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Cardioresp > Devices > Flashcards

Devices Flashcards

1
Q
A

Multivent Mask:

  • fixed –> total flow exceeds patients peak inspiratory flow demands
  • more expensive
  • flow rate 3-15L/min
  • FiO2: green = 0.24-0.30, white = 0.35-0.50
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2
Q
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Rebreather mask

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3
Q
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Plain face mask:

  • variable
  • inexpensive
  • vent holes on side for release of exhaled gases and to mix with room air
  • flow rate ≥5L/min
  • FiO2 = 0.40-0.60
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4
Q
A

Nasal prongs:

  • variable –> FiO2 varies according to patients breathing rate/depth/PIF
  • inexpensive
  • comfortable, can eat/drink
  • flow rate = 1-4L/min
  • FiO2 = 0.24-0.36
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5
Q

Dangers of O2 therapy

A
  • COPD
    • decreased drive to breathe
  • O2 toxicity
    • long periods of FiO2 0.5-0.6 leads to pulmonary changes
  • depression of ciliary function
    • thickening of secretions, further retention
  • absorption atelectasis
    • nitrogen moved out, causing collapse
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6
Q

O2 therapy - PT implications

A
  • Check devices is being worn correctly
  • Check correct concentration os being delivered
  • Monitor SpO2 with pulse oximeter
  • Mobilise post-op patients with portable O2 (if appropriate)
  • If removed to mobilise, use portable pulse oximeter and ensure replaced on return
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7
Q
A

Swedish nose/thermavent:

  • attached to tracheostomy tube
  • maintains humidity
  • prevents adverse effects of ciliary function
  • blockage of secretions
    • should not be used if productive of secretions
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8
Q

Humidification indications:

A
  • FiO2>0.35
  • thick secretions
  • consolidation
  • major infection
  • following surgery
  • artificial airway
  • diuretic therapy
  • dehydrated
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9
Q
A

Nebuliser

  • delivers respiratory medications via fine droplets
  • used to moisten upper airway of surgical patients
  • prevents adverse ciliary function
  • deposition depends on:
    • particle size
    • method of inhalation
    • degree of airflow obstruction

Application:

  • flow rate = 6-8L/min
  • slow deep breaths interspersed with TV
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10
Q
A

Metered Dose Inhaler:

  1. Shake canister ~10 times
  2. Hold conister upright
  3. Sit upright
  4. Expire gentle but not fully
  5. Slight neck extension
  6. Seal mouth around mouthpiece
  7. Slow, deep inspiration, simultataneuosly press canister to release medication
  8. Inspiratory hold (up to 10s if possible)
  9. Expire gently through nose
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11
Q
A

Turbuhaler:

  1. Unscrew and remove the protective cover
  2. Hold canister upright
  3. Load by turning grip to the right as far as it goes then back to the left until it clicks
  4. Sit upright
  5. Expire gently but not fully
  6. Seal mouth around mouthpiece
  7. Slow deep inspiration
  8. Inspiratory hold (up to 10s)
  9. Expire gently through nose
  10. Replace the cover
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12
Q
A

Handihaler:

  1. Open cap
  2. Open the mouthpiece
  3. Insert medication capsule
  4. Close mouthpiece
  5. Press green piercing button then release
  6. Sit upright
  7. Expire gently but not fully
  8. Slight neck extension
  9. Seal mouth around mouthpiece
  10. Slow, deep inspiration
  11. Inspiratory hold
  12. Expire gently through nose
  13. Open mouthpiece then tip to discard capsule
  14. Close the mouthpiece and cap
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13
Q
A

Nasopharyngeal airway:

  • soft silastic tube to pharynx
  • inserted with lubricant
  • changed several times per day
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14
Q
A

Oropharyngeal airway:

  • short plastic tube to pharynx
  • keeps airway open
  • facilitates suction
  • insertion can cause patient to gag or vomit
  • care with loose teeth and bite reflex
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15
Q
A

Endotracheal tube:

  • often requires sedation
  • condition must be reversible
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16
Q
A

Suction indications:

  • artificial airway
  • unconscious
  • inability to cough and effectively expectorate secretions
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17
Q
A

Tracheostomy

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18
Q
A

Trachy tent

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19
Q
A

Yankeur

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20
Q
A

Sputum trap

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21
Q
A

Mini tracheostomy:

  • no need for humidification
  • may need NaCl 0.9% during suction
  • size 8 or 10 FG catheter to suction
  • inserted for secretion removal only
  • maintain own airway, eat, talk
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22
Q

Spacer

A
  • increases deposition of drug in lungs instead of oropharynx by 15%
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23
Q

Aerosol therapy mechanism

A
  • topical deposition of drugs
  • gravitational sedimentation = time dependent and enhanced by breath holding
  • large particles carry more medication but do not go far
  • small particles go further but do not carry much medication
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24
Q

PEP indications

A
  • impaired airway clearance
  • prevents airway collapse
  • CF
  • COPD
  • bronchiectasis
  • chronic bronchitis
  • restrictive lung disease
  • post-op secretions or atelectasis
  • collapsible airways
  • productive asthma
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25
Q

