Ex 1: Resp Failure: Basics - Oxygenation/ABGs/ETT Flashcards
PPT slides 1-23
What is hypoxemia?
Hypoxemia: decreased oxygenation of arterial blood
Hypoxia?
Hypoxia: decreased oxygenation at tissue level
SaO2, range and define
(92-99%): Oxygen bound to hgb
PaO2, range and define
(80-100 mm Hg): Partial Pressure of oxygen dissolved in arterial blood
Hypoxemia leads to
Hypoxia
PaO2, when to treat and the life-threatening values
PaO2 Value < 60 mm Hg treated
(PaO2 60 ~ SpO2 90%)
PaO2 Value < 40 mm Hg is life threatening
How to Ensure accurate oxygen readings?
Limit movement
Avoid edematous areas
Effect of sunlight, fluorescent light, nail polish, artificial nails, and dyes
commonly used instead of ABGs for continuous assessment of oxygenation?
Pulse oximetry
Hypoxemia s/s?
Restless Agitation Confused/Decreased LOC Hypertension Dysrhythmias Tachypnea Cool, clammy, pale skin
Hypercapnea s/s?
Headache Somnolence Dizzy Coma Hypertension Tachycardia Bounding Pulse Bradypnea Warm, flushed skin
Nasal cannula FiO2
0.24-0.44 FiO
Simple face mask FiO2
0.30-0.60 FiO2
High-flow cannula
0.60-0.90 FiO2
Face masks w/ reservoirs
Partial rebreather FiO2
Nonrebreather FiO2
Partial rebreather = 0.35-0.60 FiO2
Nonrebreather = 0.60-0.80 FiO2
What Buffer systems maintain homeostasis? (2)
Compensation = Buffer system working!!
- ) Bicarbonate buffer system (Regulated by the kidneys)
- ) CO2 buffer system (Regulated by the lungs)
Partial Pressure of Carbon Dioxide (PaCO2)
What parameter does it represent and the normal value?
Respiratory parameter of Ventilation
Normal PaCO2 35-45 mm HG
Bicarbonate (HCO3) Concentration
What parameter does it represent and the normal value?
Metabolic parameter
Normal 22-26 mEq/L
Partial compensation means
pH abnormal
- CO2 and HCO3 are both out of range
Complete compensation means
pH normal range
In what order do you assess ABGs
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)
Indications for Ventilation
Hypoxemia PaO@ value?
PaO2 ≤ 60 mm Hg on FiO2 > 0.5
Indications for Ventilation
Hypercapnea PaO2 value?
PCO2 ≥ 50 mm Hg with pH ≤ 7.25
Indications for Ventilation
Progressive deterioration signs?
Increasing RR and WOB
Decreasing VT
Positive Pressure Ventilation
What is it? The opposite of?
Movement of gases into lungs through positive pressure
Opposite of normal respirations
Endotracheal Intubation
What is the preferred route?
Orotracheal route preferred to reduce infections
Endotracheal Intubation
Use to?
Maintain an airway
Remove secretions
Prevent aspiration
Provide mechanical ventilation
Endotracheal Intubation
Right size tube: for Female and Male
- 5 to 8.0 mm female;
8. 0 to 9.0 mm male
Endotracheal Intubation
What are the procedural intubation steps? (7)
- Premedicate prn
- Topical anesthetic/ paralytic medication
- Ventilate patient
- Suction oropharynx
- Intubate within 30 sec
- Inflate balloon
- Verify placement
Endotracheal Intubation
Verifying placement:
What and where do you auscultate?
Where: epigastric area
What: bilateral breath sounds
Endotracheal Intubation
Verifying placement:
What are the detector devices?
ETCO2 detector
Esophageal detector device
Endotracheal Intubation
Verifying placement:
Where is the x-ray placed?
Chest x-ray—3 to 4 cm above carina
Endotracheal Intubation
How is the placement recorded?
Record cm at the lip line for reference
