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ITT > RESP > Flashcards

RESP Flashcards

1
Q

Indications for BLES

A
  • FIO2 > .4 on PEEP> 5 to maintain SPo2 >90%

- can redose @ 4hrs

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2
Q

Mech vent calculation

A

VE: ped 100-200, neo 200-300
VT: ped 6-8 ml/kg, 4-6 ml/kg

VE/VT= RR
60sec/RR = TCT
TCT/3 = I:E 1:2
TCT/2 = I:E 1:1 (common in neos)
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3
Q

upper limit of PIP/PLat in neo

A

25cmH20

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4
Q

TTN pulmonary edema mechanism

A
  • mechanical expulsion of fluid
  • catecholamine release from labour
  • may be depressed from induction agents from GA = less cry
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5
Q

potent pulmonary vasodilator

A
  • oxygen ( max 50% ish, SPO2 > 90 PAO2 50-70)

- nitric oxide

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6
Q

Vent target for PPHN

A

PIP < 25
PEEP 4-5
Rate - 40ish

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7
Q

SPO2 targets PPHN

A

pre- 90

post- > 70

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8
Q

Goals of PPNH tx

A

1- surfactant (RDS) (MAS/pneum)
2- correct acidosis as it causes vasoconstriction (inotropes (dob, vasopressin), possibly bicarb)
3- O2 vasodilator
4- ABX
5- decrease PVR with sedation (morph, fent) or paralysis, or pharmacologically with milrinone (inotrope, PVR reduction and lucitropy (cardiac relaxation), prostin (offload RV by maintaining duct latency, also a pulmonary vasodilator)
6- start dobutamine in conjunction with initiation of nitric 20mcg/kg/min
7- adequate ventilation 8-9ribs of inflation, peep 5-8, 4-6 ml/kg, permissive CO2
**consider sidenofil

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9
Q

caution of NO initiation

A

LV over load as its not used to increase preload from RV ie start dobutamine (start @ 5mcg/kg/min)

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10
Q

effects of PPHN on CVS

A

high PVR> RV dysfunction> v/q, decreased LV preload= LV dysfunction

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11
Q

how much O2 should you give in PPHN

A

fi02 > 50 shows no benefit in maximizing pulmonary vasodilation (Pa02 50-70)

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12
Q

mechanism of NO

A

increases cAMP = increased calcium causing dilation

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13
Q

NO complication

A

hypotension, pulmonary haemorrhage ( secondary to intact sunt), Methemoglobinemia, platelet dysfunction,

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14
Q

dosing of NO

A

start at 20 PPM, wean 3-5mcg/min

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15
Q

Big heart on CXR?

A

Auscultate head look for AVM. Especially if pt has low O2 requirement

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16
Q

Pulmonary interstitial emphysema

A

Air leak secondary to rupture of an overdistended alveolus. Overdistention may be due to generalized air trapping or uneven distribution of gas. The air dissects along the perivascular connective tissue sheath toward the hilum, resulting in a pneumomediastinum, or into the pleural space, producing a pneumothorax

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17
Q

type 2 pneumocytes

A

5% on pneumocytes. produces surfactant

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18
Q

effects of surfactant

A
  • protects from collapse (surfactant gets closer together when alveoli are smaller, and become more effective, resulting in less volume required to keep alveoli open
  • protects from over-distension (
  • increases compliance
  • established FRC
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19
Q

what is MIST

A

minimally invasive surfactant therapy ( laryngoscope to visually surfactant by OG while baby is on nasal CPAP)

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20
Q

diaphragmatic hernia goals

A

intubate
ng
avoid PPV (use t piece with PPV less than 25cmh20)
heavy sedation

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21
Q

1-2 kg un-cuffed tube size

A

3

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22
Q

< 1kg un-cuffed tube size

A

2.5

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23
Q

> 2kg un-cuffed tube size

A

3.5

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24
Q

acceptable leak for volume ventilation

A

< 40%

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25
Q

BLES dose

A

5ml/kg broken into 2 doses

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26
Q

rough ETT depth

A

tip of nose to tegus + 1

OR

3 X tube size

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27
Q

TFI in healthy pre-term

A

high side of normal ie 80ml/kg/day on day 1

28
Q

what to consider when deciding how many lumens to use on UV

A
  • how much fluid you need to utalize as each lumen requires at leas .5ml/hr for patency
29
Q

how to hepranize a line

A

1ml (1 unit) in 100ml

30
Q

what solution is used for UA

A

hepranized 1/2NS

31
Q

anatomical dead space in anyone

A

2ml/kg

32
Q

what type of flow does HFJV utilize

A

transitional flow

33
Q

how does the HFJV avoid truculent flow

A

short Ti (.02)

