Respiratory Flashcards
What are critical blood gas results?
Ph less than 7.2, Paco2 >55, Pa02 <60
Calculate minute volume
Minute Volume (Ve) = Tidal Volume (Vt) x Rate (f)
S/S of Acute Resp Distress?
Rapid, shallow breathing, accessory muscle use, tripod, decrease minute volume, critical ABG results, changing breath sounds
What is a shunt?
No perfusion of alveolar beds causing no gas exchange
Classic Pulmonary Embolism patients
Smokers, birth control, surgery, cancer, pregnant, obese
Treatment of P.E.
High flow 02, Lovenox/Heparin, Fibrinolysis (TPA), Surgery
Signs of P.E.
Acute Resp Distress, Spo2 not responding to high flow 02. Elevated D-Dimer.
S/S of COPD/Asthma/Bronchitis
Bronchoconstriction, Hypersecretion and edema, Trouble breathing OUT
Treatment of COPD/Asthma/Bronchitis
Albuterol, Atrovent, Magnesium sulfate, Steroids. Ketamine for induction agent (bronchodilator)
Increase I:E ratio to 1:3 or 1:4
Causes of Pneumonia
Ventilator acquired VS Community acquired. Can be viral, bacterial, or fungal.
Treatment of Pneumonia
O2, IV antibiotics, HOB elevation of 30*, Suction mouth and upper airway PRN, Supportive treatment.
Define Adult Respiratory Distress Syndrome (ARDS)
Hyperpermeable pulmonary capillaries causing interstitial fluid build up causing separation of alveoli and capillary bed (shunt forms).
Treatment of ARDS
PEEP of 5-20, Recruit alveoli and provide O2, Monitor PIP, Vt, and Pplat.
What is normal tidal volume for the obstructive approach to ventilator management?
6-10 ml/kg
Clinical signs of Pneumothorax
SOB, Absent lung sounds on one side, JVD, hypotension, tachycardia.
Treatment of Pneumothorax
Remove from Vent / PPV! Needle chest decompression or chest tube.
Criteria for Intubation
Current airway patency (trauma, unable to swallow)
Oxygenation or Ventilation failure (pH <7.2, Co2>55, PaO2 <60)
Expected clinical course
Gcs<8
Ventilator CMV mode
Delivers Vt or PIP at preset rate. Cannot initiate breaths.
Ventilator AC mode
Delivers preset Vt or PIP. Able to trigger full breaths. Can cause breath stacking or autopeep.
Ventilator IMV mode
Provides preset Vt or PIP while allowing patient to take own breath and volume without delivering full breath.
Ventilator SIMV mode
Considered safest mode. Allows for variation of support from complete support to spontaneous breathing.
Ventilator High Pressure alarm troubleshooting
Suction tube/patient, Connections secured and not kinked, check for obstructions, pneumothorax, ETT displacement (main stem).
Ventilator Low Pressure alarm troubleshooting
Think disconnect! Check all connections starting at patient and working back. Check O2 delivery/supply, Check for leaks in vent circuit, ETT displacement (dislodged)
Ventilator Low Spo2 alarm troubleshooting
Appropriate Vt set? Appropriate rate? Appropriate I:E ratio? Consider PEEP/O2, suctioning, pneumothorax, ETT placement, P.E.
VA = (Vt-VD) x f
Alveolar minute volume = (tidal volume - dead space) x rate
Ve = Vt x f
Minute volume = tidal volume x rate
Normal VD
Normal dead space = 1/3 Vt or 1 ml/lb IBW
Normal Ve
Normal minute volume is 6.0 L/min
Normal Vt for injury approach in ventilator management?
4-8 ml/kg
To blow off CO2 increase __ first then __.
Volume first then rate
To protect injured lungs on a vent, use lower __ and higher __.
Tidal volume
Rate
Cheyne-Stokes respirations
Alternating periods of increased and decreased rate and depth with brief periods of apnea.
Causes of Cheyne-Stokes
Associated with Decorticate posturing
Cushing’s triad, brainstem herniation
Biot’s respirations
Quick, shallow, inspirations followed by apnea
Causes of Biot’s
Meningitis
Increased ICP
Damage to medulla by stroke or trauma
Kussmaul’s respirations
Deep and fast breathing without apnea
Causes of Kussmaul’s
Metabolic acidosis Renal failure DKA Salicylates Toxins
Apneustic respirations
Long gasping inspiration followed by short expiration causing chest hyperinflation and hypoxia
Causes of Apneustic respirations
Brain lesion
Common is decerebrate posturing
Central Neurogenic Hyperventilation
Very deep, rapid respiration rate >25 bpm causing alkalosis
Causes of central neurogenic hyperventilation
Increased ICP
Stroke
Lesion to brainstem
Head injury
Desired minute volume for an intubated patient
120ml/kg/min
Desired minute volume for intubated metabolic acidosis patient
240ml/kg/min
Ataxic respirations
Complete irregularity of breathing “A-Fib of breathing”
Gold standard for oxygenation
SpO2
Gold standard for ventilation
ETCO2
1 cause of iatrogenic death in the US
Ventilator Acquired Pneumonia
Gold standard for ET tube placement
Chest X-Ray
Curare Cleft on ETCO2 represents?
Patient needs resedated / paralyzed
Preoxygenation is required in what patients?
Obese patients
Pregnant patients
Pediatric patients
(10 lpm via NRB for 15 minutes)
