Vent Flashcards
SIMV (Abbrev)
Syncronised Intermittant Mandatory Ventilation
BIPAP
(Biphasic Positive Airway Pressure)
Positive airway pressure at end expiration to open alveoli and improve oxygenation
Monitor for Hypercapnia
Tidal Volume (VT)
Volume of air when inhaling or exhaled
Normal: 5-8-12mls/kg
Aim low for sicker lungs (increase peep)
PEEP (Positive End Expiratory Pressure)
Pressure that remains in the aveoli after expiration
intrinsic PEEP = 3 (5-6cmH2- PEEP on ventilator)
Sicker lungs you want to increase the PEEP
- opens aveoli
- increases surface area, O2 and spo2
- Forces fluid back into capillaries
Fi02
Concerntration of oxygen
Aim 94-99% to reduce oxygen toxicity
I:E Ratio (TI)
Inspired time compared to expired time (1:2)
COPD may require prolonged I:E or as a comfort measure
Alarm PIP
Indicates: aveolar distension, increased resistance
Increased pressure at larged part of breath
Yellow will alarm when PIP above 30cmH20
Solve: kinks or water, fighting vent
Alarm: Plateau Pressure
Measured by ‘inspiratory hold’, reducing flow to zero causing airway and alveolar pressure to equalise
Should be 5cmH20 difference between PIP and Plateau
If PIP and Plateau are raised - compliance issue (reduce TV or PEEP
RASS (Acronym, What to say, what is it?)
Richmond Agitation Sedation Scale (30minly, 5minly until -4)
“Say patients name, say to open your eyes and look at speaker”
+4 Combative, Violent to Staff
+3 Pulls or removed tubes
+2 Frequent nonpurposeful movements - fights vent
+1 Anxious, apprehensive
0 Alert and Calm
-1 Awakens to voice
+2 Light Sedation, briefly awaken to voice
+3 moderate sedation, movement or eyeopening
+4 deep sedation, no response to voice, but movement or eye opening to physical stimulation
+5 Unrousable, no response to voice or physical stimulation
Fentanyl (Start Rate, Titration range, bolus dose)
Start Rate: 1mcg/kg/hr
Titration Range: 0-200mcg/hr - titrate up increments of 20-30mch/hr
Bolus Dose: 25-50mcg
Morphine (Start Rate, Titration range, bolus dose)
Starting Rate: 5mg/hr
Titration range: 0-30mg/hr increments of 2-5mg/hr
Bolus: 1-2mg SBP OVER 100
Midazolam (Start Rate, Titration range, bolus dose)
Starting Rate: 5mg/hr
Titrate range: 0-20mg/hr - increments of 1-5mg/hr
Bolus Dose: 0.5-2mg
Propofol (Start Rate, Titration range, bolus dose)
Starting Range: 1mg/kg/hr
Titrate Range: 0-100/200mg/hr increments of 20-40mg/hr
Bolus Dose: 20mg SBP Over 100
SIMV (What is it? / What does it do?)
Delivers mandatory breathes to a set volume and RR
(also allows patient to breathe spont if needed)
SIMV (First 3 Steps in setting up the vent)
- Make sure you are in SIMV
- Gender
- Height inputed
700ml VT
5 PEEP
100% 02
RR Set 12
Alarm Limit (RR / fTotal)
Change rate in Control Settings
14-12-5
If you see more in fTotal (pt taking spont breaths)
If RR starts to increase ?indication of pt waking up
VTE/mls (Alarm ml/hr)
699 - should be close to your Vt Aim (700)
1050(12ml/kg)
700(8ml/kg)
350(4mg/kg)
(default calculated with body weight inputted)
ExpMinVol
The Amount of air passed in and out of the patients lungs in L/1 min
Vt + RR will cause this to change
Just an alarm to alert you that there has been changed
9 - 8.4 - 7.5
Peak Inspiratory Peak alarm (PPeakcmH20)
> 30cmH20 (if higher TROUBLESHOOT)
Defaults to 40 as a buffer that it wont shut off. - 5
