Test 1 Study Guide Flashcards by Savannah Robbins

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

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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

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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.

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Can help assess for the presence of infection (e.g., changes in neutrophil count, lymphocyte count, or monocyte count).

WBC

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Allergic reactions will cause an elevated level of ____ and ____

elevated eosinophil count, elevated basophil count

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Kills bacteria, fungi and foreign debris

Neutrophils

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Cleans up damaged cells

Monocytes

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Kills parasites, cancer cells, and allergic response

Eosinophils

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Helps fight viruses and make antibodies

Lymphocytes

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Involved in allergic response

Basophils

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Causes of electrolyte disorders

Renal failure
Acid-base disturbances
Dehydration

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Can be caused by kidney disease or muscle tissue breakdown

Elevated creatinine

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May increase with kidney disease, dehydration or a high-protein diet.

Blood urea nitrogen (BUN)

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Associated specifically with kidney disease

Elevated (BUN) and serum creatinine

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Associated with liver disease, biliary obstruction or a hemolytic disorder

Elevated total bilirubin

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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).

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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.

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What causes Exudative pleural effusions

infection, cancer or pulmonary embolus

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What causes Transudative pleural effusions

congestive heart failure, renal failure, liver failure, or cirrhosis.

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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

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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

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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)

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Most opioids are (schedule ___) drugs due to the danger of addiction

Opioids = Sedatives

Schedule II

Morphine, fentanyl, and hydromorphone

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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

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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)