respiratory management

Question 1

define hypoxemia

Answer 1

abnormally low arterial oxygen tension (PaO2)

Question 2

define hypoxia

Answer 2

insufficient oxygen in the tissues, and can be generalized or local.

Question 3

what should be used to detect hypoxia

Answer 3

measurements should be used to accurately and efficiently detect hypoxia, including pulse oximetry and blood gas analysis.

Question 4

What are the 5 mechanisms that can cause hypoxia

Answer 4

1. hypoventilation (myesthenia gravis, overdose)
2. V/Q mismatch (COPD, Asthma)
3. Right to left shunt (AV malformations, intracardiac shunt)
4. Diffusion abnormalities (pneumonia, pulm fibrosis)
5. reduced oxygen inspired tension (mountain climbing/elevation)

Question 5

what levels indicate the need for oxygen

Answer 5

PaO2 <60mmHg
SaO2 <90%

Question 6

what is considered high flow oxygen supplementation

Answer 6

High-flow: (Venturi masks) maintain the selected FiO2 by using an oxygen flow rate that is higher than typical inspiratory flows or a reservoir bag

Question 7

What is considered low flow oxygen supplementation

Answer 7

Low-flow: include oxygen delivery by nasal cannula (NC), simple mask, and reservoir mask (partial rebreather and non-rebreather). Low-flow systems do not deliver a constant inspired oxygen concentration since there is room air entrained into the NC or mask.

Question 7

when do you use an oropharyngeal airway

Answer 7

in a deeply unresponsive patient who is unable to maintain his/her own airway

Question 8

what are the 2 main causes of inadequate ventilation

Answer 8

1. inadequate respiratory effort via intrinsic or extrinsic factors
2. airway obstruction

Question 9

how do you insert an oropharyngeal airway

Answer 9

start with the curve of the OPA inverted (directed cephalad) then rotate 180 degrees as its tip reaches posterior pharynx

Question 10

how do you insert a nasopharyngeal airway

Answer 10

insert along the floor of the naris into the posterior pharynx behind the tongue. rotate tube slightly if resistance is encountered

Question 11

Do patients tolerate NPA or OPAs better

Answer 11

NPA

Question 12

what will happen if you insert an NPA that is too long

Answer 12

it might enter the esophagus and insufflate the stomach

Question 13

what three things does adequate bag mask ventilation depend on

Answer 13

1. patent airway
2. adequate mask seal
3. proper ventilation volume, rate and cadence

Question 14

when ventilating a patient with a bag valve mask, what is the respiration rate that you should use

Answer 14

rate should not exceed 10-12 breaths per minute

squeeze steadily over 1 second.

Question 15

In what cases are noninvasive ventilation preferred over intubation?

Answer 15

• COPD
• Acute CHF exacerbation
• asthma
• pneumonia (sometimes)

plz check this

Question 16

Is the presence/absence of a gag reflex a good way to assess airway patency?

Answer 16

NO!

20% of adults dont have a gag reflex

Question 17

what is defined by the simultaneous administration of a sedative and paralytic agent to assist in endotracheal intubation usually via direct laryngoscopy

Answer 17

rapid sequence intubation

Question 18

should you take a patients dentures out if youre going to attempt bag valve ventilation?

Answer 18

nooooo

Question 19

what are the 5 indications for mechanical ventilation

Answer 19

1. airway protection in a obtunded patient or patient with dynamic airway
2. hypercapnic respiratory failure 2/2 decease in minute ventilation
3. hypoxemic respiratory failure 2/2 failure of o2
4. CV distress where mechanical ventilation can offload energy requirements of breathing
5. expectant course (anticipated pt decline)

Question 20

what are the four phases of a mechanical ventilation breath

Answer 20

1. initiation by opening the inspiratory valve
2. delivery where air flows from vent to pt
3. termination by closure of inspiratory valve and cessation of airflow
4. exhalation by opening of expiratory valve and air transfers from pt to vent

Question 21

what are controlled mechanical ventilation breaths

Answer 21

triggered by the ventilator and have limit and cycle variables set by the ventilator operator.

Question 22

what are assisted mechanical ventilation breaths

Answer 22

similar to controlled breaths, in that limit and cycle variables are set by the operator, but in contrast to controlled breaths are triggered by the patient.

Question 23

what are spontaneous mechanical ventilation breaths

Answer 23

triggered and cycled by the patient.

Question 24

what are the general criteria to evaluate an intubated patient for a spontaneous breathing trial?

Answer 24