Module 3 Manual Ventilation Flashcards
What is VAP?
A acquired disease from a ventilator
How do we know the tubes/lines are in the right place?
If the chest or stomach rises
Why would you push against the cicrothryoid ligament?
to collapse the esophagus
What indicator is there when the endotrachial tube is too deep?
The right lung/side rises more than the left.
Why do you want to keep 5cm of PEEP?
To keep lungs/airways/alveoli open.
3 important factors for humidity
Edit
Ensure proper temperature control, maintain adequate humidity levels, and adhere to device maintenance and sterilization protocols.
- humidity level is important to ensure that airways don’t get irritated
- Adequate humidity levels help prevent the drying out of mucous membranes, reduce airway irritation, and improve mucus clearance. Insufficient humidity can lead to dry, crusted secretions and increased airway resistance.
BLS Basics
2 types of respiratory failure
Type 1: oxygenation
Type 2: ventilation
6 Procedure steps when bagging (the process)
- Assess…alertness
- Position
- Assess…airway for patency
- Consider…oral or nasal airway
- Bag
- Consider…intubation
Which inhalers are short acting and which reduce inflammation
Ventolin (open airways)
flovent falls into the beta agonist group (corticosteroid) to reduce inflammation
VSD vs Asthma…when can a person be taken off of puffers (for VSD)
Vocal chords shut causing us to hear strider
what can help elevate a exasbaration (sob) when there is CHF
CPAP can help relieve exasbaration temporarily so that we can figure out what is happening.
Causes for: (7)
Hypoxemia Respiratory Failure Type 1
When things block oxygen from getting to blood.
- V/Q mismatch
- Shunt
- Alveolar Hypoventilation
- Diffusion Impairment
5 Perfusion/diffusion impairment - Decreased inspired O2
- Venous admixture
Cause of:
Hypercapnic Respiratory failure (Type II)
Impaired Resp. Control
Neurological disease
Increase WOB
5 Therapy/treatment for Type 1 heart failure?
What are the most effective
Increasing FiO2 and PEEP are the most effective therapy methods.
FiO2 increases MAP - how does PEEP get involved?
TLDR; oxygenation
Treatment/therapy methods for Type 2 Failure?
you manage MV - manipulate rate or Vt.
Vt
Rate
MV
pH
PaCO2
TLDR: Ventilation
Peak pressure must not exceed
(refer to slide 29)
30mmhg
what about Vt? (5-8)
humidity (no greater than 37)
MR. SOPA mnemonic
M - mask
R - reposition
S - suction
O - obstruction
P - pressure
A - airway equipment
PaCO2 greater than what value indicates that the patient needs ventilatory support ?
55
Inadequate lung expansion value for Vt?
less than 5
Inadequate lung expansion value for vital capacity
less than 10
Normal vital capacity = 65-75
Inadequate lung expansion value for RR?
greater than 35
Inadequate muscle strength that indicates ventilatory support
edit later
-Increased WOB
-Maximum inspiratory pressure (MIP) greater than or equal to -20 (its normally a small number)
VC is needed for a good cough
-Normal VD = 2.2 ml/Kg
Minute ventilation (MV) = 100m x Kg increase due to amount of deadspace ventilation (swapping the use of negative pressure to positive pressure bc forcing air in)
Vt = 5-8ml/kg
= 6 (80 (bw)) = 480ml
= 8000/480ml = RR
->8000 = Mv (100 * kg)
MV is equal to what?
Aka how do you calculate
Vt x RR?
Respiratory failure is a life threatening impairment of Oxygenation, CO2 elimination, or both.
What is it caused by (usually)?
Impaired gas exchange
Decreased ventilation
or both
Symptoms of respiratory failure?
(add dx and tx later)
Situations requiring airway control: emergencies
Situations requiring airway control: urgencies
What is the purpose of the Sniffling position?
Open airways
why is PEEP (on cpap) helpful for someone with CHF
Helps push fluid out of the lungs
- Decreases the amount of fluid that backs up into the heart because of the changes in pressure
Crackles is a indicator of what?
Fluid in the lungs (or consolidation)
Suction pressure for Adults, Children, and infants?
Adult: 120-160
Children: 100-120
Infants: 80-100
Indicators for a partial obstruction
wob, strider, and snoring
Contraindications for OPA use
Conscious or semiconscious patient
-gag reflex (opa)
-vomiting
-laryngeal spasm
-trauma to oral cavity (OPA)
-trauma to mandibular or maxillary areas of the skull
What does the acronym RODS tell us?
Difficult supraglottic device placement
R: restricted mouth opening
O: Obstruction (at or below glottis)
D: distorted/ displaced airway radiation/ trauma
S: stiff lungs,chest,neck etc.
what are some functions of oral pharyngeal airways (opa)
Relieving a soft tissue obstruction
facilitate sunction
prevents patient biting on the tube
Advantages of NPAs over OPAs?
patients are less likely to gag
oral care on the patient is viable (like intubation)
more comfortable via nose
How does sizing work for NPAs?
Tip of the nose to the tragus (ear)
What does the acronym MOANS indicate?
how hard it is to bag someone
MOANS acronym?
M: Mask seal
O: Obstruction/obesity
A: Age
N: No teeth
S: stiffness of snores
What does the acronym bones measure?
difficulty to bag a person
Safety checks for the bagger
The reservoir inflates
If the valve moves
If it holds pressure
Does the bag re-inflate
What is a LMA?
Laryngeal mask airway
edit refer to slide 60 on insertion
Why would LMA be used before a endotracheal tube?
if you can’t get it in, or…
LMAS are more secure than an endotracheal tube.
Advantages of Laryngeal masks
easy to insert
no special equipment
Disadvantages of Laryngeal mask?
Short term use
- danger of aspiration (if they vomit it could go into their lungs)
- Low ventilation pressures only
- Not used on conscious or semi conscious patients due to gag reflex
Key points Manual ventilation: O2 delivery?
Edit
Key points Manual ventilation: Rate?
Edit
Key points Manual ventilation: volume?
Edit
What would you do when there is low SpO2 but adequate chest rise?
Consider using PEEP
-+5 cmH2O
Increases the amount of time held under pressure aka inspiratory time.
what does Positive pressure ventilation cause when minute ventilation (MV) is low?
Increase deadspace.
You want to keep MV high.
why would you intubate someone?
They can’t breath on their own (poor ventilation)
or
They have too many secretions that they can’t get out on their own (blockage)
Assessment of pt after suction (outcomes)
Improved breath sounds
Removal of secretions
Increase SpO2
Decreased WOB
monitor pt for changes
What is type I resp. failure?
Hypoxemic resp. failure where oxygenation fails, causes could be:
- V/Q mismatch
- Shunt
- Alveolar hypoventilation
- perfusion/diffusion impairment
- decreased inspired O2
- venous admixture
What is type II failure?
hypercapnic resp. failure, causes could be:
- Impaired resp. control
- Neurologic disease
- Increased WOB
Key concepts that affect oxygenation (type I failure)
FiO2
PEEP
MAP
PaO2
(one more but slide cut if off, check later)
Factors that affect ventilation (type II failure)?
Vt
Rate
MV
pH
PaCO2
Indications to clear upper airways (suction)?
Auscultation -> crackles
Visual WOB
- Accessory muscle use
- Indrawing
- Stridor
- Heart failure
- RR
What do you want to improve from suction?
O2 saturation
Color and perfusion
effective cough
Suction settings (vacuum pressures) for adults?
120-160 mmHg
Suction settings (vacuum pressures) for children?
100-120mmHg
Suction settings (vacuum pressures) for infants?
80-100 mmHg
