarms

Answer 25

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

Question 26

liberation from ventilator

Answer 26

weaning, reduce ventilatory support= consultant preference, protocool lead
induction to ventilator independence, management of artificial airway

Question 27

what factors cause difficulty in weaning patients- load issues

Answer 27

bronchospasm, LVF, sepsis, pyrexia, fitting, increased secretions, hyperinflation, other cause of increased BMR

Question 28

what factors cause difficulty in weaning patients- drive and capacity pump

Answer 28

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

Question 29

what factors cause difficulty in weaning patients- consider and pump capacity

Answer 29

consider- Hb, anxiety, fear, sensory overload/deprivation, communication/ depression
pump- muscle weakness, neuropathy, disuse atrophy, nutrition, sleep, electrolytes

Question 30

physio in critical care- primary role

Answer 30

Maintenance and improvement of cardiorespiratory status/ MSK function, optimisation of neurological status

Question 31

physio in critical care- extended role

Answer 31

weaning/ liberating patients from mechanical ventilation, extubating/ decannulation, troubleshooting mechanical ventilation problems

Question 32

treatments in critical care

Answer 32

ACBT, autogenic drainage, hydration, positioning, mobilisation, mannual techniques, adjuncts, suctioning,

Question 33

tools for increasing lung volumes

Answer 33

positioning, mobilisation, breathing exercises, incentive spirometry, IPPB, clearways/cough assists, neurophysiological facilitation, CPAP

Question 34

it’s not all about the chest

Answer 34

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)