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RTH 132 > PPV > Flashcards

PPV Flashcards

1
Q

what is cerebral perfusion pressure

A

CPP = amount of blood perfusing brain

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2
Q

what two values equal CPP

A

mean arterial blood pressure - intercranial pressure = CPP

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3
Q

what does PPV do to ICP

A

increases

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4
Q

what does PPV do to MAP

A

decreases

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5
Q

what is normal cpp

A

88

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6
Q

to treat ptx with CPP what can you do

A

medically induced hyperventilation

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7
Q

when is medically induced hyperventilation good for

A

in emergencys like seizures and coughing

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8
Q

where should you keep MAP at

A

30 cmH2O or less

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9
Q

increased airway pressure increases what 4 things

A

increased MAP, intrapleural pressure, intrapulmonary pressure, intrathoracic pressure

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10
Q

what factors affect MAP

A

mode of ventilation, level of positive pressure, duration of insp & exp, nature of waveforms, level of PEEP, lung/thorax mechanism

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11
Q

VILI

A

ventilatory induced lung injury

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12
Q

VALA

A

ventilator associated lung injury

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13
Q

in normal lungs what amount of pressure is transmitted to the thoracic cavity

A

50%

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14
Q

how much deadspace is increased just bc pt is on a vent

A

40%-60%

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15
Q

what types of traumas can occur in the lungs from PPV

A

barotrauma/volutrauma

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16
Q

how often does barotrauma/volutrauma occur

A

5-15%

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17
Q

what is shearing

A

one portion inflates faster than others

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18
Q

tearing

A

overdistension

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19
Q

where should you keep PIP

A

less than 60

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20
Q

what things can happen as a result of barotrauma

A

pneumothorax, pneumomediastinum, pneumoperitoneum, etc

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21
Q

biotrauma

A

causes excessive stretching of alveolar cells

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22
Q

what does biotrauma cause

A

forms edema, releases inflammatory mediators and chemical mediators

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23
Q

vent factors that increase risk of barotrauma

A

large VT, high peak/mean pressure, high PEEP, long insp times, high FIO2, infections, aspiration

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24
Q

patient factors that increase risk of barotrauma

A

decrease compliance, increase resistance, pre-existing bullous DX, surfactant deficiency, host immunity, ARDS

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25
Q

what does auto peep increase

A

WOB and pulmonary vascular resistance

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26
Q

air trapping has what length of time constant

A

long length

27
Q

in a pressure volume loop what does a flat top indicate

A

overdistending lung

28
Q

how do you fix a flat pressure volume loop

A

decrease pressure or volume

29
Q

T/F pressure in upper airway may not reflect alveoli pressure

A

t

30
Q

how many ventilator pts develop lung infections

A

15-40%

31
Q

where should you keep the head of bed

A

less than 30

32
Q

commonly isolated pathogens - gram negative

A

pseudomonas, klebsiella, E-coli, influenzae

33
Q

gram positive

A

staphlyococcus aureus, streptococcus pneumoniae

34
Q

what does high concentrations of oxygen produce

A

oxygen free radicals

35
Q

what detoxifies radicals

A

superoxide dismutase

36
Q

what produces superoxide dismutase

A

type II cells

37
Q

what does oxygen toxicity cause

A

decrease in: tracheal mucus flow, macrophage, VC, surfactant production, compliance, diffusion capacity, pul cap blood flow, cap injury, endothelial cell damage, absorption atelectasis

38
Q

hemodynamic considerations increase

A

increased intrathoracic pressure, systemic blood volume

39
Q

hemodynamic considerations decrease

A

pul blood flow, venous return, right vent stroke volume, pul arterial pressure, filing pressure, left vent stroke volume

40
Q

how much blood do the kidneys recieve

A

25% of bodys circulating blood

41
Q

what do volume receptors do

A

found within left atrium, sensing decreased volume,, which then signals increase in ADH, to stop urine output

42
Q

what do baroreceptor stimulation cause

A

carotid bodies in aortic arch decreases CMO

43
Q

what does low PAO2 effect on kidneys

A

decrease in urinary flow/function

44
Q

what level of co2 has a big effect on kidneys

A

65

45
Q

what level of o2 effects kidneys

A

below 40

46
Q

what does plasma renin activity do

A

activates cascade to retain sodium and ater

47
Q

where does blood flow redistribute in the kidneys

A

outer cortex decreases while inner cortex (juxtamedullary region) increases

48
Q

what does blood flow redistribution lead to

A

more sodium, urine, and creatine being absorbed

49
Q

what indications renal failure

A

oliguria <180 ml in 8 hours

increase BUN and creatinine

50
Q

what is normal BUN (blood urea nitrogen)

A

10-20 mg/Dl

51
Q

what is normal creatinine levels

A

0.7-1.5 mg/dl

52
Q

diet changes bun or creatinine

A

bun

53
Q

perfusion changes bun or creatinine

A

creatinine

54
Q

what can decrease portal vein flow to the liver

A

drop in CMO and diaphragm moving into abdomen

55
Q

indicators of liver dysfunction

A

prothrombin time >4 seconds
bilirubin level >50mg/L
albumin level <20g/L

56
Q

what causes mucosal edema

A

blood being pushed out from the organs

57
Q

in terms of ab considerations what can happen to bowel and stomach

A

swelling of bowels and stomach and bowel obstruction

58
Q

what can make swelling in abdomen worse

A

peep

59
Q

how many patients get ulcers caused by what

A

20% and stress

60
Q

what type of diet can lead to higher co2

A

high carb diets

61
Q

t/f vent slows wound healing

A

true

62
Q

t/f copd pts have high caloric needs

A

true

63
Q

what does induced hyperventilation do to the hemoglobin curve

A

shifts to the left causing less o2 to tissues and can cause hypoxia

64
Q

how does induced hyperventilation interfere with cerebral tissue metabolism

A

reducing atp stores and 2,3 DPG levels

RTH 132 (11 decks)

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