34
Q

how can ventilation reach the distal alvoli

A

fast high pressure jet that doesn’t have to fill dead space to inflate alvoli

35
Q

how does HFJV clear secreations

A

expiratory flow circles the inspiratory flow almost sweeping secretions along the boarders of airway parenchyma

36
Q

what type of ventilator isn’t ideal for cardiac patents

A

oscillator due to the active insp and exp causing airway collapse in inspected intrathoracic pressure

37
Q

6 candidates for HFJV

A
  • PIE and PALs ( air flow moves past large spaces)
  • BPD / gas trapping
  • non-homogeneous lung disease )MAS (also helps clear secretions)/ bronchiolitis)
  • CDH/ pulmonary hypoplasia
  • hemodynamic instability (lower Mean airway pressure)
  • prem with RDS
38
Q

key points of transitioning to CMV from jet

A
  • higher PEEP
  • Higher rate
  • smaller volume
  • try to meet Mean airway pressure or higher (typically 2 cmh2o higher)
  • consider paralysis and more sedation
39
Q

how do you transition from jet to Ti

A

2-3 cmh2o greater than MAP on jet

40
Q

how do you transition from oscillator to Ti

A

1/2 the MAP noted on oscillator

41
Q

RSV

A

cytopathological response

destruction of endothelium conducting airways, when airways repair, they lack cilia and have extra goblet cells which causes large amounts of secretions causing a restrictive pathology (poor compliance). Epithelium takes roughly 2 wks to repair

  • TX: Humidification!!!, O2 = High flow

Dx: RUL consolidation

42
Q

Resistance issues

A

asthma, bronchiolitis, airway abnormalities, croup, epiglottitis

43
Q

compliance issues

A

atelectasis/consolidation, bronchiolitis, aspiration/ fact viral pneumonia, pARDS, CHF

44
Q

when is an uncuffed tube used

A

croup on peds and neonates. this is because the trachea is an oval therefore causing leaks and damage

45
Q

what is the occluding pressure on tracheal capillaries in peds

A

roughly 15cmH2O

46
Q

ETT size formula

A

uncuffed age/4 +4

cuffed age/4 + 3.5

47
Q

what is in indication for exhibition in croup

A

cuff leak

48
Q

what is the ETT depth formula

A

tube size x 3

49
Q

suction tube size formula

A

ETT x 2

50
Q

suction depth formula

A

ETT X 3

match arrow on tube with number on suction, then note what colour is in the window

***caution in cut tubes

51
Q

viral infection

A

croup

52
Q

bacterial infection

A

epiglottitis

53
Q

benefit of PC over pRVC

A

you can control the pressure in PC vs pRVC will increase pressure to achieve the targeted volume

54
Q

why does NICU target lower vent values

A

because they are typically managing undeveopled alveoli due to immaturity

55
Q

confirming a tube

A
  • between clavicles and carina
  • T2-3
  • 1-cm above carina
56
Q

potential cause of gasping in an asthmatic patient on NIV

A

air trapping

- try to match intrinsic peep, as pt has to create a peep lower than the set peep to trigger the vent

57
Q

classic cause of R upper lobe consolidation

A

Brochoilitis

58
Q

when does the respiratory centre mature

A

35ish wks

59
Q

alveoli number in infants vs adults

A

20 milll @ birth vs 300 mill in adult

60
Q

size of alveoli in newborn vs adult

A

150-180 microM @ birth vs 240-300 microM in adult

61
Q

infant chest wall compliance results in

A
  • less opposition to elastic recoil of lungs
  • FRC low, which reach closing volume (peripheral alveoli closure) at end of expiration causing atelectasis with normal tidal volumes
62
Q

most common age for bronchiolitis

A

< 2yrs

63
Q

brochiolitis

A
  • typical < 12m
  • viral (RSV, rhino/enertovirus)
  • pathological airway edema increased mucous
  • CXR: hyperinflation with bilat shifting atelectasis (worsening compliance) (common in RUL @ beginning)
  • HFNC/BiPAP ( PEEP will ensure closing volumes don’t reach FRC) , ABX, gluc,
64
Q

common causes of pneumonia based on age

A

neo: group B, E.coli, gram -
inf: RSV, chlamydia, adenovirus
Todd: Pneumoccoccus, Group A, viral
Adolecent: All + legionella, gram -

Aspiration: staph, step, anaerobes

65
Q

asthma management

A

salbutamol neb, predisone (1mg/kg) Q12, methylpednisone (1mg/kg) Q 6 OR Hydrocortisone (4mg/kg) Q 4-6hrs

IV Mg, Aminophyllin (cannot be used with erythromycin= toxicity) , IV salbutamol ( indication is a pt who doesn’t become tachycardia regardless of lots of ventolin neb), BiPAP **all targeted to buy time until steroid works

66
Q

OI

A

oi= mapa FiO2

67
Q

why are peds more susceptible to resp failure

A

< 8 closing pressure is greater than FRC

ITT (17 decks)

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