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random Flashcards

1
Q

What happens if your PaO2 is less than 60

A

your periph chemoreceptors will kick in and increase vent RR and depth

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2
Q

what happens if your PaCo2 is low?

High?

A

Low= your breathing is too fast. need to decrease breathing

High= your breathing is to low. need to increase breathing

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3
Q

high-flow O2

A

is warmed non-invasive

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4
Q

abnormal ECG: too slow

A
  • atropine** (anticholinergic- blocks nerve receptors)
  • dopamine (A, B1)
  • Epinephrine (A)
  • temp pacemaker
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5
Q

abnormal ECG too fast

A
  • try to assess cause
  • amiodarone** (A.flutter/Afib - if dramatic)
  • adenosine**
  • BB, CCB (diltiazem, verapamil)
  • abnormal electrical cardiovert
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6
Q

abnormal ECG no P wave

A
  • chemical or electrical cardiovert
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7
Q

abnormal ECG ST changes

A
  • prevent or minimize ischemia
  • Do 12 lead ECG
  • Trops
  • thrombolytic
  • Nitro
  • ## morphine
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8
Q

what is adenosine used for?

A
  • SVT’s (A.fib/flutter/A.tachy/ JT)
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9
Q

what is dobutamine used for

A

mostly B1- increase HR

some A and B2

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10
Q

what is dopamine used for

high dose

low dose

A

high- vasoconstrict

low- + inotrop increase HR

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11
Q

what is milronone used for

A

A and some B1

Vasodilate and increase contractility

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12
Q

name some sedatives

A
  • propofol
  • versed (midazelam)
  • precedex (Dexmedetonide)
  • lidocaine
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13
Q

name the NMBAs

A
  • rocuronium

- succinylcholine

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14
Q

normal PR interval?

A

< 0.20

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15
Q

Normal QRS interval?

A

< 0.12

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16
Q

Normal QT interval

A

0.40 - 0.44

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17
Q

how do you test EF?

A

ECHO

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18
Q

What causes metabolic acidosis

A

increase acid or loss of base

  • diarrhea
  • increased acid (lactic acidosis or diabetic ketoacidosis)
  • renal failure
  • shock
  • alcoholic ketoacidosis
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19
Q

What causes metabolic alkalosis

A

decreased acids or increased base (HCO3)

  • vomit/NG drain
  • renal loss of H+ (diuretic/steroid use)
  • vol depletion
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20
Q

what does metabolic acidosis with partial compensation look like

A

pH 7.30
PaCO2 30
HCO3 15

pH and base are acidic, the PaCO2 is low (Alkalotic). Meaning that the PaCO2 is compensating but not fully

21
Q

what does metabolic alkalosis look like with full compensation

A

pH 7.45 N (on Basic side)
PaCO2 50 A
HCO3 33 B

PaCO2 is opposite of HCO3, meaning compensating and pH is normal but on the alkalotic side

22
Q

Why do you level the transducer?

A

to correct changes in hydrostatic pressure at phlebostatic axis

4th ICS mid anterior

23
Q

why do you zero the transducer

A

to calibrate to atmospheric pressure

baseline

24
Q

How do you zero the transducer?

A
  • open stopcock to air: when off you see flat waveform on monitor
  • take cap off
  • zero on screen and wait until it says ‘zeroed’
  • replace cap
  • turn stopcock again
25
Q

how do we know if there is a good ART waveform?

A
  • look at BP and MAP
  • look for dicrotic notch
  • for every heart beat, a waveform is present
  • ART waveform shouldnt change in size, If it does could indicate poor perfusion
26
Q

what is a normal square waveform

A
  • square and 1-2 oscillations
27
Q

what is a underdamped waveform

A

The ART waveform will have tall peaks and dicrotic notch is low (overshooting) - high sensitivity

The square will have many sharp oscillations after

*may give false high pressures**

28
Q

what is an overdamped waveform

A

The ART waveform will look like humps and hardly have a dicrotic notch (overdampened)

Less sensitive. The square and then low waves or no oscillations

may give false low

29
Q

what would decreased CO look like on the waveform?

