Test 1 Study Guide Flashcards
Signs and symptoms of mild hypoxemia
Shortness of breath
mild respiratory distress
excitement
overconfidence
restlessness
anxiety
euphoria
lightheadedness
nausea
dizziness
fatigue
Increased respiratory rate
increased heart rate
mild hypertension
peripheral vasoconstriction
Signs and symptoms of moderate hypoxemia
a
Increased respiratory distress
agitation
impaired judgment
confusion
decreased night vision
disorientation
listlessness
headache
tingling
loss of coordination
Tachycardia
tachypnea
hyperventilation (increased minute volume), accessory muscle use,
intercostal retractions,
hypertension,
and cardiac arrhythmias
Signs and symptoms of severe hypoxemia
Severe dyspnea
confusion
somnolence
severe headache
visual disturbances
and slowed reaction time.
Slowed, irregular breathing,
cyanosis,
hypertension followed by hypotension, tachycardia followed by bradycardia, unconsciousness,
and coma.
Can help assess for the presence of infection (e.g., changes in neutrophil count, lymphocyte count, or monocyte count).
WBC
Allergic reactions will cause an elevated level of ____ and ____
elevated eosinophil count, elevated basophil count
Kills bacteria, fungi and foreign debris
Neutrophils
Cleans up damaged cells
Monocytes
Kills parasites, cancer cells, and allergic response
Eosinophils
Helps fight viruses and make antibodies
Lymphocytes
Involved in allergic response
Basophils
Causes of electrolyte disorders
Renal failure
Acid-base disturbances
Dehydration
Can be caused by kidney disease or muscle tissue breakdown
Elevated creatinine
May increase with kidney disease, dehydration or a high-protein diet.
Blood urea nitrogen (BUN)
Associated specifically with kidney disease
Elevated (BUN) and serum creatinine
Associated with liver disease, biliary obstruction or a hemolytic disorder
Elevated total bilirubin
How do electrolyte imbalances affect the body?
Electrolyte disturbances can affect the body’s acid-base balance.
◦Low potassium (↓K+) may cause a metabolic alkalosis (i.e., hypokalemic alkalosis).
Uses for ultrasound in the ICU
Cardiac - Hemodynamics and volume status, Cardiac output, Myocardial contractility, Ventricular function, Pericardial effusion, Cardiac tamponade
Lung - Diagnosis of pneumothorax, Identification of pleural effusion, Differentiating between lung consolidation, interstitial syndrome, Distinguishing between atelectasis and pneumonia.
To evaluate cerebral blood flow, Aid in thoracentesis, Placement of arterial or central venous lines, During cardiac resuscitation to assess cardiac standstill and fine ventricular fibrillation.
What causes Exudative pleural effusions
infection, cancer or pulmonary embolus
What causes Transudative pleural effusions
congestive heart failure, renal failure, liver failure, or cirrhosis.
Transudative vs. exudative effusions
Transudative: Occurs due to increased hydrostatic pressure or low plasma oncotic pressure.
(CHF, Cirrhosis, Nephrotic syndrome, PE)
++ LOW in protein and LDH
Exudative: Occurs due to inflammation and increased capillary permeability.
(Pneumonia, Cancer, TB, Viral infection, PE, Autoimmune)
++ HIGH in protein and LDH
These drugs are central nervous system (CNS) depressants.
*Lipid soluble (need to cross blood-brain barrier).
*Reduce both physical and mental acuity levels.
*Effects are dosage dependent
Produce relaxation and calming effect
Sedatives
commonly used, safe group of drugs that treat anxiety and insomnia. Administered PO, IV, or IM
Benzodiazepines:
Diazepam (Valium), alprazolam (Xanax), Lorazepam (Ativan), Midazolam (Versed), and temazepam (Restoril)
Most opioids are (schedule ___) drugs due to the danger of addiction
Opioids = Sedatives
Schedule II
Morphine, fentanyl, and hydromorphone
an anesthesia drug used in surgery and during certain medical tests and procedures that may not be well tolerated by the patient. Administered IV or IM.
Ketamine
most used parenteral (IV) anesthetic in the (U.S.)
