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Crit Care > Peep continued > Flashcards

Peep continued Flashcards

1
Q 
PaCO2 and VA or alveolar ventilation are \_\_\_\_
\_\_\_\_\_ related.
A.  Directly
B.  Inversely
C.  Linearly
A

B. Inversely related

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2
Q 
spontaneous ventilation results in gas distribution to which regions of the lungs?
A.  Non dependent lung regions
B.  Dependent lung zones
C.  Peripheral lung zones
D.  A,B, C
E.  B&C
F.  A&C
G.  B only
A

E. Both B & C; spontaneous ventilation results in gas distribution to dep and peripheral regions

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3
Q 
PPV ventilation results in gas distribution to which regions?
A.  Non dependent lung regions
B.  Dependent lung zones
C.  Peripheral lung zones
D.  A,B, C
E.  B&C
F.  A&C
A

A PPV distributes to non dependent lung zones because of inactivity of muscles & diaphragm

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4
Q

What is a normal value for PvCO2?

A

45 mmHg

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5
Q

In emphysema, formation of bullae is cause of destruction of pulmonary capillaries the result is:
A. poor perfusion & ventilation
B. Increased perfusion & ventilation
C. Poor perfusion & normally ventilated alveoli

A

C. Poor perfusion & normally ventilated alveoli

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6
Q 
When previously collapsed alveoli are reopened what is the outcome?
A.  FRC improves
B.  Surface area increases
C.  PaO2 increases
D.  all of the above
A

D. all of the above

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7
Q

After a recruitment maneuver what is the best way to determine the optimal peep?

A

decremental peep trial

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8
Q

When increased mean airway pressure occurs what does it do to cardiac output?
What will decrease mean pressure?

A

Reduced venous return occurs and causes reduced cardiac output/you can reduce mean pressures with decrease in inspiratory time, rate, peep, or PIP.

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9
Q

If you need to absolutely control your patients minute ventilation which mode should you use?

A

Volume control

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10
Q

If a patient is on PC-SIMV and you see his WOB is high and PaCO2 high indicating respiratory acidosis, what besides changing frequency or driving pressure could be done to help reduce this PaCO2?

A

Add PSV

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11
Q 
Of the four types of hypoxia which type is attributed to altitude and/or hypoventilation
A.  Hypoxemic hypoxia
B.  Anemic hypoxia
C.  Circulatory hypoxia
D.  Histotoxic hypoxia
A

A. Hypoxemic hypoxia

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12
Q 
When looking at your a/v difference if you find your value is below the normal of 5 what does this mean?
A.  Patient not oxygenating
B.  Patient consuming too much O2
C.  Patient may have hyperthermia
D.  Both B & C
A

A. Patient is not oxygenating if you a/v difference is below normal of 5; conditions can include cyanosis or hypothermia

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13
Q

If you are using more O2 (for example in fever) what would you expect would happen to your a/v difference?
A. Increase
B. Decrease

A

If your O2 consumption increases then your a/v difference would increase

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14
Q

What is your normal oxygen extraction ratio?

A

25%

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15
Q

What is your normal venous oxygenation?

A

75%

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16
Q

In a normal patient when analyzing your FIO2 what would you expect your PaO2 to be?

A

5x the FIO2 value in normal lungs

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17
Q

What is the formula for PAO2?

A

PAO2= FIO2(Pb-47) - (PaCO2/.8)
Pb= barometric press=760
Water vapor pressure = 47

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18
Q

What is the oxygen content formula?

A

CaO2=(SaO2xHBx1.34)+(PaO2x.003)

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19
Q

What is the shunt formula?

A

Qs/Qt=CcO2-CaO2/CcO2-CvO2

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20
Q

What is your formula for CcO2?

A

CcO2=(Hbx1.34x1.0)+(PAO2x.003)

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21
Q

What is the formula for CvO2?

