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Mechanical Ventilation > Test 8 Notes > Flashcards

Test 8 Notes Flashcards

1
Q

What happens when you place a patient on a ventilator

A

we reverse the normal pressure changes in the chest

  • Normal insp causes negative pressure in chest, this expands blood vessels and heart aiding in blood delivery to the heart
  • PPV will put pressure on the blood vessels and heart impeding blood delivery to the heart and lung
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2
Q

Minimize effects Positive Pressure ventilation

A

Primary way to diminish effects of PPV on pulmonary and cardiovascular system is to keep mean airway pressure at its lowest

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3
Q

Cardiovascular - Most likely to affect cardiac patients and patient without lung disease

A

Decreased compliance (stiff lungs) and airway disease pressure not transferred to heart

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4
Q

PPV in chest of pt with CHF may improve

A

cardiac function

  • pushes blood out of heart and vessels so makes it easier for the muscle to pump the blood
  • PEEP is commonly used to treat left heart failure
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5
Q

Cardiac monitorings

A

ECG, a common cause of dysrhythmias is hypoxia

  • Arterial blood pressure monitoring
  • Continuous monitoring via arterialcatheter (Art-line)
  • Oxygen delivery is dependenton a good BP and CO
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6
Q

Hemodynamics Direct measurements

A

Pulmonary Artery Catheter (Swan-Ganz)
Central Venous Pressure (CVP)0-8 mmHg
Right Atrial Pressure (RAP) 0-8 mmHg
Pulmonary Artery Pressure (PAP) 15-30/4-12 mmHg
Mean Pulmonary Artery Pressure (PAP) 9-18 mmHg
Pulmonary Capillary Wedge Pressure (PCWP) 4-12 mmHg
Cardiac Output (CO) 4-8 L/mi

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7
Q

Barotrauma vs. Volutrauma

A

Caused by overdistention
-Barotrauma caused from too much pressure in lungs.
Volutrauma caused from too much volume in lungs, regardless of pressure
controversy over pressure vs volume, usually both pres

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8
Q

Overdistention of lungs can cause

A 
Alveolar capillary level damage
From:
Stiff lungs
ETT in rt mainstem bronchi
Too much volume in lungs
Vt too high
Auto PEEP
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9
Q

pressure ventilation can cause

A

lung damage to tissue leading to ALI and ARDS causes of overdistention

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10
Q

Avoid VILI monitor

A

Peak Pressures and set alarms appropriately
Plateau pressures
Auto-PEEP
CX

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11
Q

Prevention of VILI

A 
small Vt
decrease Vt when raising PEEP
keep plateau below 30 mcH2O
keep peak pressure below 35 cmH2O
avoid mainstem intubation
don’t use pause pressure with volume ventilation
monitor and treat autoPEEP
use PEEP for optimal lung recruitment 
permissive hypercapnia
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12
Q

Other causes of auto PEEP

A

high minute ventilation>10
High RR
I;E

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13
Q

how to find auto PEEP

A 
EASIEST WAY: FLOW TIME CURVE
-exp flow not returning to baseline
Increased resonance on percussion
Decreased BS
Expiratory Hold
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14
Q

How to get rid of auto PEEP

A 
increase E time
-faster flows, smaller Vt
Lower rate
Large ETT
or allow permisive hypercapnia
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15
Q

Inverse I:E ratios cause

A

autoPEEP and improves O2

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16
Q

O2 toxicity leads to

A

ALI/ARDS

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17
Q

In pneumothorax mediastinum moves

A

towards affected side, tension moves away

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18
Q

Pneumothorax

A

air enters pleural space

  • increased pressure in pleural space crushes the heart and great vessels causing cardiovascular collapse and death
  • treat all with chest tube unless very small and no problem
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19
Q

Signs of pneumothorax

A

subcutaneous emphysema

20
Q

Subcutaneous emphysema

A

air leaks out of lungs and into soft tissue

which is a sign of pneumo, always get CXR

21
Q

signs of tension pneumo

A

-Increased Peak Pressures
-Increased WOB
-Absent BS on affected side
-Mediastinal shift away
-Increase in HR and decrease Spo2
-Loss of BP/CO
CHEST XRAY IS BEST DX