Propofol (Diprivan)
a sedative used in the critical care setting to sedate mechanically ventilated patients. Administration IV
Dexmedetomidine (Precedex)
defined as the feeling of no pain
Analgesia
(Aspirin, Tylenol, NSAIDS)
most used nonopioid analgesic
Aspirin
The only depolarizing neuromuscular blocking agent (acetylcholine agonist). Administered IM or IV
Succinylcholine
used clinically to facilitate endotracheal intubation and to provide skeletal muscle relaxation during surgery. Administered IM or IV.
Neuromuscular blocking agents
a reversal agent for the treatment of opioid overdose. Administration SC, IM, or IV.
Narcan/Naloxone
injection is used to revers the effects of nondepolarizing neuromuscular blocking agents. (3)
Edrophonium (Tensilon)
Neostigmine
Sugammadex
reverses the effects of benzodiazepine
Flumazenil/Romazicon
not a reversal agent but is effective in treating acetaminophen (Tylenol) overdose.
N-Acetylcysteine
change the myocardial strength of contraction
Inotropes
Β1-adrenergic
Inotropes
Norepinephrine
Phenylephrine
Epinephrine
Dopamine
Dobutamine
Used in ACLS when patient fails to respond to adequate ventilation, defibrillation, and compressions or is refractory to vasopressors
Used when (pH) is (<7.15)
Will increase CO2 levels!!
Sodium Bicarbonate
indicated for symptomatic bradycardia
Atropine
due to the release of cellular inflammatory mediators associated with the use of large tidal volumes and pressures.
Ventilator Induced Lung Disease
How do we prevent or minimize ventilator induced lung injury?
Pulmonary over-distension: ◦Tidal volumes reduced to (4 to 8 mL/kg) from (10 to 15 mL/kg (used since 1970’s)).
◦Atelectasis:◦Utilization of (PEEP) to avert atelectrauma
.◦Barotrauma:◦Minimizing alveolar distending pressures by keeping plateau pressures (<30 cm H2O)
.Additional strategies include; lung recruitment, permissive hypercapnia, the introduction of newer modes of pressure limited ventilation, and noninvasive ventilation.
What is the (I:E ratio) if the (I-time) is (0.8 seconds) and (E-time) is (2.4 seconds)?
E-time/ I-time = I:E ratio
2.4 / .8 = 3
Answer = 1:3 ratio
E-time is (3 times) longer than I-time
What is the (I:E ratio) if the (I-time) is (25% or .25
.25 / .25 : (1 – .25) / .25
1: .75 / .25
Answer = 1:3
What is the (I:E ratio) if the (I-time) is (1.2 seconds) and the respiratory rate is (12)?
(E-time) = (60 / 12) – 1.2
(E-time) = 5 – 1.2
(E-time) = 3.8
(I:E) = 1.2 : 3.8
Needs to be reduced.
Answer = 1 : 3.2
Alveolar Ventilation Equation
(A) = (VT – VD) × f )
◦(500 – 150 mL) x 12 breaths = 4200 mL/min or 4.2 L/min
The alveolar ventilation equation is:
VA = (VT - VD) x RR, where:
VA: represents alveolar ventilation
VT: represents tidal volume
VD: represents dead space volume
RR: represents respiratory rate
Approximately (1 mL/lb/IBW) or 2.2 mL/kg
Reduced in (½) when bypassing upper airway with an artificial airway
Anatomical Dead Space
Examples include
Heat and moisture exchangers
Suction catheters
(MDI) or (SVN) adapters
Additional corrugated tubing
Mechanical Dead Space
What is a healthy number for plateau pressure?
<30
What is a healthy number for static compliance?
Untinbuated: 60-100
Intubated: 40-60
Formula for static compliance
CST= VT/ Pplateau – PEEP
Air trapping (dynamic hyperinflation) during expiration with positive pressure ventilation is called ______, or (intrinsic PEEP)
Auto PEEP
How to calculate auto peep
(Total PEEP – set PEEP = auto-PEEP).
