Respiratory Equipment Flashcards
wall flow meter -
adjusts the flow of O2
Nasal canula delivers between _ and _ L per minute
what % of oxygen
1-6L
24-44% O2
Normal air is what percent oxygen
21.4%
1 L is how much oxygen
24%
High flow nasal canula delivers between _ and _ L per minute
6-15 L
43-72%
What is something special about high flow nasal canula
Need a humidifier to keep air moist
Face mask delivers _ and _ liters per minute
5-10:
35-55%
Cool Aerosol mask (CAM) delivers between _ and _ liters per minut
10-12 liters per minute
need higher flow but can’t tolerate nasal
Non-rebreather - minimum flow is
10-15 liters per minute
60-80% O2 with no humidity
Non-rebreather - bag deflation
bag should not deflate more than 1/3 with inspiration
When will someone be on a non-rebreather
often when deciding to put them on vent or not - also when come off of vent
Non-rebreather - are they breathing in their own air
NO!
Misty Ox - High flow CAM - what percent O2
60-96%
with humidifier
When is misty-ox high flow CAm used
when come off vent and are trying to get them stronger so they dont go back on vent
Can you take a patient out of the room with misty-ox high flow CAM
NO! you can walk them in the room, but you cannot take them off of this system
Venturi mask flow is how many liters per minute
3-6 or 4-10?
24-50% O2
Precise FiO2
Why would you ask for a venturi mask
you can use it to take them around without having to drain an oxygen tank
Dont need to order - just ask RT
Who would you not use a venturi mask with
misty ox or non re-breather
Venturi mask - where is the air coming from
mixing the air from the outside with the air coming from the wall or tank
Trach collar - delivers how much O2
24-50%
Describe the trach collar
Pt has an artificial airway - you can connect this to venturi so not using oxygen tank up
Gas injection nebulizer (GIN)
Extremely high flow
100% O2
GREEN TOP
Ambu bag - how do you use it
push down halfway when they breath in and let it go when they exhale
Common mistake of oxygen delivery with someone who has a trach
applying oxygen over their mouth! NOO! Give it through the trach!
Should you have someone with a stuffy nose on a nasal canula
NO!
NC for mouth breather?
NO
What can lead to poor oxygen flow
valve turned off
tube is pinched
tank is empty
Patients may be cyanotic if pulse ox is lower than what
90%
Symptoms of hypoxemia
Tachycardic Dyspnea Cyanosis Perspiring (diaphoresis) HA Mental distrubance Maybe hyperventilat Inc RR
Treat hypoxemia by
dec work of breathing with oxygen
reduce myocardial work
How is oxygen found in the blood with pulse ox
bound to hemoglobin
SaO2 measures what
oxyhemoglobin
oxygen taken from blood draw!!! (ABGs)
SpO2 is measured how
pulse oximetry
Types of pulse oximetry
bedside or portable in hand
probe can be finger, ear, nose
Know what can alter pulse oximtry reading
polish, rapid HR, cold hand, excessive mvmnt…
What O2 sat is good enough for us to work with
90%
What does the textbook say is normal
More than 92
SpO2 in patients with COPD
want it to be 90-92 but if their norm is 88 you can work with them at 88
Pediatric SpO2 norm
65-85%
What is considered significant desaturation
3%
Rate it by how fast they return to baseline and how it impacts their performance
Suctioning - types
oropharyngeal
nasotracheal
endotracheal
Oropharyngeal suctioning - what is used
Yankauer suction tip
Only one that PT can do and pt could do it too
Getting suction from oral pharyngeal cavitiy
Nasotracheal and Endotracheal -
Internal and more for those on ventilator
Suctioning out of the lungs
Inadequate humidification leads to
retention of secretions
Infection
crusting of secretions
airway obstruction
Intubation refers to the process of
placing an endotracheal tube (ETT) in a patients airway
Orotracheal intubation involves placing the ETT into
the mouth or oral cavity
Nasotracheal intubation involves placing the ETT into
the nasal cavity
Ett is necessary for who
unconsious patients - to maintain an open airway and ensure ventilation
Disadvanatges to intubation include
HTN, Inc HR, tracheal wall necrosis, vasovagal, fistula, inability to eat/drink/talk
Tracheotomy is what
an artificial airway created surgically in the trache
When is a tracheotomy necessary
Complete upper airway obstruction Long term intubation Facial trauma Sleep apnea - long term Dec work of breathing and will remove secretions They can eat drink and talk
Complications of tracheotomyh
hemorrhage, thyroid injury, nerve injury, air leak, fistula, cardiac arrest
What is a stoma
the opening in the ant neck after removing the trach
THey do not suture it shut
Types of trach tubes - cuffed
has balloon at distal end to prevent air/secretions from going anywhere but the tube
cuff can be inflated or deflated
Why would a cuffed trach tube be deflated
if they want to talk - the cuff needs to be deflated but you need to get them PMV
Types of trach tube - high volume
low pressure requires high volume of air to inflate but will apply less pressure on the tracheal wall
Types of trach tube - high pressure
low volume require a low volume of air to seal the trachea
Can we inflate or deflate patient trach tube cuff
NO! talk to nursing or RT to ensure the appropriate cuff presssure first
Types of trach tubes - cuffless
no cuff at distal end - sleep apnea or long term
Type of cuffless trach tube
Metal (Jackson)
common for chronic trach patients
Foam filled - type of trach tube (Binova)
Cuff passively inflates from atm pressure
No air is injected into the foam cuff
What is good about the foam filled
it is gentle on the tracheal wall
More for a fragile trachea that is long term use
Fenestrated - type of trach tube
TALKING!