A

CvO2=(Hbx1.34xSvO2)+(PvO2x.003)

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22
Q

The goal of using PEEP is _______ in respect to alveoli & at the same time avoiding __________________ to open alveoli.

A

The goal of peep is to recruit collapsed alveoli while avoiding overdistension to open alveoli

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23
Q 
Indications for use of PEEP include:
A.  Bilateral infiltrates on chest x-ray
B.  Reduced lung compliance
C.  Atelectasis with low FRC
D.  All of the above
A

D. all of the above

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24
Q

Expiratory pressure that are kept above ambient pressure with PEEP use a variety of devices that are either _____ or _______ resistors

A

Flow or threshold resistors

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25
Q

This type of resistor is flow dependent?

A

Flow resistors; the higher the expired gas the higher the expiratory pressure generated

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26
Q

This type of resistor provides a constant pressure throughout expiration irregardless of rate of gas flow.

A

Threshold resistor

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27
Q 
Conditions which may benefit from the use of higher PEEPS include?
A.  Ali 
B.  Ards
C.  Cardiogenic pulmonary edema
D.  Unilateral pneumonia
E.  All of the above
F.  A, B, & C
G.  A, B, & D
A

Answer: F: A, B, C

Only bilateral pneumonia would benefit from PEEP therapy

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28
Q

In normal oxygen transport you would want to see your pulmonary shunt fraction less than?

A

15%

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29
Q

If you have a patient that has perfusion but no ventilation what would you suspect was going on?

A

Shunt is present, use of peep would be beneficial

30
Q

When PEEP is used and you see a restoral of FRC what else should improve?

A

Compliance

31
Q

T or F: When using Peep you would expect an increase of Ve

A

False

32
Q

T or F: TWhen monitoring patients with chest wall injuries or hypovolemia the measurement of Compliance would serve as a good indicator of optimum PEEP or cardiovascular changes.

A

False

33
Q

In a hypovolemic patient what should be used to judge if you have a good level of peep without cardiovascular decline?

A

Invasive technique such as balloon tipped pulmonary artery catheter

34
Q

What is a normal value for your arterial to venous oxygen difference?

A

5vol% at rest

35
Q

When Peep is applied successfully what would you expect to happen to your alveolar to O2 tension gradient?

A

The gradient difference of P(A-a)O2 should decrease to reflect improving V/Q.

36
Q

Oxygen delivery depends on what 3 factors?

A

Oxygen delivery depends on FIO2, CaO2

and CMO

37
Q

FIO2 change of 10% = ____ torr

A

50 torr

38
Q

Your goal of oxygenation is to keep FIO2 at _________

to prevent oxygen toxicity

A

60% or less

39
Q 
A patient with myasthenia gravis is
started on mechanical ventilation. THE
chest x-ray is normal. Breath sounds are
clear. Initial ABG’s on 0.25 are pH 7.31,
PaCO2 62, PaO2 58 and HCO3 31 mEq/L
A.  increase FIO2 to improve oxygenation
B.  improve ventilation
C.  Make no change at this time and monitor patient until prognosis worsens
A

B improve ventilation; patient in respiratory acidosis

40
Q

T or F: It would be acceptable to treat a patient that has cardiac tamponade (heart leaking fluid) post- heart surgery with PEEP

A

True

41
Q 
Conditions that will not respond to O2 and cause shunt include:
A.  Pneumothorax
B.  Atelectasis
C.  Pneumonia
D.  all of the above
E.  none of the above
A

D. all of the above cause shunting that will not respond to O2

42
Q

What affect does PEEP have on Mean airway pressure?

A

It will increase mean airway pressure

43
Q

What is a normal therapeutic range for PEEP?

A

above 5

44
Q

All of these patients would be poor candidates for PEEP except:
A. Emphysema patient
B. Patient with highly compliant lungs
C. A patient with a head injury
D. A patient with bilateral lung disorder

A

D. bilateral lung disorder

45
Q 
Hazards of Peep include?
A.  Increased CMO
B.  Increased Venous return
C.  Increased Right ventricle afterload
D.  all of the above
E.  A & B only
F.  B & C only
A

Right ventricle afterload

46
Q

When you experience right ventricle afterload what is the effect felt to the patient?

