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Vent Support + Lab > quiz 5 > Flashcards

quiz 5 Flashcards

1
Q

What does the P(a-ET)CO2 tell us?

A

The difference between arterial CO2 and end tidal CO2
Increases in the difference indicate an increase in deadspace

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2
Q

What can cause dead space?

A

PE
Loss of circulation
COPD
Being dead (cardiac arrest)

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2
Q

What is dead space?

A

Ventilation without perfusion

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3
Q

How do you determine the ratio of deadspace to tidal volume

A

VD/VT ratio

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4
Q

What is the formula for the VD/VT ratio?

A

PaCO2 - PeTCO2 / PaCO2

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5
Q

What is a normal VD/VT ratio?

A

.2-.4

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6
Q

What does an elevated VD/VT ratio mean?

A

An increased amount of deadspace

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7
Q

What can cause respiratory acidosis?

A

Parenchymal lung disease
Airway disease
Pleural abnormalities
Chest wall abnormalities
Neuromuscular disorders
CNS depressing

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8
Q

What are the diagnostic benchmarks for determining respiratory acidosis?

A

pH < 7.35
PaCO2 > 45 mmHg

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9
Q

What is the formula to determine an appropriate tidal volume for a patient on a vent with respiratory acidosis?

A

Desired VT = (known PaCO2 x Known VT) / Desired PaCO2

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10
Q

What is the formula for determining an appropriate RR with a patient on a vent with respiratory acidosis?

A

Desired RR = (Known PaCO2 x Known RR) / Desired PaCO2

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11
Q

What is the risk of a high respiratory rate?

A

autoPEEP

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12
Q

How can you determine if a patient has autopeep?

A

On exhalation, flow will not return to zero before a new breath is given

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13
Q

What can cause respiratory alkalosis?

A

Metabolic problems
Hypoxia
Medications
CNS disorders

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14
Q

What are the diagnostic benchmarks for diagnosing respiratory alkalosis?

A

pH > 7.45
PaCO2 < 35 mmHg

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15
Q

What are the most common causes of respiratory alkalosis in vented patients?

A

hyperventilation …..oops
Pain
Fever
Asynchrony
Hypoxemia

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16
Q

What are the diagnostic benchmarks for determining if someone has metabolic alkalosis?

A

pH > 7.45
HCO3 > 26 mEq/L

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17
Q

What are the diagnostic benchmarks for determining if someone has metabolic acidosis?

A

pH < 7.35
HCO3 < 22 mEq/L

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18
Q

What can cause a metabolic acidosis?

A

Ketoacidosis
Loss of bicarb (diarrhea)
Medications
Lactic acidosis
Toxins

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19
Q

What can cause a metabolic acidosis?

A

Loss of gastric fluid (vomiting, NG suctioning)
Diuretics
Medications

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20
Q

Will a patient with metabolic alkalosis become apneic?

A

Apparently not

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21
Q

What are some indications for suctioning?

A

Patients has a weak cough
Changes in waveform
Deterioration of oxygen saturation

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22
Q

What is the formula for determining the correct suction catheter size?

A

(ETT size x 3) / 2

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23
Q

What is the appropriate suction pressure for adults?

A

-100 to -120 mmHg

24
Q

What is the appropriate suction pressure for children?

A

-80 to -100 mmHg

25
Q

What is the appropriate suction pressures for infants?

A

-60 to -100 mmHg

26
Q

What are some potential complications from suctioning?

A

Your patient hating you
Atelectasis
Hypoxemia
Loss of PEEP
Cardiac arrhythmias
Bradycardia
hypo/hypertension
Infection

27
Q

T/F: For a patient on a vent, a SVN is more effective than an MDI with a spacer

A

False. MDIs with a spacer have been shown to be more effective than SVNs

28
Q

What should be considered when giving an MDI through a vent?

A

Whether or not an HME is being used as it will take the medication out before it reaches the patient

29
Q

What are some indications for bronchoscopy?

A

Presence of lesions
Evaluation of atelectasis or pulmonary infiltrates
Assess upper airway patency
Suspicious sputum cytologic results

30
Q

What are contraindications for a bronchoscopy?

A

Hemodynamic instability
Poor oxygenation

31
Q

When performing a bronchoscopy, what piece of equipment should be used to maintain PEEP?

A

No fucking clue, slides call it a PEEP keep. Probably just need to know that you need something special to maintain PEEP

32
Q

What is normal urine production?

A

50-60 ml/hour
1 ml/kg/hour

33
Q

What is the term for low urine output?

A

Oliguria

34
Q

What is the term for high urine output?

A

Polyuria

35
Q

What are the 5 drivers of hypoxemia?

A

Low oxygen tension of inspired gas
Alveolar hypoventilation
Diffusion defect
V/Q mismatch
Shunting

36
Q

T/F: Healthy individuals have a natural V/Q mismatch

A

True. the apical sections of the lungs will have more ventilation and less perfusion than the bases which will have more perfusion and less ventilation

37
Q

What is the most common cause of hypoxemia?

A

V/Q mismatch

38
Q

What is a shunt?

A

Blood that does not participate in gas exchange either because of anatomical layouts or unventilated alveoli

39
Q

What is ficks law?

A

Vgas = A/T x Dgas(P1-P2)
Vgas = volume of gas diffusing across a membrane
A = Surface area tension
T = thickness of the membrane
Dgas = diffusibility of the gas (solubility coefficient)
P1-P2 = pressure gradient

40
Q

What is circulatory hypoxia?

A

Hypoxia caused by not having enough blood in circulation
Primarily caused by vampires

41
Q

What is anemic hypoxia?

A

When you have enough blood (for now) but insufficient red blood cells in the blood

42
Q

What is histoxic hypocia?

A

An excellent band name
When you have sufficient blood and RBCs, but for some reason tissues are unable to use the oxygen

43
Q

What are the two main tools we have to combat hypoxia?

A

Supplemental oxygen
PEEP

44
Q

What settings on the ventilator control ventilation?

A

Control variable
Rate

45
Q

What settings on the ventilator control oxygenation?

A

PEEP
FiO2

46
Q

List some reactive oxygen species

A

Superoxide ions (O2-)
Hydrogen peroxide (H2O2)
Hydroxyl ions (OH-)

47
Q

What can large amounts of reactive oxygen species do to the body?

A

Damage lung tissue
Disrupt cell signaling
Break strands of DNA

48
Q

What can hyperoxia cause?

A

Systemic vasoconstriction
Pulmonary vasodilation
Inflammation
Oxidative stress on pulmonary, cardiovascular and neurological systems
Create ROS

49
Q

What is the normal partial pressure of oxygen in arterial blood?

A

80-100 mmHg

50
Q

What is the normal partial pressure of oxygen in venous blood?

A

40 mmHg

51
Q

What is the range of the partial pressure of oxygen in the alveoli when on room air and when on 100% oxygen?

A

100-673 mmHg

52
Q

What is the oxygen content of mixed venous blood?

A

15 vol%

53
Q

What is the normal saturation for mixed venous blood?
75%

A

75%

54
Q

What is the oxygen content of arterial blood?

A

20 vol%

55
Q

What is normal oxygen delivery? (DO2)

A

1000 mL/m

56
Q

What is normal oxygen consumption?

A

250 ml/min

57
Q

What are the main goals for oxygenation?

A

Maintain a PaO2 of 60-90 mmHg
Try to keep FiO2 below 0.5-0.6
Maintain CaO2 at 20 mg/dL

58
Q

What are the main dangers of prolonged high FiO2?

A

Oxygen toxicity
Absorption atelectasis

Vent Support + Lab (5 decks)

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