Exam 1 Flashcards
What is ventilatory failure?
Inability of pulm system to maintain proper CO2 removal
1) Ventilation Failure is also called__________
2) Oxygenation Failure is also called__________
1) Hypercapneic RF
2) Hypoxic RF
What is oxygenation failure?
Severe hypoxemia that doesn’t respond to mod to high (50-100%) of suppl O2
What is a traditional tidal vol?
6-8 ml/kg
How to calculate minute ventilation?
Vt x RR = LPM
What parameters does ventilation affect?
What setting can you manipulate?
1) pH, pCO2, and HCO3
2) minute ventilation
What parameters oxygenation affect?
What settings can you manipulate?
1) O2 and PaO2
2) PEEP and FiO2
1) How is Rapid Breathing Index or Rapid Shallow Breathing Index calculated?
2) What range is highly predictive of successful extubation?
1) f/Vt (resp rate / tidal vol)
2) <100
What is the first intervention after identifying symptomatic bradycardia (narrow or wide QRS)?
Atropine IV
1st dose: 0.5 mg bolus
Repeat: 3-5 min
Max: 3 mg
What alternatives can be used after INITIAL therapy is ineffective for symptomatic bradycardia (narrow or wide QRS)?
1) Transcutaneous pacing
2) Dopamine; 2-10 mcg/kg/min
3) Epi; 2-10 mcg/min
Interventions for pulseless dysrhthmia identified?
1) CPR
2) Epi/vasopressin
3) Atropine
Initial Rx intervention for symptomatic narrow regular QRS tachycardia?
Adenosine IV:
First dose - 6 mg RAPID IVP –> NS flush
Second - 12 mg
Other alternatives for treatment of symptomatic narrow regular QRS tachycardia?
1) Vagal maneuvers
2) Synchronized cardioversion
3) CCBs and BBs
What is initial Rx therapy for symptomatic wide complex tachycardia?
Amiodarone:
- First dose: 150 mg over 10 mins
- Repeat if VT cont
- Then maint. infusion of 1 mg/min for 1st 6 hours
When is adenosine an option for symptomatic wide complex tachycardia?
regular or monomorphic
What are the interventions for pulseless wide complex tachycardia?
1) Defibrillation
2) CPR
3) Epi/vasopressin
4) Amiodarone/Lidocaine
What Rx is indicated for torsades do pointes (wide complex polymorphic vent tachycardia)
magnesium
Causes of shunting
- small airway occlusions (bronchitis, asthma, mucus plugs)
- Fluid in alveoli
- Atelectasis
- ASD, VSD
What is the V/Q ratio for shunt?
V/Q <1
Initially, shunting is hypoxemic and __________?
hypocapnic
Dead space is caused by?
- loss of alveolar area
- pulm embolus
- low blood flow states
- artificial airways (ETT)
What is the V/Q ratio for Dead Spacing?
V/Q ratio >1
Dead spacing is hypoxemic and ___________?
hypercapnic
How is P:F ratio calculated?
PaO2 / FiO2
What are the following P:F ratios?
1) Normal
2) On PPV
3) Shunt of >20%
1) 450
2) > 300
3) <200
Definition of Hypoxemic
On suppl O2 to keep Pt > 90%
Definition of Hypercapnia
pCO2 > 45mmHg and not compensating for met alkalosis (HCO3 > 27)
Obvious reasons to intubate?
- GCS <9
- Cardiopulm Arrest
- Impending Airway Compromise
What is ARDS
- diffuse injury to lungs –> inflammation that’s not a primary condition
- Extra-pulm or intrapulm
- Starts w/ neutrophils
CHAD Vasc
- Age
- Sex
- CHF
- CVD
- Valvular Dz
Clinical features of ARDS
- Acute onset
- Bilat infiltrates on CXR
- Non-cardio pulm edema
- Severe hypoxemia (w/ PEEP of 5)
What are the P:F ranges for mild, moderate, severe ARDS
< 300 mild
< 200 moderate
< 100 severe
First 3 things to rule out when chest pain presents?
- ACS
- Aortic Dissection
- Pulmonary Emboli
Unstable angina definition
- new onset or angina at rest
- ## angina occurring at increasing frequency
Conditions that elevate BNP?
- Advanced age
- Obesity
- Renal Dysfunction
- Anemia
- Arrhythmia
- Toxic Metabolic Insults
