Forms of Invasive Life Support Flashcards
parenchyma
the functional tissue of an organ as distinguished from the connective and supporting tissue.
pulmonary toilet
exercises and procedures that help to clear your airways of mucus and other secretions.
Indications for Mechanical Ventilation - respitory
Meetphysiologicneedsinacute respiratory failure
Indicated by failure of the respiratory system to maintain an adequate balance of pH, PaO2, and/or PaCO2
indications for Mechanical Ventilation - protect
Protect the airway and lung parenchyma (drug overdose, cerebrovascular accident, head or spinal cord injury)
indications for Mechanical Ventilation - upper
Relieve upper airway obstruction (tumor, allergic reaction, edema)
indications for Mechanical Ventilation - toilet
Improve pulmonary toilet in pt with excessive secretions or inability to successfully clear secretions by coughing
Patient not able to breath - b/c
- Airflow obstruction
- Noncompliant lungs/thorax
- Respiratory muscle weakness
- Need for positive pressure mechanical ventilatory assistance (acute respiratory failure with resulting inadequate oxygenation)
pt should not breath - b/c
- Need to minimize oxygen consumption by decreasing work of breathing (septic shock)
- Inability to protect the lower airway from aspiration
- Surgical or diagnostic procedure
Ventilator pressure
Positive pressure – air pushed in to fill the lungs
Intubation or Airway Adjunct - ventilation
- Oral pharyngeal
- Nasal pharyngeal
- Endotracheal
- Tracheal
when is Oral Endotracheal Tube used
it is the last resort
Oral Endotracheal Tube 4 primary reasons
- Upper airway obstruction
- Inability to protect the lower airway from aspiration
- Inability to clear secretions from the lower airways
- Need for positive-pressure mechanical ventilatory assistance
Tracheostomy Tube - upper
Complete upper airway obstruction
(emergent)
Tracheostomy Tube - intubation
Long term intubation
Tracheostomy Tube - face
ETT (endotracheal tube) impossible due to facial trauma
Tracheostomy Tube - work
decreased work of breathing
Tracheostomy Tube - weaning
Facilitate ventilator weaning- reduced need for sedation, improves ability to clear secretions, improved patient comfort
Possible Complications of Tracheostomy
- Misplacement of tube
- Primary hemorrhage
- Pneumothorax, hemothorax * Surgical emphysema
- Infection
- Late hemorrhage
- Tracheoesophageal fistula
Tracheostomy
an opening created at the front of the neck so a tube can be inserted into the windpipe (trachea) to help you breathe.
Speaking with a Tracheostomy
Passy-Muir Valve
Passy-Muir Valve mechnism
- Opens on the inhale, closes (“seals”) on exhale
- Air is redirected around the trach tube, up through the vocal cords, upper airway, and out the mouth
Settings that affect oxygenation - ventilator
- FiO2
- Positive end-expiratory pressure (PEEP) (mm of H2O)
Settings that Affect Ventilation - ventilator
- Respiratory rate (breaths per
minute - Tidal volume (milliliters)
- Minute volume (mL/min)
- Inspiratory to expiratory ratio (I:E)
Controlled mechanical ventilation (CMV) - spontaneously breathing
Patient not spontaneously breathing
Controlled mechanical ventilation (CMV) - machine control
Total control of ventilation à patient matches machine settings
Controlled mechanical ventilation (CMV) pt status
Patients in coma, sedated, or cannot breathe on own
Assisted Control (AC) - TV
Patient initiates breath and machine delivers pre-determined TV
Assisted Control (AC) - RR
Pre-determined RR when breaths are not initiated
Synchronized Intermittent Mandatory Ventilation (SIMV)- between machine breaths
Patient can breathe btw ventilatory breaths, which are not supported by machine
Synchronized Intermittent Mandatory Ventilation (SIMV) - RR and TV
RR set, and each breath receives a TV that depends on the patient’s effort
Pressure Support Ventilation (PSV) - applies to what kind of breaths
Applies only to spontaneous breathes
Pressure Support Ventilation (PSV) - mechanism
Once the patient triggers the ventilator, the preset positive pressure is delivered
Pressure Support Ventilation (PSV) - TV and RR
Patient controls RR and inspiratory time; TV determined by pt and machine
Pulmonary Barotrauma
Complications Associated with Mechanical Ventilation
- alveolar rupture due to the use of positive pressure
- If too much pressure is pushed in can cause pneumothorax
Auto PEEP
Complications Associated with Mechanical Ventilation
- Incomplete expiration prior to the initiation of the next breath causes
progressive air trapping (hyperinflation). - Need to ensure correct settings or could have inc CO2 retention
Reduced cardiac output
Complications Associated with Mechanical Ventilation
- Could occlude the aorta or vena cava based on patient position or
pressures being delivered - Increase in mediastinal pressures could shift the heart and reduce CO
Mechanical Ventilation Weaning
The process of discontinuing mechanical ventilation so that the patient can return to spontaneous breathing.
During weaning, patient is monitored for
- ABG’s (arterial blood gases)
- Respiratory rate, depth and pattern
- Pulse oximetry
- HR and rhythm
- Mental status changes
T piece used when
during the process of ventilatory weaning
T piece process
the pt is doing all of the work
CPAP or BiPAP weaning
CPAP or BiPAP modes to provide airway support and trial weaning
Pacemaker
small device that’s placed (implanted) in the chest to help control the heartbeat. - arrhythmias
AICD
implantable cardioverter-defibrillator - able to perform defibrillation, and depending on the type, cardioversion and pacing of the heart.
VAD
a mechanical pump used to support heart function and blood flow in people with weak or failing hearts. The device is implanted in the body and pumps blood from the heart’s lower chambers to the rest of the body.
ECMO
people with life-threatening illness or injury that affects the function of their heart or lungs. ECMO keeps blood moving through the body and keeps blood gasses (oxygen and carbon dioxide) in balance.
Intraaortic balloon pump (IABP) - femoral insert
cannot flex hip
Intraaortic balloon pump (IABP)
Assists with circulation of blood and reduce oxygen consumption
Hemodialysis function
Replaces the function of the
kidneys
hemodynamically stable pt - is PT okay
yes, Must monitor vital signs
Hemodialysis precautions
Avoid using the arm with arteriovenous fistula when measuring BP
