Ex 1: Resp Failure: Basics - Oxygenation/ABGs/ETT

Question 1

What is hypoxemia?

Answer 1

Hypoxemia: decreased oxygenation of arterial blood

Question 2

Hypoxia?

Answer 2

Hypoxia: decreased oxygenation at tissue level

Question 3

SaO2, range and define

Answer 3

(92-99%): Oxygen bound to hgb

Question 4

PaO2, range and define

Answer 4

(80-100 mm Hg): Partial Pressure of oxygen dissolved in arterial blood

Question 5

Hypoxemia leads to

Answer 5

Hypoxia

Question 6

PaO2, when to treat and the life-threatening values

Answer 6

PaO2 Value < 60 mm Hg treated
(PaO2 60 ~ SpO2 90%)

PaO2 Value < 40 mm Hg is life threatening

Question 7

How to Ensure accurate oxygen readings?

Answer 7

Limit movement

Avoid edematous areas

Effect of sunlight, fluorescent light, nail polish, artificial nails, and dyes

Question 8

commonly used instead of ABGs for continuous assessment of oxygenation?

Answer 8

Pulse oximetry

Question 9

Hypoxemia s/s?

Answer 9

Restless
Agitation
Confused/Decreased LOC
Hypertension
Dysrhythmias
Tachypnea
Cool, clammy, pale skin

Question 10

Hypercapnea s/s?

Answer 10

Headache
Somnolence
Dizzy  Coma
Hypertension
Tachycardia
Bounding Pulse
Bradypnea
Warm, flushed skin

Question 11

Nasal cannula FiO2

Answer 11

0.24-0.44 FiO

Question 12

Simple face mask FiO2

Answer 12

0.30-0.60 FiO2

Question 13

High-flow cannula

Answer 13

0.60-0.90 FiO2

Question 14

Face masks w/ reservoirs

Partial rebreather FiO2
Nonrebreather FiO2

Answer 14

Partial rebreather = 0.35-0.60 FiO2

Nonrebreather = 0.60-0.80 FiO2

Question 15

What Buffer systems maintain homeostasis? (2)

Answer 15

Compensation = Buffer system working!!

1. ) Bicarbonate buffer system (Regulated by the kidneys)
2. ) CO2 buffer system (Regulated by the lungs)

Question 16

Partial Pressure of Carbon Dioxide (PaCO2)

What parameter does it represent and the normal value?

Answer 16

Respiratory parameter of Ventilation

Normal PaCO2 35-45 mm HG

Question 17

Bicarbonate (HCO3) Concentration

What parameter does it represent and the normal value?

Answer 17

Metabolic parameter

Normal 22-26 mEq/L

Question 18

Partial compensation means

Answer 18

pH abnormal

• CO2 and HCO3 are both out of range

Question 19

Complete compensation means

Answer 19

pH normal range

Question 20

In what order do you assess ABGs

Answer 20

Look at your pH first, if that is normal, look at your CO2 and HCO3

STEP 1: Look at each number and label

STEP 2: Evaluate oxygenation

STEP 3: Determine the acid-base status
Evaluate the pH

STEP 4: Determine the primary cause of the acid-base status (respiratory or metabolic)

STEP 5: Determine compensation (absent, partial, or complete)

Question 21

Indications for Ventilation

Hypoxemia PaO@ value?

Answer 21

PaO2 ≤ 60 mm Hg on FiO2 > 0.5

Question 22

Indications for Ventilation

Hypercapnea PaO2 value?

Answer 22

PCO2 ≥ 50 mm Hg with pH ≤ 7.25

Question 23

Indications for Ventilation

Progressive deterioration signs?

Answer 23

Increasing RR and WOB

Decreasing VT

Question 24

Positive Pressure Ventilation

What is it? The opposite of?

Answer 24

Movement of gases into lungs through positive pressure

Opposite of normal respirations

Question 25

Endotracheal Intubation

What is the preferred route?

Answer 25

Orotracheal route preferred to reduce infections

Question 26

Endotracheal Intubation

Use to?

Answer 26

Maintain an airway

Remove secretions

Prevent aspiration

Provide mechanical ventilation

Question 27

Endotracheal Intubation

Right size tube: for Female and Male

Answer 27

7. 5 to 8.0 mm female;

8. 0 to 9.0 mm male

Question 28

Endotracheal Intubation

What are the procedural intubation steps? (7)

Answer 28

1. Premedicate prn
2. Topical anesthetic/ paralytic medication
3. Ventilate patient
4. Suction oropharynx
5. Intubate within 30 sec
6. Inflate balloon
7. Verify placement

Question 29

Endotracheal Intubation
Verifying placement:

What and where do you auscultate?

Answer 29

Where: epigastric area
What: bilateral breath sounds

Question 30

Endotracheal Intubation
Verifying placement:

What are the detector devices?

Answer 30

ETCO2 detector

Esophageal detector device

Question 31

Endotracheal Intubation
Verifying placement:

Where is the x-ray placed?

Answer 31

Chest x-ray—3 to 4 cm above carina

Question 32

Endotracheal Intubation

How is the placement recorded?

Answer 32

Record cm at the lip line for reference