Lecture Week 2 Flashcards
How does an intraaortic ballon pump work
cath goes from the femoral artery into the aortic arch. During ventricular diastole (when the aortic valve closes) the ballon inflates pushing blood back toward the left ventricle where it can enter the coronary artery orifaces
what should you do to decrease cardiac workload
- give o2
2. decrease SVR
what are the two types of respiratory failure
- hypoxic (such as in pneumonia)
2. hypercapnic (such as in COPD)
what are the early signs of hypoxic respiratory failure
- restless
2. premature ventricular contractions
what are the early signs of hypercapnic respiratory failure
1.lethargic
what do you do to treat hypercapnic respiratory failure
give BiPaP to reduce CO2 levels, but the patient needs to be awake because unlike cPAP it does not push the air in and the patient actually has to breath.
normal CO2 levels for COPD patients
60-70 you really dont wanna drop them lower then that because their instinct to breath is dependent on CO2 rather then O2 like us
what kind of people end up getting elective intubations
surgery and CVA patients
what are the ET sizes in men vs women
women: 7-7.5
men: 7.5-8
where is a normal ET placement? what happens if the ET tube gets pushed down? what happens if it gets pulled up?
about 1 inch above the carina. If it gets pushed down it will go down the right lung and cause the left lung to collapse. If it goes up neither lung will receive proper oxygenation.
what drugs do you give patients before intubation
- benzo(versed)
2. paralytic agent (succenylcholine, proprofol, vecuronium)
which patients are hardest to put an ET in? what are they at risk for? how do you care for these patients
1.short necks
2.obese
at risk for hypoxia (due to multiple attempts) watch for bradycardia and hypoxia(observe monitor) during insertion
how do you confirm ET placement and which landmark is the carina at?
CXR, 4th intercostal space at the nipple line.
what will happen if you have no fully inflated an ET cuff
you will hear gurgling
What are the different modes on a vent and what do they do
- AC (assisted control)-machine does all the work
- SIMV(synchronized intermittent mandatory ventilation) -it will help the patient reach some goal. such as if the patient inhales 200 it will push the extra 300 in.
- CPAP (continous positive airway pressure)-patient does all the work the machine just helps keep the alveoli open
- PEEP (positive end expiratory pressure) - increases oxygenation by keeping the alveoli open. It is contraindicated in hypotension because it increases intrathoracic pressure which decreases preload. You need an order to add PEEP to patients post CABG. Normal PEEP (5-10)
What is the VT setting on vent
Tidal volume, it is dependent on weight normal tidal volume is 6-8 ml/kg
what is the normal RR on a vent
14 plus minus 2
what vent setting would you adjust first if a patient is hypoxic
set FiO2 to 100%
what is hyperventilation
has nothing to do with oxygen and everything to do with RATE of respirations and flushing of CO2
what vent setting would you adjust to lower CO2
increase the RR
what is the difference between O2 sat and PO2
- O2 sat is the % of hemoglobin that has oxygen attached to it
- PO2 is the amount of oxygen dissolved in blood. (80-100)
what is the difference between hypoxemia and hypoxia
hypoxemia means the PO2 levels are dropping (60-80)
hypoxia means that the PO2 levels have dropped below 60 and due to the oxyhemoglobin dissociation curve the tissues are now not getting enough oxygen.
describe the oxyhemoglobin dissociation curve
O2 sat lateral and PO2 level horizontal. It looks like the graph of pH buffers the magic numbers being PO2 of 60 and O2 sat of 90%
what is the general purpose of the pulmonary function test (PFT)
tell us how good the lungs are
