Notes Unit 2 Flashcards
Indications for intubation
Airway swelling, surgery, to clear secretions, neurologic compromise, seizures, respiratory failure (ARDS), 50/50 rule.
What is the 50/50 rule?
50-CO2 is above, 50-O2 is below.
What supplies are needed for intubation?
ETT tube, stylet, lubricant, blade and handle (laryngoscope), 10cc syringe, blunt needles, flanges, bougie, CO2 detectors.
What is an ETT tube?
Endotracheal tube, standard size 7-8, with a bulb that inflates, and 24 at teeth.
What types of laryngoscope blades are there?
Miller (straight) and Mac (curved).
What is the purpose of CO2 detectors?
Clips to ambu bag and indicates color changes.
What should be done before intubation management?
Sedate the patient, suction at bedside, have ambu bag ready, auscultate, ensure equal rise and fall.
What are the steps for intubation?
Measure tube, stat chest x-ray for length, ABC within 30 minutes, tape tube in place.
What medications are used in intubation?
Pantoprazole (peptic ulcers), Propofol (sedative), Midazolam (sedative), Dexmedetomidine (sedation for vent), Vecuronium (paralytic), Succinylcholine (paralytic).
What are the side effects of Propofol?
Hypotension, bradycardia, when wean off.
What are the side effects of Midazolam?
Hypotension, bradycardia, titrate when wean off.
What is the purpose of Dexmedetomidine?
Sedation for ventilation without affecting respiration, easier to wean.
Why do we need potassium labs?
To monitor for hyperkalemia, especially with succinylcholine.
What is Acute Respiratory Distress Syndrome (ARDS)?
ARDS is a condition characterized by lung injury leading to flooding and collapse of the alveoli.
What are the diagnostic criteria for ARDS?
Diagnosis is based on lung injury, chest x-ray findings, and clinical symptoms such as bilateral infiltrates and hypoxia.
What does ARDS look like clinically?
Patients may present with dyspnea, pallor, crackles, rapid shallow breathing, substernal retractions, tachycardia, and cyanosis.
What are the key interventions for ARDS?
Interventions include prevention of hypoxia, intubation, mechanical ventilation, and prone positioning.
What are the characteristics of ARDS?
Characteristics include low tidal volume, high PEEP, impaired gas exchange, and bilateral infiltrates on x-ray.
What does it mean if BNP is slightly elevated in ARDS?
A slightly elevated BNP may indicate heart failure or non-lung related issues.
What is the normal pH range?
7.35-7.45
What is the normal range for CO2?
35-45 mmHg
What indicates alkalosis in blood gas interpretation?
pH > 7.45 or CO2 < 35 mmHg
What indicates acidosis in blood gas interpretation?
pH < 7.35 or CO2 > 45 mmHg
What does a pH of 7.1 indicate?
Acidosis
CO2: 56 (acidosis), HCO3: 23 (normal) - Uncompensated respiratory acidosis
What does a pH of 7.22 indicate?
Acidosis
CO2: 30 (alkalosis), HCO3: 20 (acidosis) - Partially compensated metabolic acidosis
What does a pH of 7.54 indicate?
Alkalosis
CO2: 40 (normal), HCO3: 29 (alkalosis) - Uncompensated metabolic alkalosis
What does a pH of 7.43 indicate?
Normal
CO2: 31 (alkalosis), HCO3: 20 (acidosis) - Fully compensated metabolic acidosis
What does PH measure?
The measure of free hydrogen ions in the body.
What does CO reflect?
How well the lungs are ventilating.
T CO2 = V PH
How is HCO3 related to hydrogen ion production?
Inversely related.
1 HCO3 = 1 PH
What is the role of the lungs in acid-base balance?
They are the 2nd line of defense, responding by altering the rate/depth of respirations.
What happens during acidosis in terms of respiration?
The rate/depth of breathing increases to ‘blow off’ CO2.
What happens during alkalosis in terms of respiration?
The rate/depth of breathing decreases to ‘retain’ CO2.
What is the role of the kidneys in acid-base balance?
They are the 3rd line of defense, altering excretion and absorption of bicarbonate and hydrogen.
What do the kidneys do during acidosis?
Excrete H+ and retain HCO3- to help balance pH.
What do the kidneys do during alkalosis?
