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NBRC Questions > Mechanical Ventilation 3A > Flashcards

Mechanical Ventilation 3A Flashcards

1
Q

Vital capacity must be at least ___ to wean. (x2)

A

10 ml/kg or at least 1000

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2
Q

Minute Volume must be lower than ___ to wean someone.

A

10 L/min

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3
Q

Before weaning a patient, the PF ratio must be greater than ___.

A

300

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4
Q

Before weaning, you must verify that that the original disease process ____.

A

…has been reversed. (Don’t fall for a trap! If the numbers look great but the original disease process hasn’t resolved, don’t try to wean.)

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5
Q

An SBT is the best method to evaluate readiness to wean. What’s the minimum time for a spontaneous breathing trial? Maximum time?

A

30 min to 2 hours

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6
Q

If the patient fails an SBT, how long should you wait to try again?

A

24 hours. (DO NOT try the SBT again earlier than 24 hours!)

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7
Q

When weaning a patient, you may place the patient on SIMV and drop the rate down to a very low number. (True or false?)

A

False

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8
Q

While weaning, SBT will fail if HR increases by ___ beats. If it increases less than 20 beats, ___.

A

20

Continue weaning, but consider increasing FiO2.

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9
Q

Criteria for terminating SBT includes a resp rate above ___, or heart rate above ___. Also ___, and ___.

A

Resp rate increases above 35 for 5 min
Heart rate increases above 100
Anxiety
Arrythmias

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10
Q

What’s the indication for recruitment maneuvers?

A

ARDS, atelectasis

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11
Q

What’s the most common recruitment maneuver?

A

Increase PEEP to 40 for 40 seconds

20 for 20 seconds if pt is on CPAP

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12
Q

What if you do a recruitment maneuver and the SpO2 rises, but then falls again?

A

Do the recruitment maneuver again. After the recruitment maneuver, increase the PEEP.

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13
Q

The purpose of APRV is to increase oxygenation, not ventilation. When putting a patient on APRV, how high do you set the Phigh? (Pt is on PC)

A

2-3 cm H20 higher than MAP

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14
Q

When putting a patient on APRV, how high do you set the Phigh? (Pt is on VC)

A

Same as Pplat

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15
Q

How much volume should you set a patient who is starting on APRV?

A

4-8 ml/kg but keep pressure under 30-35

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16
Q

When putting a patient on APRV, how high do you set the Plow?

A

0-8

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17
Q

How long should Tlow be when setting APRV?

A

0.5-1 second

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18
Q

What will the resp rate be when setting APRV?

A

8-12 breaths per minute

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19
Q

What if you set your patient on APRV and they’re not getting good oxygenation?

A

Increase Phigh

Increase Thigh

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20
Q

What if you set your patient on APRV and they’re not getting good ventilation?

A

Increase Tlow

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21
Q

How do you wean someone from APRV?

A

“Drop and stretch method”
Gradually drop high pressure
Increase high time
Eventually high time becomes CPAP

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22
Q

If you want to put the patient from APRV to another mode, what mode should you put him on?

A

Don’t do this! Once they’re on APRV, the patient should stay there until they wean off APRV onto CPAP.

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23
Q

You put the patient on APRV and the patient keeps breathing at a high rate (45 bpm). This is okay, keep them on APRV. (True or false)

A

True. High rates on APRV are okay.

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24
Q

What’s the purpose of HFOV?

A

Improves oxygenation in patients with severe lung injury.

25
Q

A hertz (Hz) is ___ cycles per ___.

A

1 Hz = 60 cycles per minute

26
Q

How much tidal volume to HFOV patients usually get?

A

3-5 ml

27
Q

HFOV: Amplitude is the same as ___ or ___

A

Power or Delta P

28
Q

When using HFOV, what’s the primary control to adjust CO2?

What’s a secondary control to adjust CO2?

A

Amplitude/Power/Delta P

Frequency is a secondary control but won’t help much.

