Pulmonary Flashcards
What are the contraindications for succinylcholine?
Malignant HTN, hyperkalemia, U/LMN lesions, myopathy, crush injury, severe burns, prolonged immobility
What are causes of tracheal bleeding after 7 days?
Granulation tissue, stomal site infection, erosion of thyroid vessels/gland, tracheal wall erosion, tracheoinnominate fistula
When can plateau pressures be measured?
no-flow conditions on end-expiration
What biomarkers do you test for in anaphylaxis?
Histamine 30-60 min after event
Tryptase 60-90 min after event
Hw does prone ventilation affect the RV?
Reduction in RV size, less TR, normalize the interventricular septum
How is transmural pressure calculated and titrated?
Transmural = airway pressure - pleural pressure
Esophageal is a substitute for pleural pressure.
Measure at end expiration when airway pressure = PEEP
When pleural pressure is negative at end expiration, the outside pressure is greater than the inside pressure. Increase PEEP
Keep pleural pressure below 20
What are the different causes of high PIP=Plat versus low PIP-Plat?
How do you identify flow starvation on the vent?
The Pressure mustered is high and the Paw is low because of the negative flow associated with the attempted triggered breath
Can increase the flow and flow profile (to decelerating to square to maintain the flow during the inspiratory phase)
How do you identify double triggering on the vent?
Inspiratory efforts extend into the expiratory phase to trigger a second breath and causes stacking
Increase the Vt/Ti or increase sedation
How is wasted effort seen on the vent?
Ineffective flow triggers
Improve trigger sensitivity or address any auto-PEEP leading to ineffective breaths due to stacking or set PEEP
How is reverse triggering seen on the vent?
Inspiratory effort that is delayed but often doesn’t meet criteria to generate a new breath, a slightly off-beat initiation attempt. , bumpy flow but no double trigger on volume
May need to paralyze
How is premature cycling seen on the vent?
Vent terminates the breath but the inspiratory muscles continue to contract from patient effort
Decrease expiratory trigger, increase Vt, decrease flow, increase Ti
How is delayed cycling seen on the vent?
Duration of the mechanical breath is longer than the duration of the inspiratory effort
Decrease Ti or increase expiratory trigger sensitivity
