Mr. small dick Pabalate's must know!!!! from his review on friday!!!!!!

Question 1

with the volume mode of a ventilator what do we need to set?

Answer 1

TV

RR

PEEP

Others less known are

peak flow

FiO₂

Question 2

when in volume mode we know you will always give that dialed in amount of Volume, but b/c of this what is sacrificed or varies in this mode

Answer 2

pressure

Question 3

what does the Ventilation pattern look like in volume mode

Answer 3

saw tooth

Question 4

What needs to be set or what can be changed in the pressure mode?

Answer 4

the amount of pressure

RR

other less known are:

Inspiratory pressure

I:E time

Question 5

we know that when in pressure mode no matter what happens the pt will always always always get that set amount of pressure, since this occurs what is sacrificed or varies

Answer 5

volumes

Question 6

what type of surgery would be ideal for using pressure mode? and why? (there are probally many but he specifically used one type as his main example)

Answer 6

laporoscopy procedures

b/c when they induce the peritonium(something), basically when they insulfate the abdomen it causes intraabdominal pressures to increase and elevate the diapraghm and cause inceased intrathoracic pressures, that make ventilation with volume alone difficult. and your TV can decrease.

Question 7

What pressure can cause barotrauma

Answer 7

????? i dunno i think he said saty under 60 I will cont to look

Question 8

What is the ventilatory wave form for pressure mode?

Answer 8

Square

Question 9

What is volutrauma

Answer 9

ALVEOLI damage from the repetative expanding then streatching then expanding and streathcing of the lungs. this causes the alevoli to be in pain and swell and get thincker, as we know the thicker the membrane the worse diffusion. also the cell mediated response can cause ARDS.

It’s like the name says VOLUtrauma- too much voume.

think of it as if you went and did the worlds best streatch as dr. P did (which we are in no way as fine of a specimen as he) but we would be sore and ur muscles wouldn’t work well. the same thing happens in our lungs.

except for dr. p his alveoli would just multiple and grow extra alveoli b/c he is a badass

Question 10

what is Barotrauma

Answer 10

the lung actually POPs, you develope MICRO tears, you cause actual damage to the lung it self.

this often occures from too much pressure and the lung just pops

it’s like over inflating a balloon too much pressure and pop goes the weasle

Question 11

what is a concern with isolated pressure control ventilation, (not the fancy ones), just plain old PCV

Answer 11

there is no alarm for TV’s and too much volume can be easily given

an example of this if if you are using PCV on a LAP case and have the pressure on 45 to ensure proper TVs and SPO₂ on this fat bastard and they deflate the abdomen and you are not watching they will continue to get that presure. which could take their 400 TV and make it 1200 and pop instant barotrauma

now u need to nig rig a chest tube with a 14 or 16g angio cath into their proximal mid clavicular chest to decompresses your ignorant mistake

Question 12

what will alarm on the PCV mode say if they get too large of a TV since the TV alarm itself will not go off?

Answer 12

MV alarm

it will state High MV usually these are set at approx 10-12L/min (just a ball park figure he through out to us)

for ex of your pt has RR 8 and gets a TV of 250= 2,000mL/min or 2.0L/min not bad

if you all of a sudden deliver a TV of say 1400 ml to this pt then 11,200 mL/min =11.2 L/min a huge increase

Normal MV is around 5-10 L/min

Question 13

what is MV

so what is MV if the pt is the following

O₂ Sat 86%

TV 250 ml

I:E 1:2

RR 15 min

Pressue suport 22

PEEP 5

Answer 13

TV x RR

3,750 mL/min= 3.7 L/min

Question 14

what does PCVVG mode stand for?

Answer 14

Pressure controlled ventilation volume guarentee

Question 15

What does PCVVG mode do? what must be dialed in? why is it good or bad? what alarms may go off? when and why?

tell me all you know about it

Answer 15

You dial in the TV and RR and it will deliver that TV at the lowest possiable pressure needed to acheive that volume

this is great for Lap cases b/c it will prevent to large of TVs being given if abd is deflated thus protects the lungs from too much TV form too high set pressure!!!

iIf it can’t reach the TV with the max pressure set it will alarm 2 times, once to say pressure too high and once to say low TV

Question 16

What mode is this pic from

Answer 16

Volume mode

notice the (shitty) saw tooth

Question 17

What mode if this pic of

Answer 17

pressure

Notice the fantastically drawn Squares

Question 18

what mode is this in and explain what is occuring per the wave form

for your assistance

TV 500

RR 12

Pressure 40

Answer 18

PCVVG

Question 19

what ventilation mode was invented b/c @ emergence the last bit of VAA hangs around for ever. So you are trying to have them breath spont and they have small TV (basically not enough th actually cause VAA to exchange) so this mode will assist with every breath to allow pt to poss have a larger TV?

Answer 19

PSVPRO

Question 20

So it sounds like PSVPRO os just like PSV right?? but what is the main Differnce that separates them?

Answer 20

the PSVpro mode will sense if the pt is apnic for 30 sec or has low Tv and will change to an alternate mode called SIMV-PC.

So basically with every spont breath it will give and assisted breath based on pressure and when the pt is apnic the SIMV still provides a set amount of breaths a min

Question 21

what is the blue wave form?

Answer 21

a pt initiated breath

Question 22

what is the signal to initiate the breath?

can be synced to ventilator initiated breaths via a timer

or (more commonly seen) senses the pt effort

Answer 22

trigger