29
Q

If you turn up the amplitude, you’re really increasing the ___.

A

Volume

30
Q

When using HFOV, what’s a good I-time? (% and ratio)

A

30%, or 1-2 ratio. (I-time is expressed as a percent when using HFOV.)

31
Q

When using HFOV, what’s the primary control for oxygenation?

A

Mean Airway Pressure

32
Q

HFOV initial settings:

Amplitude

A

60-70 cm H2O (Look for chest wiggle)

33
Q

HFOV initial settings:

Frequency

A

5-6 Hz

34
Q

HFOV initial settings:
Bias flow
You can adjust from ___ to ___
Bias flow affects ___.

A

30 lpm
May adjust 25-40
Affects MAP.

35
Q

HFOV initial settings:

Mean Airway Pressure

A

20-30 cm H2O

36
Q

HFOV initial settings:

FiO2

A

Start at 100% then titrate down

37
Q

Making adjustments on HFOV: What should you do if you need to increase the PO2? (Primary and secondary options)

A

Increase the MAP

Secondarily, increase FiO2

38
Q

What two types of drugs should be given to all HFOV patients?

A

Sedation and NMBA

39
Q

Name some benefits of iNO.

A 
Dilates pulmonary arteries
Decreases PAP
Decreases stress on R heart
Improves hypoxemia
Reduces pulmonary vascular resistance
40
Q

When should we use iNO?

A

Refractory hypoxemia related to high PAP (ARDS)

41
Q

What is the standard dosage for iNO?
What is the maximum dose of iNO?
When weaning off iNO, you may decrease the dose down to ___.

A

Start at 40 ppm
Max dose is 80 ppm.
When weaning off iNO, you may go down to 20 ppm.

42
Q

What are the side effects of iNO?

A

Methemoglobin levels increase
Purple-blue cyanosis
Low O2 sat

43
Q

How can you measure methemoglobin levels?

A

Co-oximeter/Heme-oximeter

44
Q

How do you treat high methemoglobin?

What’s the secondary treatment?

A

Methlyne Blue

If they don’t have that, Ascorbic acid

45
Q

What is a common dangerous side effect of iNO? (Not high methemoglobin)

A

Nitrogen dioxide

46
Q

What might happen if you turn off the iNO too quickly?

A

Rebound pulmonary hypertension

47
Q

True or false: It’s okay to transport someone who is on iNO.

A

True.

48
Q

To wean someone, the RSBI must be less than ___.

A

100

49
Q

How do you regulate the flow using the O2 flowmeter to regulate the flow with heliox?

A

Multiply flow on flowmeter by 1.8 for an 80/20 mix

or 1.6 for 70/30 mix

50
Q

When pulling the ET Tube, you want to remove it at ___ ___.

A

Peak inhalation (prevents vocal cord damage)

51
Q

On HFOV, if you lower the frequency, you will (raise or lower) the tidal volume.

A

Lowering the frequency will raise the tidal volume.

Doesn’t make sense. Just go with it.

52
Q

To increase ventilation on HFOV, what should you do? (x3)

A

First increase amplitude/ power/ Delta P
Then decrease frequency
Then increase I-time %.

53
Q

To increase oxygenation on a patient on HFOV, you what should you do? (x3)

A

Increase MAP

Then increase FiO2

54
Q

There are a few different inhaled vasodilators you can give, like iNO, floLan, and Illoprost. Which one should you give?

A

iNO

55
Q

When using iNO via an anesthesia machine, the minute ventilation must be greater than the patent’s ___.

A

must be greater than the patient’s minute ventilation.

56
Q

How often should the iNOvent delivery system should be calibrated?
Can it be done while ventilating a patient?

A

Every 24 hrs.

Yes

57
Q

Two benefits of inhaled vasodilators:

A

Decreases V/Q mismatch and shunting.

58
Q

On the test, what patients should you extubate to NIV?

A

COPD’ers.

NBRC Questions (22 decks)

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