Respiratory 4 Flashcards
mechanical ventilators use…
- *all positive pressure
- pushing air into lungs
- decreases BP
normal tidal volume
5-15 ml/kg or about 450-500
normal FiO2
fraction of inspired air
25-100%
normal rate
12-15 min
normal PAP
5 cm (of H2O)
normal PEEP
5 cm
normal I/E ratio
1:2
describe what the PEEP is
- at the very end of push, exerts more pressure (about 5) to open up at the end of the tubes of alveoli
- *increases O2 to alveoli (if something is blocking, it will need an extra push and increase)
these are used to open alveoli
pressure support and PEEP
some of the complications of ventilators
Decreased cardiac output, decreased BP, barotrauma, pneumothorax, atelectasis, oxygen toxicity, stress ulcers and VAP
what is barotrauma
- pressure trauma
- alveoli collapse and can lead to atelectasis
how do you prevent VAP
- no ventilator longer than >3 days
- HOB >30-45 degrees
- mouth care q4 hrs
if in ARDS, what should the FiO2 be set to
100%
what is assist control (AC) ventilator
- ventilator is mainly controlling their ventilator
- used when pt is not breathing well (can’t ventilate well) or are not awake
- set to deliver a specific amount, assist to hit what they need
- typically start on this after surgery
describe thoracentesis
- Procedure to remove lung fluid or blood
- May be done at the base of the ribs or under sternum
- Done at the bedside, patient is medicated and site is numbed
features of ARDS
- Patchy infiltrates
- No signs of heart failure
- No improvement in PaO2, desprite increasing oxygen delivery (FiO2 at 100%)
- Tissues lining the alveoli and capillaries are injured
only treatment of ARDS
Only treatment is to ventilate and give 100% O2
lung injury/ARDS leads to
Inflammation Impaired gas exchange Stiff lung tissue Shunts blood away from alveoli, right-left shunt Thick, frothy sputum (common)
causes of ARDS
Sepsis, trauma PE, shock, DIC Pancreatitis, burns Drug overdose Aspiration Pneumonitis, pneumonia Inhalation of noxious gases
how does ARDS start out
hyperventilatory
progresses through stages 1-4
tests for ARDS
- ABG’s- PaO2 low, PaCO2 low and pH is increased, showing respiratory alkalosis at first, then becomes acidotic, pH is low, PaCO2 is high
- CXR
- PA catheter for PAWP, PAWP is very elevated, > 15
treatment for ARDS
ET and mechanical ventilation, PEEP Prone positioning Diuretics Antibiotics Steroids
describe acute respiratory failure
- Lungs just give out, cannot oxygenate or ventilate (cannot get rid of CO2)
- impaired gas exchange
- mismatch VQ
- acidosis and lactic acid develop
why would a pt dies of ARF
d/t not being able to ventilate
what to look out for in pt with ARF
- tachypnea >30/min
- tachycardia >100/min
- cold, clammy sking, diaphoresis
- diminished breath sounds
treatment of ARF
Oxygen therapy (hyperoxygenate) Ventilator if needed Reversal agents, Narcan Bronchodilators Antibiotics Steroids Inotropic agents to maintain BP and output Diuretics
what is ECMO
- extracorporeal membrane oxygenation
- Blood is extracted, oxygenated, remove CO2 and then reinfuse
- 100% o2 in blood to attempt to save organs and lungs
treatment of ARF
Oxygen therapy Ventilator if needed Reversal agents, Narcan Bronchodilators Antibiotics Steroids Inotropic agents to maintain BP and output Diuretics
types of COPD
Emphysema (cannot recoil), chronic bronchitis (swollen bronchile tubes, asthma