A

Stiffness

47
Q

T or F: Volutrauma and barotrauma are known to be a hazard of PEEP

A

True

48
Q 
Other Hazards of Peep include?
A.  Decreased CMO
B.  Decreased Venous return
C.  decreased left ventricular distension
D.  Decreased liver and renal function
E.  All of the above
A

E. All of the above

49
Q

T or F: PVR is another hazard associated with use of peep which means increased ventricular resistance

A

true

50
Q

T or F: When using the recruitment maneuvers, patients suffering from direct lung injury such as those conditions affecting lung tissue will be less successful than those suffering indirectly injuries

A

True

51
Q

T or F: It is impossible for lungs to hyper-inflate without overstretching?

A

False

52
Q

________ is defined as a higher than normal ratio of gas to tissue.

A

Hyperinflation

53
Q 
Increases to alveolar wall tension or distending pressure causes?
A.  Over-distention/overstretch
B.  Hyperinflation
C.  increased levels of inflammatory mediators
D.  A & B
E.  A & C
F.  ABC
G.  B & C
A

D: overdistention and increased levels of inflammatory mediators results from too much pressure on alveolar walls

54
Q

T or F: Use of PEEP in patients with head injuries is not recommended as it may cause an increase in CVP.

A

True

55
Q

T or F: Peep can be effective in treating either overdistention or already existing hyperinflation.

A

False; Peep is not effective in treating hyperinflation in patients like emphsyema

56
Q

An example of a condition that causes overdistention is ______ while another condition of _________ causes hyperinflation.

A
  1. Ards

2. Emphysema

57
Q

T or F: When a patient presents with fluid consolidation, pink frothy secretions, and crackles this is indicative of development of ARDS and use of PEPP would be indicated

A

False: Pink, frothy secretions with fluid buildup is a symptom of CHF and cardiogenic pulmonary edema which is different from edema of ARDS; They will benefit from PPV that reduces venous return and the amount of blood the heart must pump which reduces the work of the heart

58
Q

Why is oxygen therapy less effective in

absolute shunt than in V/Q mismatch?

A

With V/Q mismatch there is still contact with the alveoli but in absolute shunt no contact is made which is why O2 not effective

59
Q

Name an absolute contraindication for Peep

A

Untreated Tension Pneumothorax

60
Q

Name 4 relative contraindications of Peep.

A

Hypovolemia
Increased ICP
Increased FRC due to emphysema or over compliance
Unilateral lung diseases

61
Q

In the case of Hypovolemia it is still possible to use PEEP but what must first be done?

A

Vasopressors must first be given to increase volumes

62
Q

The best Peep will provide what important outcomes? Name 4

A 
Improved O2 transport at best FRC
Improved FRC
Improved Compliance
Opening of alveoli
Avoids unmanageable cardiovascular side effects
63
Q

How do you find your O2 transport from cardiac output?

A

CO x CaO2 = O2 transport

64
Q

What is a normal value for alveolar-arterial O2 tension gradients?

A

5-10 mmHg on room air;

65
Q

When you measure your O2 delivery you look at what is getting to the tissues; what is a better indicator of O2
A. DO2
B. C(a-v)O2

A

B. O2 utilization is better illustrated to show us what the tissue is taking

66
Q

A normal CvO2 is

A

15 vol%

67
Q

Normal DO2 is?

A

1000 ml/min

68
Q

Normal O2 consumption is?

A

250 ml/min

69
Q

You can determine O2 consumption with which formula?

A

VO2=CO x (CaO2 - CvO2)

70
Q

In a normal lung the greatest amount of perfusion occurs in which zone?
A. Zone 1
B. Zone 2
C. Zone 3

A

C. Zone 3

Crit Care (8 decks)

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