Retain H+ and excrete HCO3-.
What are the signs/symptoms of respiratory acidosis?
Hypoventilation, hypercapnia, hypertension, tachycardia, confusion, disorientation.
What are the severe effects of hypercapnia?
Vasodilation, increased intracranial pressure, and potential for fibrillation.
What causes metabolic acidosis?
Acid accumulation in serum or loss of bicarbonate.
What are the signs/symptoms of metabolic acidosis?
Headache, confusion, drowsiness, nausea/vomiting, vasodilation, and arrhythmias.
What are the signs/symptoms of respiratory alkalosis?
Hyperventilation and loss of CO2.
Signs include lightheadedness, inability to concentrate, numbness/tingling, tachycardia, and arrhythmias.
What causes metabolic alkalosis?
Stomach acid loss or electrolyte imbalance.
What are the signs/symptoms of metabolic alkalosis?
Hypocalcemia (numbness, dizziness, tetany) and hypokalemia (U-wave on ECG).
What are the modes for mechanical ventilation?
There are 2 modes for mechanical ventilation.
What is Tidal Volume in mechanical ventilation?
Tidal volume is the volume of air delivered with each breath.
What does Fio2 stand for?
Fio2 stands for the fraction of oxygen delivered, ranging from 20-100%.
What is PEEP?
PEEP stands for Positive End Expiratory Pressure.
What is the purpose of spontaneous breathing trials?
Spontaneous breathing trials allow the patient to initiate breaths while the vent supports.
What is the role of pressure support in mechanical ventilation?
Pressure support delivers support at a preset pressure while allowing the patient to initiate breaths.
What is SIMV?
SIMV stands for Synchronized Intermittent Mandatory Ventilation, where the vent delivers support at a set rate and tidal volume.
What is the purpose of oral care in mechanically ventilated patients?
Oral care is important for preventing ventilator-associated pneumonia (VAP).
What is the recommended head of bed (HOB) position for critically ill patients?
The recommended HOB position is -30 degrees.
What is the significance of using a humidifier in mechanical ventilation?
A humidifier is used to moisten the air delivered to the patient.
What is the purpose of repositioning the ET tube?
Repositioning the ET tube is necessary to prevent pressure sores on the mouth .
What is fluid retention related to?
Cardiac output
What is Barotramva?
Excessive pressure popped lung
Tension premo
What does tracheal deviation refer to?
Chest tube
What is volutrauma?
Tidal volume too high
Damage to one lung, using placement
What does self extubate indicate?
Med emerg
Ambo bag, call for help!
What are the steps to wean to extubate?
OG tube, trend ABG’s
HOB 30, wean sedations, oval cave, DUT prophylaxis
What should be monitored until commands are followed?
CPAP mode, protonix - vicer, sedation vacation, extubate
What are the steps for deep suctioning?
Cut ties, tube holder off, air out of bulb
Pull quickly, suction again, monitor!
Indications for tracheostomy
Move stable airway, sturdy - harder to pull out, easier to sedate, less sedation, less stress on vocal cords, easier to wean off, 10-14 days of vent = trach them.
Pre-operative considerations for tracheostomy
Done at bedside, hold anticoagulation (like heparin), NPO night before, sedate → paralytic!
Maintenance after tracheostomy
Vessel changes, will see bleeding mucosa, document, bright red days later, wean off to lowest setting, move to trach collar, then keep downsizing.
What to expect after weaning off tracheostomy
Will have button from trach once off.
What are the characteristics of Sinus Bradycardia?
P-Wave: yes
QRS: present
Rhythm: regular
HR: 140
What are the characteristics of Sinus Tachycardia?
P-Wave: yes
QRS: present
Rhythm: regular
HR: 7100
What are the characteristics of Ventricular Fibrillation?
P-Wave: NO
QRS: absent
Rhythm: none
HR: none
What are the characteristics of Atrial Fibrillation?
P-Wave: NO
QRS: present
Rhythm: Irregular
HR: controlled: 4100, uncontrolled: 7100
What are the characteristics of Ventricular Tachycardia?
P-Wave: NO
QRS: present
Rhythm: regular
HR: 7100 (100-170)
What are the characteristics of Asystole?
P-Wave: NO
QRS: absent
Rhythm: none
HR: None
