Test 1 Flashcards
FiO2 greater than what and SATS still low, do what
60% - CPAP if ventilating adequ
When patient low on O2 , but ventilating adeq.
as well as Ph Normal, WOB not too high , SATS still low
apply more O2 up to 60%
When pt on FiO2 0.6 or more and still hypoxic
- Pt can ventilate adeq still
- Normal or high pH, PaCO normal or low
Mask CPAP
Pt not keeping up with ventilation, and can maintain airway and cooperate
BiPap (bilevel)
When to switch to CPAP from O2
Lower FiO2 of 0.6 or less, raise CPAP until PaO2/SpO2 adequate.
Goal= Use less O2 compensate with PEEP
(never go down on CPAP)
When to switch to BiPAP
Vent. failure assessed by pH and PaCO2
-Retaining CO2
pH is low and PaCO2 is high=
signs of early vent. failure
Bipap initial settings
IPAP 10-12cmH2O
EPAP 5cmH2O
FiO2 > or equal to pts current
When to intubate
Failing BiPAP, On higher IPAP , Low pH and PaCO2 still high, signs of fatigue, poor oxygenation, Apnea
Severe Resp Failure=
Low pH, lower than 7.25 and PaCO2 above 55
Comatose
out of it
obtunded
sort of out of it
combative
fighting it
Apneic? what to do
intubate and ventilate
Diaphoretic
cold and sweaty
pH < 7.25
intubate
Patient on Nonrebreather going to CPAP what oxygenation should be set at?
100%, Match NONREBREATHER
AA gradient when to intubate?
3-30
NIF worse than what to intubate
-20 cmH2O and FVC (minute ventilation) less than 10-15 ml/Kg
Normal NIF
-20 cm H2O or greater
Ventilatory Failure=
High PaCO2 and Low pH
Oxygenation Failure=
Low PaCO2, Norm or low PaCO2
-not exchanging enough gas
Oxygenation failure? do what
Consider positive and expiratory pressure. Apply with mask CPAP or while intubated
Ventilatory failure? do what
Consider mech ventilation
-Apply with mask ventilation or intubate
Hypoxic Resp Failure:
PaCO2 < 60 (PEEP, CPAP, EPAP)
Hypercapnic (vent. failure):
PaCO2 > 50 (consider bipap or intubate)
Deadspace vs. shunt
Both V/Q mismatch
Shunt=
purfusion with no ventilation, alveoli collapse
-Does not respond to oxygen
Deadspace
Ventilation without perfusion
-Low SpO2 or PaO2 that responds to O2
Obstructed lung diseases
COPD, Asthma, Bronchiectasis, bronchitis
-they are not getting oxygen ( 70-80%pts)
Restricted
Small lungs, stiff lungs. can lead to obstructed.
-All other lung disease
Patient hypoventilating=
Alveolar air equation will come out normal
Hypoxia=
tissue, first sign:increase HR
hypoxemia=
blood
Acute Hypercapnic Resp Failure causes
decrease ventilatory drive, Resp muscle fatigue or failure, increase WOB
Chronic Resp. Failure=
Combination of hypoxic and vent. failure
-Increase in PaCO2 lead to kidneys retaining bicarbonate to normalize the pH
Fully compensated resp. acidosis=
Chronic resp failure
O2 failure
Low O2 from disease, shuntlike effect, or pure shunting
Vent. Failure
Retaining CO2 and Low PH
AA Gradient
Pb-46= # x FiO2= # - CO2 (getby PaCO2/FiO2)= # PaO2= NUMBER
Then PF ratio PaO2/ FiO2
AA gradient order
Pb -47, xFiO2, -CO2, -PaO2
Find CO2
PaCO2/ 0.8
How do you tell the cause of resp failure?
V/Q mismatch and shunt will have elevated P(A-a)O2. There will be a response to O2 with V/Q mismatch and no response with a shunt
Hypoventilation will have a normal P(A-a)O2
true
P(A-a)O2 >
350, intubate
Vital Capacity
10ml/Kg
Tidal Volume
5ml/kg
Ve
<5 or > 10
