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Pediactric and Neonatal Respiratory Care > PNRC07 > Flashcards

PNRC07 Flashcards

1
Q

Two main complications of INO

A

Methemoglobinemia and Nitrogen Dioxide NO2

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2
Q

What can you do if the complications arise from INO?

A

decrease the Nitric

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3
Q

What are the levels that we are concerned with when it comes to MetHb and NO2

A

Need to wean if:
>5% methemoglobin
>5 ppm

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4
Q

Indications for weaning INO

A

hemodynamically stable on FIO2 <40% with Peep of 5 or less.

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5
Q

A pt that has ventilation problems can benefit from what

A

HELIOX

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6
Q

A pt that is having issues with oxygenation would benefit from what?

A

Nitric

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7
Q

Nitric Oxide enhances what vessels?

A

It will selectively produce pulm dilation.

**It will only dilate the blood vessels adjacent to functioning alveoli…NOT alveoli that is collapsed/fluid filled

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8
Q

Hyperoxygenating a pt who is ready to wean from INO

A

Set FiO2 to .6 to .7 OR 20% above before DCing the INO.

***This is done AFTER the INO has been reduced to lowest possible dose.

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9
Q

The FDA has approved INO tx for what ppl

A

Respiratory failure associated with pulmonary HTN and >34 weeks

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10
Q

OI formula

A

(Mean Airway Pressure x O2%) / PaO2

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11
Q

Why does INO work well with HFOV

A

Improves the response to INO by decreasing shunting

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12
Q

What likely causes methemoglobinemia vs Nitrogen Dioxide

A

Met Hb caused from high INO doses

NO2 caused from high PPMs and high FiO2

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13
Q

How to wean down INO

A

Reduce the INO to the lowest effective dose in increments of 50%. (10 to 5 to 2.5 ect)

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14
Q

What is the best attribute of Helium?

A

It has an extremely low density allowing it to decrease WOB, which is why it aids in ventilation NOT oxygenation.

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15
Q

Main indications for Heliox treatment

A

Upper airway obstruction (Foreign body aspiration) and Status asthmaticus.

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16
Q

How does heliox work?

A

It decreases Raw by creating more laminar flow and removes a much larger amount of CO2.
***DOES NOT treat the problem, only acts as a band-aid, this is called a temporizing agent

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17
Q

How do you deliver heliox if pt is not on ventilator?

A

non-rebreathing mask

**HAVE TO KEEP valves closed on the mask

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18
Q

Available ratios for heliox delivery

A

80/20 and 70/30

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19
Q

What patients receive 70/30 heliox?

A

Patients that are already on oxygen or pt that isnt on oxygen with an ABG showing hypoxia
**Think about it, 70/30 has more O2 in it than 80/20

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20
Q

Why do you need a special flow meter/regulator?

A

Because the flow meter will read a very false LOW

**Need to use conversions to calculate actual flow

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21
Q

How to calculate actual flow with Heliox delivery

A

80/20 mixture? Multiply flow by 1.8

70/30? multiply by 1.6

22
Q

Some vents may cause what with some vents

A

erroneous flows and volumes

23
Q

As someone goes up in altitude, what will you need to change to maintain the same PaO2

A

you need to increase the % of O2 (FiO2)

24
Q

Temperature vs altitude

A

Almost always has to do with hypothermia, and fix this by blankets and warming all IV fluids

25
Q

Positioning of patient on flight transport

A

parallel with the wings to decrease acceleration forces

26
Q

do you place someone with the good lung up or down?

A

Good lung DOWN

*This helps match the ventilation with perfusion

27
Q

OI of >30

A

Needs HFOV

28
Q

OI >25

A

Needs INO

29
Q

OI >40

A

ECMO

30
Q

Mortality rates associated with OI values

A

> 25 is 50% mortality

>40 is 80%

31
Q

How to calculate P/F ratio

A

PaO2/FiO2

32
Q

PF ratio values and indications

A

200-300= ACUTE lung injury
100 to 200 moderate ARDS
<100 is severe and NEEDS ECMO

33
Q

Two types of high frequency ventilators

A

Jet and Oscillatory

34
Q

Similar characteristics between Jet and Oscillatory

A

Breaths delivered at 150+ rates
Very non-compliant vent circuits (very stiff)
TV that are small 1-3ml/kg

35
Q

Primary goal of HFV

A

to minimize negative consequences of ventilatory support through lung protective strategies

36
Q

Requires a special ETT adapter and requires a ventilator

A

HFJV

37
Q

Range is 4-11Hz

A

HFJV

38
Q

Has PASSIVE exhalation

A

HFJV

39
Q

What verifies adequate amplitude in HFOV?

A

waves that produce a vibration aka “wiggle”

40
Q

Hz for HFOV

A

3-15Hz

41
Q

1Hz = ?

A

60 breaths per minute or one cycle per second

42
Q

How is the breath generated in HFJV?

A

delivered by a high-pressure pulse of gas

43
Q

Active exhalation

A

This is a characteristic of HFOV. The machine, during exhalation, actively “pulls” the gas out of the lungs

44
Q

Three main things that the HFJV

A

Creates sigh breath via CMV to prevent atelectasis and produce surfactant
PEEP
Cont. flow to allow for jet propelled breaths

45
Q

**How do you decrease the amount of CO2 on the oscillator?

A

You want to DECREASE the frequency (Hz) because it will increase the minute ventilation

46
Q

**On the oscillator how does changing the amplitude effect CO2 ventilation?

A

Increase the amp/power will remove CO2, decreasing the PaCO2

47
Q

If you need to increase elimination of CO2 on the oscillator what would you adjust first, second?

A

First change the AMP then the frequency (Hz)

48
Q

On the oscillator, what are the two settings you can change to effect oxygenation?

A

MAP and FiO2

49
Q

How do you know if you have enough ‘wiggle’

A

wiggle needs to be below the nipple line. If it isn’t, you need to increase the AMP via the power
**Want it past the nipple line or even down to groin/feet

50
Q

Difference in weaning from HFOV and HFJV

A

If on HFJV, reason for being placed on the jet is resolved. For HFOV, you want FiO2 <60 and MAP <20

Pediactric and Neonatal Respiratory Care (9 decks)

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