Intern Prep Class - 2/29 Flashcards
Mallampati Class I and II
- complete visualization of soft palate
2. complete visualization of the uvula
Mallampati Class 3 and 4
- Visualization of base of uvula only
4. soft palate not visible at all
Thyromental distance
tip of mentum to thyroid cartilage
should be around 6 inches (3 fingers)
less is not good
RF for difficult ventilation
obesity, snoring age>55 years, lack of teeth presence of a beard mallampati 3 or 4 abnormal mandibular protrusion test
Reasons down syndrome pts are difficult to intubate
c1/c2 instability
macroglossia
small mouth opening
short, thick neck
Adequate oxygenation
spo2 more than 90
pao2 more than 60
Appropriate oxygenation
estimate Pao2 with Fio2 x 5
fio2 from 1L o2
2%
A-a gradient
difference between calculated alveolar oxygen partial pressure and measured arterial oxygen partial pressure
A-a gradient value based on
fio2
Room air ~10mm difference
100% fio2 ~100mmhg
BIPAP, support to
both ventilation and oxygenation
BIPAP, ventilation
IPAP
BIPAP, oxygenation
EPAP (functionally similar to PEEP?)
BIPAP and CPAP contraindications
mental status issues
risk of emesis
CPAP, support to
oxygenation
condition that may require CPAP only
cardiogenic pulmonary edema
Pressure Control - constants and variables
constant: Paw, Palv
variable: Vt, peak flow
Flow: decelearting
Volume Control - constants and variable
Variable: Paw, Palv
Constant: vt, peak flow
preset flow pattern
peak inspiratory pressure
pressure required to deliver the tidal volume
plateau pressure
pressure required to distend the lung
compliance
peak inspiratory flow
greatest flow used to deliver the tidal volume
resistance and compliance
mean airway pressure
time weighted average airway pressure measured during entire cycle
PEEP
increase mean airway pressure
increase recruitment of collapsed alveoli
prevent de-recruitment of easily collapsible alveoli
PEEP and worsening oxygenation
over-distended alveoli
PEEP and worsening hypoventilation
deadspace ventilation is increased
PEEP and hypovolemic pt
causes hypotension
give fluids or turn off peep
Control Mandatory Ventilation
OR
machine triggered, no ability to sense pts
Assist Control Ventilation
constant TV, rate
trigger breaths with machine + pt spontaneous effort (neg pressure)
AC Ventilation - issues
develop mild resp alkalosis
Norepinephrine receptors
alpha one
beta one
Norepinephrine uses and considerations
first line for septic shock (increase SVR)
but can cause cardiac dysrhythmias
Phenylephrine Receptors
alpha one
Epinephrine Receptors
B1, B2 low dose
alpha1 high dose
Epinephrine Considerations
can elevate lactate during initial administration
B1 receptor & SVR
initially decreases VR
Dopamine receptors
d1, b1, alpha one
Vasopressin works by
vasoconstricting, increases SVR
caveat for vasopressin
decreases UOP at high doses
Treatment for local extravasation
phentolamine alpha1 blocker, SQ
Vasopressor complications
dysrhythmias, hyperglycemia from inhibition of insulin secretion, local extravasation
Dobutamine receptors
B1 and B2
getting vasodilation and afterload reduction
Dobutamine major AE
hypotension, dysrhytmias
Milirinone mechanism
PDE III inhibitor
increases CO, contractility, profound vasodilation
Milirinone metablized in
kidneys
Milirinone better suited for…
right sided HF from pulm HTN
How do we treat flash pulmonary edema?
Afterload reduction, hypertensives. Not necessarily diuretics.
NIPPV - decreases mortality w/
COPD and CHF
NIPPV - don’t use w/
AMS, emesis
What is CPAP to start at?
- Titrate 2-5 q15min.
Max is 20. (why?)
BIPAP setting to start with
10/5
Epi pen IM dosing
0.3 mg of 1 in 1000
Epi IV bolus dose
0.1mg (1/10000) over 5-10min
Epi IV drip dose
1 mg of 1/1000 added to 250ml D5w
