Student Clinical Knowledge Evaluation 3 Flashcards
Mechanical Ventilation: Indications (4)
- IVF (VC < 10mL/kg, MIP > 20cmH2O, RSBI > 105,
VT < 5mL/kg, RR > 35, VE > 10L) - AVF (pH < 7.20, PACO2 > 55, Apnea
- Prophylactic (CHI, Smoke Abd/Thoracic surg)
- Severe Oxygenation Issues (P/F < 200, P(A-a)O2 on 100% O2 > 350, PaO2 < 60 on > 50%)
Mechanical Ventilation: Hazards/Complications/Precautions (3)
- Decreased CO, VR, and urine output, decreased gastrointestinal and liver perfusion and function
- Increased ICP
- Barotrauma from pressures
Tidal Volume Settings: Normal and ARDS
Normal: Vt 6 -8 ml/kg
ARDS: Vt 4 -8 ml/kg
Types of Ventilation/Presets and Varied
- Volume: Preset Volume & Rate, Pressures vary
- Pressure: Preset Pressure & Rate, Volumes vary
Ventilation Terms
1. Trigger
2. Cycle
3. Limit
- Trigger: Initiates the breath
- Cycle: Ends the inspiratory breath - can be pressure, volume, flow, time
- Limit: Stops the inspiration early - can be pressure, volume, flow, time
Vent Modes (4)
- CMV
- IMV
- CSV
- Dual Mode
CMV
Types: (3)
- CMV - Control or Assist
- VC - CMV
- PC - CMV, PCV
CMV - Control / Assist
1. How it works
2. Trigger’s
3. Other info
4. Hazards
- All breaths are mandatory and can be volume or pressure targeted
- a) Control Mode: Time Trigger
b) Assist Mode: Time, Flow, Pressure - a) Control Mode: All machine breaths. Pt. cannot trigger. Only used when Pt. cannot make an effort to breath
b) Assist Mode: Pt. can trigger the vent, but will get a set volume or pressure with every breath - a) CM Hazards: Cruel mode if Pt. is conscious
b) AM Hazards: Sometimes difficult to prevent Resp Alkalosis without the use of Resp depressant or muscle relaxer. IMV mode may help
VC - CMV
1. How it works
2. Trigger’s
3. Other info
4. Hazards
- Preset Volume and Rate with pressures varying
- Triggers - Time, Flow, Pressures
- None
- Need to monitor and adjust Pts. inspiratory flow by looking at the pressure-time curve for smooth and rapid peak
PC - CMV, PCV
1. How it works
2. Trigger’s
3. Other info
4. Hazards
- Preset Pressure and Rate with Volumes Varying
- Triggers - Time, Flow, Pressures
- a) Mode indicated when PIP > 40 CMH2O, Plat > 30 CMH2O on volume mode
b) Set the preset pressure by the plateau pressure on CMV or you take PIP - PEEP - None
IMV
Types: (2)
- IMV
- SIMV
IMV
1. How it works
2. Trigger’s
3. Other info
4. Hazards
- Pt. is able to breathe spontaneously between machine breaths getting their own spontaneous Vt.
- Triggers - Time, Flow, Pressure
- Can be PC or VC Mode - IMV modes can also use PS to assist with spontaneous breaths
- Lack of coordination between mandatory and spontaneous breaths causes breath stacking
SIMV
1. How it works
2. Trigger’s
3. Other info
4. Hazards
- This allows for spontaneous breaths and tries to synchronize with the patient whenever possible - preventing breath stacking
- Triggers - Time, Flow, Pressures
- Can be PC or VC Mode - IMV modes can also use PS to assist with spontaneous breaths
- None
CSV
Types: (3)
- CPAP
- PSV
- APRV
CPAP
1. How it works
2. Trigger’s
3. Other info
- All breaths are spontaneous at an elevated baseline pressure to recruit and distend alveoli
- Triggers - Flow or Pressures
- None