PEP precautions

A
  • active haemoptysis
  • lung surgery
  • pneumothorax
  • undrained empyema or lung abscess
  • emphysematous bullae
  • increased WOB
  • haemodynamic instability
  • facial fractures or surgery
  • middle ear infection
  • sinusitis
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26
Q

O2 therapy indications

A
  • hypoxaemia
  • increased WOB
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27
Q

Nasal prongs complications

A
  • pressure areas
  • mucosal damage
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28
Q

Partial rebreather

A
  • variable
  • exhaled O2 from anatomic dead space is conserved
  • flow rate = 6-10L/min
  • FiO2 ≤0.60
29
Q

Non-rebreather

A
  • variable
  • one-way valve prevents exhaled gases re-entering, prevents room air entering
  • flow rate = 10-15L/min
  • FiO2 = 0.80-0.90
30
Q

Rebreather indications

A
  • very hypoxaemic
  • severe respiratory distress
31
Q

Rebreather complications

A
  • drying of secretions
  • risk of retaining CO2 (partial rebreather)
32
Q

Turbuhaler indications

A
  • suitable if unable to coordinate MDI
33
Q

Inhalation of steroids

A
  • decrease oral candidiasis by rinsing mouth following inhalation of steroids and using a spacer device
34
Q

Nasopharyngeal airway precautions

A
  • nasal/facial fractures
  • CSF leak
  • torn dura
  • coagulopathy
  • anticoagulant therapy
  • hypotension
35
Q

ETT indications

A
  • airway obstruction
  • inadequate oxygen
  • inadequate ventilation
  • elevated WOB
  • airway protection
  • facilitation of tracheobronchial suctioning
  • facilitation of mechanical ventilation
36
Q

Cuffed ETT indications

A
  • unconscious
  • unable to swallow
  • requires full mechanical ventilation
37
Q

Cuffed ETT advantages

A
  • prevents aspiration of gastrointestinal contents
  • provides good seal for ventilation
  • prevents movement/holds tube in
38
Q

Cuffed ETT complications

A
  • can cause damage to vocal chords
39
Q

Uncuffed ETT indications

A
  • awake or able to swallow
  • paediatric use
  • able to speak
40
Q

Uncuffed ETT complications

A
  • may cause increased secretions due to irritation and movement
41
Q

ETT complications

A
  • trauma
  • malposition
  • obstruction
  • disordered physiology
    • increased secretions
    • decreased cilial activity
    • inability to cough
    • infection
    • inability to talk/swallow
    • lack of humidification (so need to humidify)
42
Q

ETT - PT implications

A
  • need to suction/other ACTs
  • infection control
43
Q

Suction contraindications

A
  • pulmonary oedema
  • haemoptysis
  • respiratory burns
  • head injuries
  • high levels PEEP, FiO2
  • severe infection
44
Q

Suction complications

A
  • hypoxaemia
  • cardiac arrhythmias
  • haemodynamic alterations
  • increased ICP
  • gastric aspiration
  • trauma
  • distress
  • atelectasis
  • reflex bronchospasm
  • infection
45
Q

Tracheostomy indications

A
  • long term intubation
  • prevent laryngeal damage and oedema from ETT
  • ETT not well tolerated if patient not sedated
  • URT obstruction
  • facilitation of suctioning
  • permanent bypass obstruction or tumour
46
Q

Tracheostomy complications

A
  • operative risks
  • placement in pre-tracheal tissues
  • haemorrhage of innominate artery
  • tracheal stenosis
  • tracheomalacia
  • trachea-oesophageal fistula
  • surgical emphysema
  • blockage with secretions
47
Q

Closed-suction system

A
  • prevents disconnection from ventilator (prevents loss of FRC and O2)
  • prevents pathogens sprayed into air
  • not always effective if thick secretions
48
Q

MHI indications

A
  • secretion removal
  • prevent/reverse atelectasis
  • improve compliance
  • hyperoxygenation prior to suction (rare)
49
Q

MHI contraindications

A
  • pulmonary oedema
  • severe haemoptysis
  • undrained pneumothorax
  • nitric oxide
  • severe bronchospasm
  • acute septic shock
  • low BP
50
Q

MHI precautions

A
  • bullae (use manometer)
  • PEEP ≥10 (use VHI)
  • FiO2 ≥0.7 (use VHI)
  • low lung compliance
51
Q

MHI complications

A
  • pneumothorax
  • barotrauma, volutrauma
  • desaturation
  • decreased venous return
  • decreased cardiac output
52
Q

Flow rates

A
  • nasal prongs = 1-4L/min
  • face mask = ≥5L/min
  • partial rebreather = 6-10L/min
  • non-rebreather = 10-15L/min
  • MVM = 3-15L/min
  • nebulizer = 6-8L/min
  • MHI = 10L/min
53
Q

FiO2

A
  • nasal prongs = 0.24-0.36
  • face mask = 0.40-0.60
  • partial rebreather ≤0.60
  • non-rebreather = 0.80-0.90
  • MVM: green = 0.24-0.30, white = 0.35-0.50
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Cardioresp (12 decks)

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