Quiz review Flashcards
An ICU pt has been intubated and on a vent for 7 days, pt is expected to have a prolonged ventilator support (more than 30 days). Which of the following would be the recommended method of continuing airway control
a. repeat oral intubation with smaller ETT
b. Switch to nasal intubation
c. Tracheotomy w/trach tube insertion
d. laryngectomy
C. Tracheotomy w/trach tub insertion
If a pt is to be intubated via RSI, how long should you preoxygenate?
3-5 minutes
During RSI, if pt is sufficiently pre-oxygenated and then vent is discontinued, how long does it take for the SpO2 to decrease to 90?
8 minutes
How often should the dressing be changed on a patient who has had a tracheostomy for more than 1 week
Once daily and PRN
What airway device would most be most appropriately used on a semi conscious adult pt who is obstructing?
Nasopharyngeal airway
What affect will raising PPV on a mech. ventilated Pt have?
Increase FRC
How do you calculate dynamic inspiratory time (Ti)?
- Vt/flow (lps)
- Remember to convert to seconds.
- Ti = [TCT/ I + E ratio]
Regarding a pressure control breath, when equilibrium is occuring, what can you expect?
Plateau pressure to be the same as peak peak pressure
Is a time triggered breath mandatory or assisted?
mandatory
What happens to mean airway pressure when a inspiratory pause is added?
Mean airway pressure increases
A Pt requiring NIV for management of COPD exacerbation requires what?
BiPap settings to allow for alleviation of resp. effort.
- Greater delta pressure/pressure support = greater tidal volumes
which pathology would benefit from CPAP?
Cardio pulmonary edema
what physiological effect does EPAP provide?
Increases FRC (oxygenation)
What is the purpose of a continuous controlled leak in non-invasive ventilation
Allow exhaled gas to escape
During NIV, adding an appropriate IPAP has what affect?
Reduces resp. muscle fatigue
On NIV, If EPAP improves EPAP what does IPAP do?
Reduces WOB by reducing resp. muscle fatigue.
Explanation:
- IPAP helps to increase the tidal volume by providing a higher pressure during inspiration.
- This helps to overcome any resistance in the airways and deliver a greater volume of air to the lungs.
- IPAP can also help to reduce the work of breathing by assisting the patient with inhalation.
An air bubble in the arterial line may produce what effect?
Pressure waveform having reduced amplitude
When the inflated balloon tipped PA catheter wedges in a small pulmonary artery, the BP measured through the distal lumen is approximately the same as what?
left atrial pressure
note proximal would be a measure of the PAP
Besides placement/location, to obtain an accurate wedge pressure reading, what condition must be met?
There must be uninterrupted blood flow between the catheter tip and the left heart
what are indications for open endotracheal (ETT) suctioning?
Visible secretions in the ETT
During CPR after an advanced airway is in place, how many breaths should be given?
one breath every 6 seconds (10 breaths in one min)
What is postural drainage?
Technique that involves laying/ sitting in certain positions to drain secretions from your airways using gravity.
Postural drainage is most appropriate for what condition?
Patient with an ineffective cough
If I:E is getting bigger, what does that mean about the ratio?
It is getting closer to 1:1
what size of particles would most likely be deposited into the lower parenchyma/alveolar region?
0.8 - 0.3 microns
what inspiratory flow should all turbuhalers, diskus, handihalvers have?
30 - 60 lpm
A pt with a FEV1 below normal (less than 0.7 of predicted) would likely have what pathology?
obstructive
what pulmonary function test requires the pt to inhale carbon monoxide (CO)
DLCO
When a thoracic drainage unit is being tested, why would a underwater seal be bubbling continuously when the chest tube is clamped?
The thoracic drainage system has a leak.
Nasopharyngeal airways are contraindicated by what factor?
Coagulation disorders
what is esophageal intubation?
Incorrect intubation placement
How can you rule out esophageal intubation?
Expired CO2 with a capnograph (confirms ventilation)
What is a common complication that occurs while intubating?
Esophageal intubation
If the patient is cleared for extubation, what should be done before the tube itself is removed?
Preoxygenate
A patient with long term ventilator requirements would benefit and serve as an indicator of?
Tracheostomy
For a patient with a cuffed tracheostomy tube, before a speaking valve can be applied what needs to be done?
Deflate the cuff
What is a primary physiological effect of PEEP?
Increases FRC
what is the most common complication post extubation
Air obstruction aka STRIDOR
What do the following mean
- Positive leak test
- Negative leak test
- A positive cuff leak test means that there is a significant difference in the patient’s ability to breathe with the cuff inflated versus deflated. This suggests that the ETT is obstructing the patient’s airway and there is a risk of developing post-extubation stridor or airway edema
- Negative cuff leak test means that there is no significant difference in the patient’s ability to breathe with the cuff inflated versus deflated. This suggests that there is a low risk of developing post-extubation stridor or airway edema, and the patient may be a candidate for extubation.
What is the most important consideration for extubation?
If the pt can protect their own airway.
- aka has cough/gag reflex
Passive ventilator circuits are also known as
non-heated vent circuits
How often should passive ventilator circuits be changed?
The circuits should be changed whenever they become visibly soiled or contaminated, or if there is a suspected or confirmed infection.
- In critically ill patients or those with copious secretions, the circuits may need to be changed more frequently, such as every 24-48 hours.
- In patients who are less critically ill or have minimal secretions, the circuits may be changed less frequently, such as every 3-7 days.
How will minute ventilation be by PC-CMV adaptative (PRVC)
PRVC will maintain a set min volume
(it will adjust pressures to meet volume requirements)
In pc-imv how would a decrease in endotracheal tube size (ETT) effect Ti dynamic (Ti)
- A smaller ETT will increase the resistance in the airway and require a higher inspiratory pressure to deliver the same tidal volume, resulting in a longer Ti dynamic.
- The vent will need to maintain the inspiratory flow rate for a longer time to reach the set tidal volume.
