Respiratory Therapy Flashcards
Why do you always need to be bagging when you’re using an ambubag?
There is a valve that prevents the bag from sucking the breath you just gave back after you release the squeeze. That valve remains closed whenever it’s not being squeezed, so no blow-by, PEEP, or CPAP can happen through an ambubag.
True or false: if you see that your ambubag doesn’t have it’s manometers, then you need to get a new bag because that bag won’t give breaths.
False
The ambubag can give breaths without its manometers, you just won’t know what the PEEP and PIP are. To make sure you’re giving appropriate breaths, look for chest rise and listen for a leak. It’s nice to have the manometers but not strictly necessary.
True or false: ambubags need to be connected to the wall to give breaths.
False
An ambubag that is not connected to the wall will simply give room air that is aspirated from where the wall oxygen would connect. It won’t be supplemental oxygen, but if your patient is apneic then you can help them breathe.
Why should you not squeeze all of the air out of a flow-inflating bag when you’re giving breaths?
The residual air is what allows you to be able to squeeze a breath out of the bag. If you completely deflate it then you will have to wait for the oxygen to fill it up, which is just time that you’re not giving breaths.
What are the three sizes of masks for ventilation?
Newborn, pediatric, and adult
What amount of flow is needed to inflate a flow-inflating bag?
It depends on the size of the bag. A small, newborn bag only needs 8 LPM. A large, adult bag needs 15 LPM.
What is one advantage to a flow-inflating bags?
The bag will only inflate if you have a seal on the patient’s face, so you will know if you aren’t maintaining a seal.
What is one disadvantage to flow-inflating bags?
There is no pop-off valve like on ambubags, so you can actually hurt the lungs by giving high-pressure breaths.
What’s the name of the ventilation that’s given to newborns (as in the machine that gives it)?
T-piece resuscitation
One difference to T-piece resuscitation is ________________.
that lung compliance cannot be felt (like it can when squeezing a bag) so if the patient has noncompliant lungs then your normal PIP might hurt them without you knowing
In LFNC, how does increasing the LPM affect the FiO2?
For every 1 LPM increase, the FiO2 increases by 4%. So 1 LPM = 25% and 6 LPM = 45%.
What are CNC (conventional nasal cannula) and RNC (reservoir nasal cannula)?
- CNC is when NC comes from the wall and has only tubing between wall and nose.
- RNC is when NC comes from the wall but has a reserve of some kind in the tubing. This can look like a ball on the tubing or a rectangle beneath the nasal piece. The reserve allows people to breathe more O2 at the same flow rate.
LFNC can go to what LPM?
1-6 LPM
What is the conversion of HFNC flow to PEEP?
Every 10 LPM = 0.7 cm H2O PEEP
So 60 LPM HFNC = 4.2 cm H2O PEEP
Why is higher flow from NC helpful?
There is always a resistance to inflow in the nose because of exhalation. In respiratory distress, the force of exhalation increases because of airway congestion. High flow overcomes this resistance.
In an air blender, air comes in a _________ tube and oxygen comes in a __________ tube.
yellow; green
What are contraindications to BIPAP?
- Inability to trigger a breath (e.g., drug overdose, neurologic injury)
- Inability to protect airway (e.g., AMS, airway obstruction)
- Vomiting
- Excessive secretions
- Recent head and neck surgery
What are the four types of NIPPV?
- Helmet
- Full face mask (covers mouth, nose, and eyes)
- Partial face mask (covers mouth and nose)
- Nasal mask
The nasal mask is the only one in which people can take oral medicines, but it can’t go to as high of pressures as the others.
What is EPAP?
Expiratory Positive Airway Pressure
Also called CPAP or PEEP.
What is BiPAP?
It is a type of NIPPV in which there is breath pressure (IPAP or Inspiratory Positive Airway Pressure) on top of continuous baseline pressure (CPAP aka EPAP).
There are timed and spontaneous modes. In the spontaneous mode, patients trigger their own breaths. In the timed mode, you set a rate.
What parameters do you need to set in BiPAP?
- EPAP/CPAP/PEEP: typical values 5-8 cm H2O
- IPAP: typical values ~16 cm H2O
- Backup rate (if timed): typically 8-12
- FiO2: 21%-100%
- Time of breath
- Risetime
What is AVAPS?
Adaptive Volume Assured Pressure Support
This is a mode of BiPAP that adjusts inspiratory pressure (IPAP) to give a stable volume. It is essentially like volume control for BiPAP.
You might consider this if you’re having trouble controlling ventilation in a person on BiPAP.
Describe the path of the phrenic nerve.
It originates from C3-C5, passes anterior to the anterior scalene muscle, dives into the thorax between the lung apices and the large vessels from the top of the hear, and passes between the heart and lungs in the mediastinum.
What are the ranges of O2 delivery for a simple mask?
FiO2: up to 60%
LPM: 6-10 LPM
How can you tell a non-rebreather mask from a simple mask across the room?
A non-rebreather mask has to have an oxygen reservoir because the unidirectional valves will not let air back in, so you will see a bag on a non-rebreather.
A simple mask has perforations in the sides so air can go in and out so it does not need a bag.
What are the ranges of O2 delivery for a non-rebreather mask?
FiO2: up to 90%
LPM: 10-12 LPM
If a child is not oxygenating well despite increases in supplemental oxygen, what things should you think about to troubleshoot it?
- Is the O2 tubing kinked?
- Has the child been suctioned?
- Do we need to adjust them to open their airway?
- Is the O2 connected to a source and is that source full?
- Is the pulse-ox malfunctioning (e.g., bad sensor, nail polish on the finger, BP cuff inflating, sensor coming off)?
Bag-masks require a minimum rate of __________ in order for the oxygen reservoir to continue to be filled up.
10-15 LPM
How can you tell if your bag-mask is sized correctly for the patient?
The mask should extend from the bridge of their nose to the cleft of their chin.
To increase ventilation in BiPAP, you need to increase the RR or ___________.
driving pressure, which is the inspiratory pressure minus the PEEP
If you have the standard 10/5 settings you could do 12/5, for instance.
What is the max FiO2 through LFNC?
~44%
What is an oxymizer?
A nasal cannula supplemental O2 with a hard circular reservoir
It allows for a steady flow of O2 with bolus of O2 from the reservoir as well.
You should limit plateau pressures to ___________.
< 30 cm H2O (though higher can be delivered if someone has a stiff chest wall or is morbidly obese)
In lung-protective ventilation, what is the goal SpO2 and PaO2?
SpO2: 90-95%
PaO2: 55-60 mm Hg
Rank the FiO2 of each of these: Venturi, simple face mask, LFNC, non-rebreather.
Venturi: 21-40%
LFNC: 21- 50%
Simple face mask: 40-60%
Non-rebreather: 80-100%
