Final Consideration Flashcards

1
Q

Factors that affect NML expiratory gas flow

A
  • elastic recoil (+2) and intrathoracic (+3)
  • total pressure at alveolus (+5) > than that at mouth so air moves out of lung
  • some pressure (-1) is lost to Raw
  • intraluminal pressure is +5 -1 = +4
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2
Q

Factors that affect ABNML expiratory gas flow

A
  • aging and emphysema decrease elastic recoil to (+1). total exp (+4) not (+5)
  • more pressure is lost to Raw (-2)
  • intraluminal pressure is (+2)
  • because intrathoracic pressure of +3 is greater than intraluminal pressure, the airway collapses
  • pursed-lip breathing increases intraluminal press
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3
Q

Expiratory gas flow

A
  • ON vent, no pursed-lip breathing
  • expiratory retard used - not available now
  • low level of PEEP may help
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4
Q

What do post surgery patients develop?

A
  • atelectasis
  • shunting
  • decreased PaO2
  • reduced compliance with ventilation
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5
Q

What kind of breaths reduce atelectasis, shunting, and decreased PaO2 and compliance?

A

sigh

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6
Q

What causes a decreased in compliance and PaO2?

A
  • loss of FRC in the supine position

- may be improved by PEEP

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7
Q

What kind of patients want sigh breaths and why?

A

paralyzed patients want sigh breaths to feel like they’re getting giant breaths

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8
Q

What is the suggested time to give sigh breaths?

A

3-4 times per hour (once every 10 minutes)

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9
Q

How much VT do sigh breaths give?

A

1 and 1/2 times tidal breath

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10
Q

Other studies found that what reduced atelectasis?

A

large tidal breaths

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11
Q

Some other studies found that atelectasis is common with what mode and what may be helpful?

A

PSV; sigh breaths

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12
Q

Not indicated is ___ for hypoxemia

A

CPAP

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13
Q

Sensitivity

A
  • patient should be able to easily flow or pressure trigger a breath
  • watch for auto-PEEP
  • watch to see if accessory muscle use decreases
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14
Q

Settings for sensitivity

A
  • flow 1-10 L
  • pressure -1 to -2 cmH2O
  • watch for auto-PEEP (do an expiratory hold)
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15
Q

How should you increase PEEP?

A

until PIP rises

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16
Q

In pressure control, what determines the tidal volume?

A

driving pressure

17
Q

You want to make sure you don’t change the driving pressure when making ___ changes?

18
Q

A patient with COPD is receiving PSV and seems to be having difficulty triggering the vent even though you have it set at -1 cmH2O. What must be causing this problem and can you do anything to correct it?

A
  • it could be auto-PEEP (do an expiratory hold to see)
  • make peep match auto-PEEP
  • to get rid of auto-PEEP, decrease rate and increase VT
19
Q

Selection of FiO2?

A
  • arterial tension between 60-100 mmHg
  • jf had ABG place on same oxygen
  • no ABG place 100% to restore oxygenation
  • no need to worry about hypoxic drive if vent MV is meeting patient’s needs
  • get ABG within 15-30 mins and adjust
20
Q

What kind of patients is SpO2 not accurate in?

A
  • smoke inhalation patients
  • someone with met hemoglobin
  • hypothermia patients
  • carbon monoxide poisoning patients
  • patients who smoke
21
Q

If FiO2 required is greater than 0.50 what should you consider?

22
Q

Humidification

A
  • need to provide 30 mgs H2O/L of absolute humidity at a range of about 31-35 for flows up to VE of 20-30 L/min
  • Nml 100%
23
Q

What HME exceptions are noted?

A
  • thick, copious or bloody secretions
  • VT < 70% of inhaled VT
  • body temp 10L/min
  • with aerosolized medication
24
Q

Nebulization

A
  • should not add VT or change FiO2

- should not change alarm function

25
What are the 3 alarm categories?
- immediate life-threatening - potentially life-threatening - not life-threatening but a potential source of patient harm
26
What could cause an immediate life-threatening alarm to go off?
- electrical power failure - no gas delivery - exhalation valve failure - excessive gas delivery - timing failure
27
What could cause a potentially life-threatening alarm to go off?
- circuit leak - circuit obstruction - heater malfunction - I:E ratio inappropriate - inappropriate oxygen - autocycling - inappropriate PEEP
28
What could cause a not life-threatening alarm to go off?
- changes in compliance and resistance | - changes in vent drive
29
Low pressure alarm
- 10 below PIP - detects leaks and disconnection - MOST important
30
High pressure alarm
- 10 above PIP - usually ends inspiration - cough - secretions - bucking - bronchospasm - kinks
31
Low CPAP/PEEP alarm
5 below, usually LP
32
Apnea alarm
20 seconds
33
I:E alarm
TI is > 1/2 TCT
34
What are some critical alarms that cannot be silenced?
- low gas source pressure - low battery - vent inoperative - exhalation valve leak
35
What are some other alarms not already mentioned?
- low VT - low/high VE - low/high F - low/high O2
36
What are the steps of commitment?
- prepare the patient - decide negative vs positive pressure - decide invasive vs non invasive - establish an airway - have manual vent bag at bedside - select ventilator - select mode