Improving Ventilation Flashcards
What do you do if the VT increases higher than 8ml/kg
Decrease and increase RR
Formula for desired VT
Known PaCO2 x Known VT/desired PaCO2
Formula for desired frequency
Known PaCO2 x known f/desired PaCO2
Formula for desired VE
Known PaCO2 x Known VE/ desired PaCO2
What is the desired PaCO2 for a bicarbonate of 28-32
50
What is the desired PaCO2 for a bicarbonate of 30-40
60
What is the desired PaCO2 for a bicarbonate of 35-43
70
What is the desired PaCO2 for a bicarbonate of 33-45
80
What is intentional ventilator used for
Acute head injury to decrease PaCO2 and constrict cerebral blood vessels
What patients do we use permissive hypercapnia for
ARDS
COPD
Asthma
Patients without cardiac or renal issues can handle what pH
7.20-7.25
What should you watch for when utilizing permissive hypercapnia
May increase patient drive to breath so sedate
May affect oxygenation
How can you manage carbon dioxide production during permissive hypercapnia
Use paralytics
Cool patient
Restrict glucose intake
How do you maintain normal breathing during permissive hypercapnia
Remove sources of mechanical deadspace
Increase mandatory frequency
How is HCO3 used for permissive hypercapnia
Tris-hydroxymethyl aminomethane (THAM) and carbocations are given to keep pH above 7.25
Monitor for contractions
What are contraindications for permissive hypercapnia
Intracranial lesion
Cardiovascular instability
Pulmonary hypertension
What systems are affected by increased CO2 and decreased pH
Regional bloodflow
Skeletal and smooth muscle
Nervous system
Endocrine
Digestive
Hepatic
Renal
How do you achieve the best aerosol on the ventilator
Close to the patient
Between the leak port and the face mask
Benefits of the MDI on the vent
Fewer problems than SVNs
MDI with spacer is more efficient
Indications for the flexible fibreoptic bronchoscope
Unknown Lesion in CXR
Evaluate atelectasis
Pulmonary infiltrates
Assess the upper AW
Suspicious or positive sputum cytologic result
Contraindications for flexible fibreoptic bronchoscopy
Lack of consent or cooperation
Lack of experienced bronchoscopist
Lack of personal
Moderate to severe Hypoxemia
Inability to oxygenate
Hypercarbia
Myocardial infarction
Unstable angina
Partial tracheal obstruction
Monitoring device for flexible fibreoptic bronchoscopy
Pulse Ox
ECG
Auscultation
Whole body radiation badge for personnel if fluoroscopy is used
Capnography
The three options for providing ventilation during transport
Manual ventilation
Transport ventilator
ICU ventilator