22
Q

Emergent tx for tension pneumo

A

14 guage needle

  • anterior 2nd and 3rd on affected side, midclavicular space
  • pt head up position
23
Q

papillary response

A

pinpoint, drug overdose
dilated and fixed, atropine
mid-position and fixed, severe cerebral damage

24
Q

gag reflex used to

A

used to test cranial nerve function but also to assure airway protection post extubation.
-Place a tongue depressor in back of throat and there should be a response of those muscle

25
Q

what controls breathing

A

brainstem, there would be no breathing if this is affected

26
Q

Cheyenne stokes breathing

A

increase in ICP, CHF, Hyoxia

27
Q

ICP

A

amount of pressure in brain

  • increased pressures cause decreased perfusion in brain
  • goal to keep lowest pressures possible in chest keeps blood from entering the chest causing a back up of blood in the skull leading to increased ICP
28
Q

What will decrease ICP

A

hyperventilation- CO2 is a cerebral vasodilator

-Keep CO2 28-32 on closed head injury 24-36 hours

29
Q

ICP Monitoring

A

normal mean ICP is 10-15 in a supine position
15-20 compress the capillary bed and compromise circulation
30-35 venous drainage is impeded and edema develop
40-50 perfusion cannot be maintained

30
Q

Cerebral perfusion pressure (CPP)

A

blood floww through brain, maintain above 70

31
Q

CPP=

A

MAP-ICP

wanna maintain above 70

32
Q

Glasgo Coma Scale

A

Scale 3-15
9-13 need ICU
8 or less need an ICP

33
Q

Endocrine effects

A

increase in anti-diuretic hormone(ADH) causes lower urine output
several other hormone changes that may lead to lower urine output

34
Q

ABG with RENAL FUNCTIONS

A

(Kidney, Endocrine, ABG)

lower PaO2 and higher PaCO2 lead to lower urine out

35
Q

Normal urine output

A

is 1ml/kg/hr or about 30-70 ml/hr

-poor urine output leads to pulmonary edema from too much fluid in the body and acid base problems, usually acidosis

36
Q

PPV and liver functions

A

PPV can lead to venous distention with ischemia to the liver

increased bilirubim

37
Q

Gastric effects with PPV

A

PPV can lead to GI bleed and ulcers
acid reflux can lead to pneumonia
pt needs to be on antacids and histamine H2 blockers (Pepcid)

38
Q

Nutrition and PPV

A

Nutrition
not enough calories to breath
too many carbs lead to increase CO2, makes weaning difficult for COPD
Oral feedings best

39
Q

Lung protective Strategies

A

keep peak pressures <35
Keep Plateau pressures <30
Vt 6 ml/kg may need to increase RR to compensate
Permissive hypercapnia

40
Q

Lung recruitment maneuver

A 
Sustained high-pressure inflation
Intermittent sigh
Extended sigh
Intermittent PEEP increase
Pressure control + PEEP
41
Q

VAP causes within

A

48-72 hours, usually bacterial

42
Q

Causes of VAP

A 
Aspiration of oral secretion
Aspiration of gastric contents
Inadvertent instillation of an infectious agent
down the artificial airway
Inhalation of infectious aerosol
43
Q

Risks of VAP

A 
nasal intubation
Reintubation
Low endotracheal tube cuff pressures
Supine position
Enteral feeding
Hyperglycemia
Blood transfusion
Inadequate staff
44
Q

CVP Catheters

A

Filling pressure or preload of rt atrium

-most useful in pts with volume-depleted state

45
Q

PA catheter

A

Estimate SVR and PVR

-Assess pulm hypertension

46
Q

adding a plt will

A

Increase the MAP
add to the I time
Improve O2

47
Q

Does rate affect Pressures and volumes

A

NO

Mechanical Ventilation (11 decks)

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