Healthy number for mean airway pressure
5-10
Factors that can increase mean airway pressure
Increased inspiratory time, (I:E ratio)
tidal volume
and extrinsic (PEEP)
decreased expiratory time and spontaneous breathing,
auto-PEEP,
decreasing inspiratory flow pattern,
low lung compliance,
and high airway resistance (RAW)
What it means to Increase (PEEP) incrementally until adequate oxygen delivery (O2) or other related parameters are achieved
Optimal PEEP
Allows the alveoli to remain open with less pressure required to expand the lung
The mechanism by which a ventilator initiates a patient breath is the ____ variable
Trigger Variable
In this mode, The control variable can be either volume or pressure, and every breath is mandatory.
The patient may trigger inspiration (assisted breath), but every breath is machine cycled to expiration.
◦Commonly referred to as “assist control” ventilation.
Continuous Mandatory Ventilation (CMV or Assist/Control)
In this mode, The control variable is volume and every breath is mandatory.
◦The patient can initiate inspiration, and the clinician set tidal volume is delivered with each breath
Volume Control - Continuous Mandatory Ventilation (VC-CMV) or (AC-VC)
In this mode, The control variable is pressure, and the set inspiratory pressure is delivered with each breath.
◦The patient can initiate inspiration, and the clinician set inspiratory pressure is delivered with each breath
Pressure Control - Continuous Mandatory Ventilation (PC-CMV) or (AC-PC)
This mode provides an inverse the (I:E ratio) and to improve gas distribution and (PaO2).
◦Commonly used for patients with (ARDS)
Pressure Control – Inverse Ratio Ventilation (PC-IRV)
In this mode, The control variable can be either volume or pressure, and every breath is mandatory.
Combined time-triggered mandatory respiratory rate with a system to allow the patient to breathe spontaneously in between mandatory breath
Intermittent Mandatory Ventilation (IMV)
Initial ventilator settings are usually set to provide full ventilatory support.
Based on patient’s response, the number of mandatory breaths can be then reduced, to provide partial ventilatory support, whereby patient must contribute a sufficient level of his or her required ventilation in the form of spontaneous breathin
Synchronized Intermittent Mandatory Ventilation (SIMV)
provides patient triggered and patient cycled breaths at an elevated baseline pressure to increase (FRC) and improve gas exchange
Patient must be spontaneously breathing
CPAP
Indications for CPAP
Improving oxygenation in patients with respiratory failure, prevention of atelectasis, treatment of cardiogenic pulmonary edema, patients undergoing spontaneous breathing trials (SBT’s) prior to extubation, and obstructive sleep apnea (OSA
Provides for patient-triggered, pressure limited, flow-cycled ventilation which may be used as a stand-alone mode or in conjunction with IMV/SIMV.
May be further described as spontaneous breathing with inspiratory pressure augmentation, and may include the addition an elevated baseline (PEEP/CPAP
Pressure Support Ventilation (PSV)
The intent of this mode is for ventilation and oxygenation in patients with regional lung compliance heterogeneity and severe oxygenation problems, most commonly for (ARDS) patients
Provides two levels of (CPAP) that are time triggered, and time cycle. Patient may breathe spontaneously at both levels
Airway Pressure Release Ventilation (APRV)
Automated form of ventilatory support that adjusts level of support provided based on patient’s measured inspiratory flow, elastance, and resistance
Proportional Assist Ventilation (PAV)
Delivers a volume-targeted, pressure-controlled breath.
An adaptive targeting scheme is employed in which the ventilator automatically adjusts pressure between breaths to reach the targeted volume in response to varying patient conditions.
Pressure-regulated Volume Control (PRVC
Can be used in spontaneously breathing patients not requiring time-cycled, machine delivered breaths
, the (PSV) level is automatically adjusted to achieve a volume target
Volume Support (VS)
A dual control mode available for a patient with variable respiratory drive (fatigue, irritability, pain, changing lung mechanics, intermittent apnea) which switches between controlled and supported ventilation based on the patient effort
Auto mode
Closed-loop, automated ventilation that combines aspects of pressure support and pressure control to adjust the amount of support needed to achieve the target minute volume based on changes in respiratory mechanics and patient inspiratory effort
Adaptive Support Ventilation (ASV)
Dual control mode that monitors gas flow and volume during inspiration to ensure a preset (VT) is delivered. ◦Breaths are patient-triggered, pressure limited, and flow cycle
Volume Assured Pressure Support (VAPS)
