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WI-18 Pulmonary > ICU > Flashcards

ICU Flashcards

1
Q

hypoxia

A

decreased O2 delivery to TISSUE

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2
Q

hypoxemia

A

decreased arterial oxygen tension

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3
Q

MC causes of dypsena

A 
obstructive dz
PNA
ischemia 
psychogenic 
CHF
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4
Q

LIFE threatening cause of dypsnea

A 
upper airway obstruction 
PE 
tension PTX
Fat emboli 
muscle neurogenic (MG, GB, botulism)
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5
Q

mild respiratory distress

A

sentences
22 RR
NML consciousness

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6
Q

moderate respiratory

A

23-28 RR

3-5 word sentences

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7
Q

severe respiratory distress

A

> 28 RR
0-1 words
AMS/Fatigue

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8
Q

mechanism of hypoxia

A

decreased O2 saturation
decreased cardiac output
decreased hemoglobin

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9
Q

mechanisms of hypoxemia

A 
R to L shunt
hypoventilation 
decreased diffusion 
low O2 intake 
VQ mismatch
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10
Q

R to L shunt

A

blood skipping pulmonary circuit oxygenation before going to tissue

WILL NOT IMPROVE WITH OXYGENATION

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11
Q

body response to hypoxemia

A

increased minute ventilation

sympathetic response (Increased HR, CO)

pulmonary vasoconstriction

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12
Q

diagnosis of hypoxemia

A

ABG PaO2 < 60

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13
Q

hypercapnia

A

caused by HYPOVENTILATION

PaCO2 > 45

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14
Q

etiologies of hypercapnia

A
  1. decreased respiratory drive
  2. decreased tidal volumes
  3. rapid shallow breathing
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15
Q

Alveolar volume =

A

Tidal Volume - Dead space

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16
Q

alveolar hypoventilation via:

A

decreased respiration
decreased tidal volume
increased dead space

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17
Q

DDX of hHypercapnia

A

decreased central respiratory drive (brainstem lesion, opioids/sedatives, tetanus)

thoracic cage disorder

neuromuscular impairment (organophosphate)

COPD

18
Q

actue hypercapnia s/ s

A

raises ICP = vasodilation

HA, dyspnea, confusion

peropejra; ams cpmkimctova; ju[ere,oa

19
Q

chronic hypercapnia ABG

A

this state is actually tolerated, pts adjust

Bicarb >28
PCO2 >45
Normal pH

20
Q

diagnosis of hypercapnia

A

ABG

Chronic: large bicarb compensation (kidney)

Acute: mild elevation in bicarb bc kidney can’t keep up

21
Q

tx hypercapnia

A

increased minute ventilation via BiPap/CPAP

22
Q

central cyanosis

A

tongue + mucous membranes

inadequate pulmonary oxygen or abnormal HgB

via hypoxemia, VQ mismatch, RL shunt, HgB abnormalities

23
Q

peripheral cyanosis

A

extremities and digits

vasoconstriction/diminished peripheral flow

via decreased CO, cold extremities, shock

24
Q

dx and tx cyanosis

A

ABG

supplemental oxygen

25
Q

criteria for diagnosing ARDS

A
  1. new bilateral infiltrates
  2. respiratory failure not explained by HF/volume
  3. impaired oxygenation
26
Q

pathogenesis ARDS

A

interstitial and alveolar pulmonary edema , alveolar collapse, hypoxemia

27
Q

respiratory failure

A

abnormalities of oxygenation or ventilation

pulmonary and non pulmonary

28
Q

s/s of respiratory failure

A

hypoxia and hypercapnia

high decree of suspicion + ABGs

29
Q

indications for mechanical vent

A
  1. hypoxemia
  2. upper airway obstruction
  3. impaired airway protection
  4. inability to clear secretion
  5. respiratory acidosis
  6. progressive fatigue, tachympna AMS’
  7. Apnea
30
Q

modes of mechanical vent

A
  1. controlled mechanical vent (VC/PC)
  2. SIMV
  3. Pressure support
  4. T piece
31
Q

tidal volume based on

A

IDEAL body weight (5-7 L/kg)

32
Q

respiratory failure and mechanical vent

A

Lung protective ventilation (lower tidal volume)

33
Q

postivie pressure ventilation

A

decreased diastolic filling and increases output during systole

REDUCES ventricular filling therefore preload and afaterload changes

34
Q

assisted control

A

volume and flow rate OR pressure and I:e ratio

35
Q

PEEP

A

ventilation setting

keeps small airway open to reduce damage to alveolar

36
Q

peak airway pressures should be less than

A

35

37
Q

CMV

A

continuously pumps air in despite patient effort

not common

38
Q

assist control MOA

A

vent delivers MINIMUM number of supported breathes

pt breath triggers fully assisted vent reacts but machine will breath if pt doesn’t

39
Q

SIMV

A

combined ventilation with spontaneous breathing

limits breath when pt is exhaling but delivered minimum number

completely turns off it pf breathes

40
Q

airway devices steps

A

pressure control/bipap (awake, can trigger breath) - NO SET RATE

SIMV v (assisted, coincides with inspiratory)

AC (pt trigger or machine trigger, BREATHES for pt)

41
Q

general supportive care ventilation

A

decreased potassium
decreased phosphate
sedatives/hypnotics
analgesics

42
Q

mechanical vent complications

A 
atelectasis.overextension 
barotrauma
volutrauma
respiratory alkolosis
HoTN
VAP

WI-18 Pulmonary (11 decks)

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