A

low BP, smaller waveform and perhaps loss of dicrotic notch

30
Q

How do you trouble shoot an ART line?

A
  • Assess Pt: ABC
  • Insertion site: bleeding?
  • HR or BP changes?
  • tubing
  • flush solution and pressure bag
  • transducer, cable, monitor
31
Q

Scvo2 and Svo2

A

Scvo2 is upper body and Svo2 is mixed

drawn from CVC

NOT ART line

normal is 60-80%

less than 60 = O2 not meeting demand

32
Q

AC mode

A
  • Set RR and TV

- Pt can breath above RR but they get a set TV

33
Q

what is a normal Vt?

A

6-8ml/kg normal

4-7 mls/kg for decreased lung compliance

34
Q

What is Ppeak

A

pressure + Peep

If this or PIP starts to increase = decreasing lung compliance

35
Q

What is PIP

A

peak inspired pressure of entire system

Should be < 50

Watch for trends

36
Q

what is Plateau pressure. What does it measure?

A

Lung compliance only

< 30

37
Q

Pressure Control

A

Used for decreasing lung compliance
typical RR 15/pressure 25

Set RR
Set Pressure

Pt can breath above RR but gets set pressure. Volume will vary

Use when Peak pressures have been increased or concerns about lung compliance

Peak pressure= pressure + peep

38
Q

What is Pressure support

A

Pt has to breath spontaneous. Weaning mode (ICU)

No set RR or Tv

  • ventilatory senses pt’s attempt to inhale and adds an additional 5-10% of pressure to help you take a breath. This method helps to SUPPORT SPONTANEOUS RESPIRATION because you initiate inhalation on your own.
39
Q

What is SIMV

A

synchronized intermit mandatory vent
Weaning

Set RR and Tv

Doesn’t breathe for you, breaths in synch with you. set the RR to something and it will give these breaths to the patient at a certain TV regardless, when the patient tries to breath spontaneously, the ventilator will sense this and assist the patient with these spontaneous breaths. the machine knowns when you are trying to breath spontaneously so it knows how to space out the certain number of set breaths that it has to give.

*** TV varies

PACU with PS

40
Q

parameters to wean vent:

A
  • FiO2 < 40%
  • Pt has gag and can maintain own airway
  • Wean PEEP to 5 and maintain for 12-24hrs
  • RR< 32
  • SpO2> 90%
  • pH> 7.25
  • hemodynamic stable SBP >90 or < 180
  • low or no vasopressors
41
Q

Weaning vent failure:

A
  • HR > 140 or increase > 20% from baseline
  • SBP > 180 or < 90
  • RR > 35 FOR > 5min or signs increased WOB
  • PaO2 decreased by 10mmHg from preweaning OR < 50 mmHg
  • diaphoresis, anxiety, agitation
42
Q

Diagnose ARF

A

acute resp failure

Fail in one or both: Vent/ gas exchange

  • PaO2 < 60
  • PaCO2 > 45
  • pH < 7.35
43
Q

Indication for Mech vent

A
  • compromised airway: cough/gag. secretions. vomit? GI bleed? loss muscular tone
  • Severe oxygenation issue (pneumonia, pulm edema)
  • Severe Ventilation Issue (COPD, decreased LOC, pneumonia)
  • anticipated clinical course- expected to get worse
  • possible sx
44
Q

what does BNP test for

A

Heart failure

> 400 = HF

45
Q

Lactate

A

from hypo-perfusion or hypoxia
< 2 is normal
> 4 = lactic acidosis

46
Q

Trop

A

cardiac biomarkers

47
Q

what electrolyte shifts do you see in Refeeding syndrome

A

hypoMg
Hypo Phos
Hypokalemia

If you see very low phos think refeeding or diabetic keto

48
Q

what meds prolong QT

A

some antibiotics: mycins, flagyl,
antifungal: fluconazole

Haldol

49
Q

what is ROSC

A

return of spontaneous circulation

Review important info for clinical (1 decks)

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