window in the tube that allows air to pass from lower to upper airway for speech
Bad thing about fenestrated trach tube
doesnt work well with thick secrettions so if you notice they are short of breath might be clogged
Trach tubes are selected based on
individual patient needs
Primary reason people on vents feel anxiety, fear, panic
inability to communicate
How to communicate with patients who have a trach
nonverbal handwritting, gestures, lip reading, communication boards, augmentative communication
Verbal methods for talking with those who have a trach
Passy muir valve - placed in the trach that allows air to be inhaled but then closes to allow air to exit PMV for speech
What to be cautious of with PMV
cuff has to be deflated
they may be more tired when you are working with them
Effects of trach on swallowing
Dec laryngeal elevation
Dec sensation
Dec subglottic pressure
Can cause aspiration (debated)
Indications for mechanical ventialtion
Resp failure CNS dysfunction drug overdose Obesity Sleep apnea Stroke B or SC injury MS Metabolic imbalance Infection
Resp failure
lack of adequate gas exchange within the lungs
Endotracheal tube
used initially
securred to mouth with tape
optimal position for endotracheal tube
1-2 cm above carina
Nasoendotracheal tube used when
if endotracheal causes more damage
Tracheostomy tube
surgically inserted around 2nd or 3rd tracheal ring
Two types of ventilators
Neg pressure
Pos pressure
Problems with neg pressure ventilators
not easy access to patient
Neg pressure ventilator - how it works
pull the air out and cause someone to breath
but messes with their CO
Pos pressure ventilator
pushing air into their lungs and then they exhale
Classification of ventilators
pressure ventilators
Volume ventilators
Tidal volume - norm
5-10 ml/kg of body weight
Tidal volume is what
volume of air in a normal breath
what is the tidal volume for ventilator dependent patients
10-15 ml/kg
Ventilator - rate
number of ventilatory breaths delivered per minute
Norm - rate
10-12 breaths per minute but will vary with idal volume
FiO2 what does it stand for
fraction of inspired air
FiO2 is what
Oxygen concentration of the gas delivered by the ventilator
Has a humidifier on it
Usually 30-100%
FiO2 that we wont work with
80-100%
Peak inspiratory pressure is what
pressure exerted on the lung when the required volume is delivered
Peak inspiratory pressure alarm goes off when
pressure limit is reached before the preset volume is delivered
or if something is obstructing it
PEEP stand for what
positive end expiratory presure
PEEP is what
an expiratory maneuver in which the airway and intrathoracic pressure are not allowed to return to atmospheric
What is PEEP used in conjunction with
positive pressure ventilation
Classic criterion for using PEEP
inability to maintain PaO2 above 60mmHg with and inspired O2 conc of 50% or higher
What is normal PEEP
5
Ventilator can give what PEEP
0-15
What PEEP do you consider as precaution for whether to work with them or not
10-15 range
Inspiratory Hold
Maneuver that either presets the pressure or a predetermined volume is reached and held for a period of time before the exhalation is initiated
This is a setting on the vent - trying to mimic normal breathing
Expiratory retard
resistance applied to exhalation whereby the circuit pressure is permitted to drop slowly to atm.
Also hleps mimin normal breathing
Modes of ventilator - Control mode is also called
Constant minute ventilation
Controlled mandatory ventilation
Modes of ventilator - control mode does what
# of breaths you have is preset typically after surgical procedures Vent is doing pretty much everything for them - usually used when undergoind a durgical procedure and they are sedated
Modes of ventilator - assist control
set minimum # of breaths and tidal volume
Can be pressure or volume controlled
Modes of ventilator - assist control - sensitivity is set so that if patient does breath above the preset number of breaths what happens
the ventilator will adjust
They can be breathing on their own and if they dont reach set volume or pressure then the machine will supplement what is needed to match the specific setting
SIMV stands for
synchronized intermittent mandatory ventilation
SIMV does what
sets the min number of assisted breaths and tidal volume
SIMV - pt might breath on their own with this but what is differenct with this and assist control
this one they can take a breath on their own but if they do not reach the set setting it wont help them get to it… but it does have a min number of assisted breaths
MMV stands for
Mandatory minute ventilation
MMV does what
gives mandatory breaths when needed
Consered with rate
PSV/CPAP stands for
Continuous positive airway pressure
PSV/CPAP does what
technique to apply PEEP to a spontaneously breathing pt
Maintains pos pressure through resp cycle
used to wean off ventilator
what is CPAP with smartcare
ventilator makes changes on its own depending on pt needs
Caution with CPAP and smartcare
turn it off when working with pt
it will reset them and then the settings might be too high when you are done working with them
NIPPV stands for
non invasive pos pressure vent
NIPPV does what
connected to vent via tight mask
for those that dont want to be intubated but need to be ventilated
Vent alarms
1 high pressure from anything clogging it 2 low pressure if something disconnected 3 Low PEEP/CPAP - break in line 4 low exhaled volume - something leaking 5 apnea alarm - pt not taking breath 6 inc volumes - shallow breathing 7 inc frequency - pt breathing faster
What to do first for someone on vent
talk with nursing and check medical record
